With funds unspent, deadline ends soon

Despite a five-year implementation window, the Directorate General of Health Services (DGHS) has made limited progress in terms of infrastructure development under the Covid-19 Emergency Response and Pandemic Preparedness project.

Of the planned 500 intensive care unit (ICU) beds to be set up across 50 district headquarters hospitals (10 beds each), ICU services have become operational in only 13 districts.

Similarly, no progress has been made in establishing 16 paediatric intensive care units (P-ICUs) across 14 medical college hospitals, Bangladesh Shishu Hospital and Institute, and the Institute of Child and Mother Health in Matuail.

The situation is equally concerning in the case of obstetric intensive care units (Obs-ICUs), where all 15 proposed installations, including 14 in medical college hospitals, remain unimplemented.

Furthermore, there has been no advancement in setting up 20-bed isolation units across 50 district hospitals, totalling 1,000 planned beds.

These findings have emerged from an in-depth monitoring report, which is awaiting publication and has been prepared by a third-party consulting firm commissioned by the Implementation Monitoring and Evaluation Division (IMED) under the Ministry of Planning.

In April 2020, amid the government-imposed lockdown following the global outbreak of the Covid-19 pandemic in March, the Executive Committee of the National Economic Council (ECNEC) approved a Tk 63.87 billion project.

The initiative aims to strengthen the health system to combat the pandemic, prevent and control infectious diseases, and prepare the country for future public health emergencies by providing essential emergency manpower for the health sector.

The World Bank and the Asian Infrastructure Investment Bank (AIIB) are jointly providing loan support amounting to Tk 59.14 billion, covering 92.60 per cent of the total project cost, while the remaining 7.40 per cent will be funded by the government exchequer.

Although the project was initially scheduled for completion within three years, delays in implementation have led to two revisions, extending the deadline by an additional two years, now set to end this month.

The IMED report states that as of last December, the project achieved 76 per cent physical progress, with total expenditures reaching Tk 47.19 billion - equivalent to 73.90 per cent of the total allocation.

Against the allocated Tk 46.86 billion in the revenue component, Tk 40.23 billion (85.86 per cent) has been spent primarily on various procurements.

In contrast, only Tk 6.96 billion - 40.93 per cent of the allocated Tk 17.01 billion in the capital component - has been utilised, reflecting a significant shortfall in capital expenditure.

Project stakeholders observed that capital expenditure under the project has remained relatively low due to significant delays in infrastructure development.

They fear that a substantial portion of the allocated funds will remain unutilised if the project concludes this month.

"One of the most disappointing aspects of the project's implementation has been the poor progress in establishing ICUs, which was among its core objectives," reveals the IMED report.

"For instance, although the plan was to set up ICUs in 50 general hospitals, the facility has been established in only 13 hospitals over the project period," it added.

The report also said not a single P-ICU has been completed out of the 16 planned for medical colleges and specialised hospitals.

The target of establishing Obs-ICUs in 15 hospitals has also seen zero progress.

The report finds the delayed start of civil works by the Public Works Department (PWD) as a major bottleneck in setting up ICU facilities.

It also identifies several factors that have contributed to these delays, including delays in opening letters of credit (LCs), depreciation of the Bangladeshi Taka against the US Dollar, and disruptions in global supply chains - particularly due to the Russia-Ukraine war.

"Following audit objections raised by the Foreign Aided Projects Audit Directorate (FAPAD), the project director and officials concerned became apprehensive about carrying out project activities, leading to a significant slowdown in overall implementation," reveals the report.

Quoting one of the former project directors (PDs), the report further explained that the PD became heavily occupied with responding to media inquiries, Anti-Corruption Commission (ACC) investigations, and legal proceedings, severely disrupting the day-to-day operations of the project.

"The full implementation of the project on time would have been crucial for managing the crisis posed by the emerging Covid-19 variants and other health-related challenges. Unfortunately, the government failed to meet these goals," said Dr Syed Abdul Hamid, a professor at the Institute of Health Economics under Dhaka University.

He observed that the critical project, designed to develop life-saving health infrastructure, has ultimately been deemed a failure due to negligence and rampant corruption in both procurement and implementation.

Dr Hamid further emphasised the importance of establishing ICUs and isolation centres at the district level, noting that such facilities are essential for ensuring access to treatment for people living outside major cities.

He added that decentralising healthcare infrastructure this way is vital for reducing overdependence on the capital city and improving healthcare equity across the country.

Even in hospitals where ICUs have been set up, many are not operational due to a lack of essential equipment and trained personnel, such as technicians and medical staffers, revealed the report.

Citing an example, it said the ICU at Cumilla General Hospital, which has been operational since November 2023, faces several challenges, including inadequate staffing, unpaid project employees, and the need for additional equipment, such as portable X-ray machines, pulse oximetre lines, and ventilator flow sensors.

At the 250-bed General Hospital in Jashore, the ICU cannot be made operational as it is located on the fourth floor, above the reach of the existing elevator, and there is also a severe shortage of trained manpower.

Similarly, the ICU at Tangail General Hospital, inaugurated in May 2021 and functional until December 2024, is now inactive due to a manpower shortage.

The one at Sher-e-Bangla Medical College Hospital in Barishal is operational, but it lacks a dedicated ICU doctor, a standby generator, and an arterial blood gas (ABG) analysis system.

These examples illustrate that while physical structures may exist, the ICUs cannot function effectively without resolving critical gaps in equipment and human resources.

From the inception of the project till the fiscal year 2023-24, the FAPAD raised a total of 76 audit objections involving financial irregularities amounting to Tk 4.65 billion.

These objections highlight a wide range of procurement and financial management violations, including the awarding of contracts to inexperienced and unqualified suppliers in breach of the Public Procurement Act 2006 and Public Procurement Rules 2008.

Other issues include under-deduction or non-deduction of income tax and VAT, failure to deposit deducted amounts in the government treasury, and non-collection of liquidated damages despite delays in the delivery of goods.

Additionally, the report cites irregular use of the direct procurement method and the acceptance of substandard medical supplies without proper quality verification.

These findings paint a troubling picture of widespread mismanagement and alleged corruption throughout the project's execution. Since the inception of the project, seven government officials have served as project directors, and some of them were posted only for two months.

Only two served full-time, while five managed the project as an additional duty. The position changed six times over five years, a frequent turnover that has undoubtedly hindered the project's progress.

Professor Dr Iqbal Kabir was the first project director. It was assigned to him as an additional responsibility, and he served for only about two months and a half while also managing another project.

He was succeeded by Dr Kazi Shamim Hossain, an officer on special duty (OSD) of the health directorate, and served as the full PD for approximately four months.

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