‘Not money, leadership matters’ in Bangladesh health sector, says minister Nasim

Bangladesh buys medical equipment worth millions of dollars, but last year a survey revealed a serious lack of basic amenities and equipment in government hospitals at districts and at the lower levels.

The Bangladesh Health Facility Survey 2014 found that only around 25 percent of such facilities have all the six basic equipment - stethoscope, thermometer, blood pressure apparatus, adult weighing scale, child or infant scale, and a light source -- a list WHO and USAID propose for basic health services.

Is it money that matters? The Bangladesh Heath Reporters’ Forum (BHRF) put the question to Health Minister Mohammed Nasim at a meet the press event on Sunday on the proposed 2016-2017 budget.

The health minister said it was leadership that mattered. “There are many institutions that I see doing a fantastic job because of their leadership. You can do so many things for improving services that do not even need extra money,” he said.

The health ministry gets around 5 percent of the total budget, but Bangladesh Medical Association (BMA) Secretary General Prof M Iqbal Arslan, who also spoke at the event, said “money does not matter all the time”.

“Managerial problem is the main problem in the health sector,” he stated. “We have to develop this system. But our health ministry’s human resource department is still at a rudimentary stage”.

Director General for Health Services Prof Deen Mohammad Noorul Haque seconded the comment of the BMA leader.

“This is a problem of leadership and governance,” he said. “We give them (hospitals) money for many purposes….are they not in a position to buy a thermometer….or weighing machine… how much does it cost? It’s nothing,” he said.

He, however, lamented that the health sector was not getting enough budget required to ensure services for all.

“Our services have been expanded, but the budget has decreased over the years,” he said, adding that 8.66 percent was the highest budget ,in the health sector of the 1996-1997 total outlay.

“But it dropped to 4.30 percent of the total budget last year,” he said, adding that the proposed budget had kept 5.10 percent for health.

The reporters’ forum pointed out the fact that manpower management was also a challenging area of the health ministry. Doctors not staying at their workplaces are a common topic of discussion in Bangladesh.

The reporters’ forum, citing the Bangladesh Maternal Mortality Survey (BMMS), said even the field staff at the lowest level of the health ministry did not work properly.

For example, the government has over 4,500 family welfare visitors (FWVs) posted in rural areas.

They are getting salaries from tax payers’ money. They are trained, but the latest BMMS found that they were assisting in less than one percent of the total deliveries.

The BMA President, Prof Mahmud Hassan, said: “Whatever amount we get in the budget, the main important issue is proper utilisation”.

The proposed 2016-2017 budget will be passed on June 30.