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The recently-submitted health sector reform commission's report has various shortcomings as an important document of the government, speakers claimed at a webinar on Sunday, demanding its revision to make all recommendations relevant and implementable with a time-based financial methodology.
They observed that the report has gaps, including in areas of priority setting for the short-, middle-, and long-term implementable reform proposals and guidelines that policymakers will need to start and manage huge finances.
South Asian Network on Economic Modeling (SANEM) organised the webinar titled "Health Reform Commission Report: Quick Fixes or Transformation".
Mahtab Uddin, assistant professor of economics at Dhaka University, moderated the event, where SANEM Executive Director Dr Selim Raihan also joined.
Shafiun Nahin Shimul, a professor in the Institute of Health Economics at Dhaka University, presented the highlights of the reform commission's report by appreciating the fact that it has covered almost all aspects of the complex healthcare sector.
But he said financing options and priority are needed to increase budgetary allocation to 5.0 per cent of the gross domestic product (GDP) from 1.0 per cent as the rights of all citizens were not highlighted properly.
He said a wide range of health services have been covered in 32 recommendations, but the report fails to address many important issues like mental health, age-based health of women and children, elderly population, adolescent population, children with special needs, private sector engagement strategy, and institutional reforms on a priority basis.
Dr Shimul also said the coverage of free primary health care and rural services, investment, and diaspora linkage are missing in the report.
Moreover, he said that as health services for all or primary health care cannot be covered with over-dependence on taxes, there is no guideline on health insurance coverage modality or public-private partnership (PPP) financing in support of huge financing needs.
He further said that though filling up vacancies is among the recommendations, no advice was given to review the vacant posts in the present circumstances or political influence in services and appointments.
Dr Selim Raihan laid importance on reviewing the report critically from the point of improvement and said a clear roadmap for health reforms with political economy as well as addressing corruption and accountability are important from the point of sustainability.
He said a unique financial methodology is necessary to increase the health sector investment to 5.0 per cent of the GDP, adding that a higher budgetary allocation often does not work due to a lack of the right focus on political economy.
The report needs to add value as the interim government will not be its owner. Other political governments in the coming years will have to commit to implementing the recommendations for universal health care, he added.
Assistant Professor Mahtab Uddin said as the report will be considered a unique document for being the first such initiative in history, its acceptability is needed more with clear guidelines for all concerned on what should be done immediately and then in phases.
He also said the report has covered topics as widely as possible but does not relate the recommendations, purposes, and action coherence to cover its recommendations for free primary health or universal health care.
"It seems the reform commission committee has found that the organogram is more or less fine and recommended filling up the posts for better health services," the keynote speaker said.
Considering that the health budget allocated in the previous years could not be fully spent, how increasing the allocation to 5.0 per cent of the GDP could be utilised was not clear in the report, the moderator said.
smunima@yahoo.com