ADP execution: Health ministry’s poor scorecard

The poor performance by the Ministry of Health in executing the Annual Development Plan (ADP) has long been a recurring challenge, affecting the health sector more than any other. In the current fiscal year 2024-25, the situation has reached a new low, with only 21 per cent of the ADP implemented -- the worst performance among all government agencies. This dismal record has left the country's health services increasingly fragile and unable to respond effectively to mounting challenges. Despite increases in budget allocations over the years, the ministry -- one of the country's key stakeholders -- has consistently failed to deliver. Analysts point out that while funding has grown, execution capacity has remained stagnant, if not deteriorated. What is even more concerning, according to sources, is that the government has neither questioned nor held ministry officials accountable for these repeated failures. Data from the Implementation Monitoring and Evaluation Division (IMED) of the Planning Commission highlight the long-standing nature of the problem. For over a decade, the Health Services Division (HSD) under the ministry has lagged behind the national average in ADP execution. In FY2025, the HSD managed to implement only 21 per cent of its projects, compared with the national average of 67.85 per cent. Even in FY2024, when the ministry performed somewhat better, it completed only 76.65 per cent of its projects, still trailing the national average of 80.92 per cent.

Bangladesh's overall public investment in health is alarmingly low. In FY2025, health spending stood at only 0.74 per cent of GDP -- well below the South Asian average and a fraction of what developed countries invest. For two decades, this figure has remained under 1.0 per cent, underlining the government's continued neglect of the sector. Although the health sector received 5.20 per cent of the national budget this year, weak project implementation has drastically limited the impact of this allocation. A lack of institutional capacity is often cited as the main cause of underperformance. Experts explain that this refers to inexperienced manpower, many of whom lack the necessary skills to implement projects effectively. The situation is worsened by insufficient monitoring and supervision. Moreover, allegations of widespread corruption, misuse of resources and irregularities in infrastructure projects and procurement further undermine the system.

The persistent failure of the health ministry in executing its budgetary commitments has had dire consequences. It may be recalled how the health system was grossly underprepared to deal with the Covid-19 pandemic, despite emergency allocations. The crisis laid bare the governance flaws in the sector, showing that even the funds spent yielded limited benefits. The same shortcomings continue to hinder effective management of recurring public health threats, such as dengue and chikungunya, which claim lives every year.

Given the critical importance of healthcare-related projects under the ADP, the health ministry's repeated underperformance raises pressing questions. How does the ministry explain such gross failure, and more importantly, what measures are being taken to correct this long-standing problem? Without decisive reforms in project execution, accountability and governance, Bangladesh's health sector risks remaining perpetually unfit to serve the nation's needs.