PC flags flaws in Tk 198b health projects

Two ambitious health-sector projects worth Tk 198.09 billion have hit a major scrutiny, as the Planning Commission (PC) has pushed back against their approval citing serious procedural and financial gaps.

Concerns range from the 'absence of feasibility studies to vague cost estimations', dominated by lump-sum allocations and components inconsistent with project goals.

The proposed projects, planned towards system strengthening and climate-responsive health service delivery, are now being returned to the health ministry with instructions to revise and resubmit their development project proposals (DPPs).

Officials say the move aims to ensure transparency and accountability in the use of both foreign aid and domestic resources before the Executive Committee of the National Economic Council (ECNEC) can consider them.

They said that separate meetings of the Project Evaluation Committee (PEC) hosted by the Planning Commission have decided to return the Development Project Proposals (DPPs), instructing to revise and resubmit with detailed cost breakdowns based on feasibility studies.

The Ministry of Health and Family Welfare earlier proposed the two projects titled "Health and Nutrition Services Improvement and System Strengthening" with an estimated cost of Tk 151.24 billion, and "Climate-Responsive Reproductive Health and Population Services Improvement and System Strengthening Project for Results" with a cost of Tk 46.85 billion.

Some Tk 78.11 billion-or over 39.43 per cent of the cost-is expected to come from foreign loans and grants, while the remaining amount will be financed from the government's exchequer, reveal project documents.

However, the health ministry has insisted on expediting the projects' approval, arguing that failure to finalise agreements with development partners by the end of this June could jeopardise US$ 404 million in foreign aid.

In a letter to Planning Adviser Dr. Wahiduddin Mahmud, Health Adviser Farida Akhter requested urgent approval of five health-sector projects, including the two, at the ECNEC.

Following receipt of the letter, the Planning Adviser forwarded it to Planning Division Secretary and Programming Division Member Iqbal Abdullah Harun and Socio-Economic Infrastructure Division Member Dr. Quayyum Ara Begum for necessary action.

Sources say that the approval process for the two projects has already begun, despite several key preconditions remaining unmet.

Md. Abdur Rouf, Chief (Additional Secretary) of the Socio-Economic Infrastructure Division, said the two proposed projects are not included in the list of unapproved new projects under the Revised Annual Development Programme (RADP) for FY2024-25.

He pointed out that no feasibility studies have been conducted for either project, and necessary approvals from the Finance Division for staff recruitment and vehicle procurement have not been obtained.

"Moreover, key documents, including the agreement or commitment letter from the donor agency via the Economic Relations Division (ERD), are missing," he said, adding that the meetings have instructed the health ministry to complete all required procedures and submit revised project proposals with proper documentation.

Health ministry officials said the government has decided to discontinue the sector programme-based approach in the health sector and shift to project-based implementation.

Although sector-wide activities have been in place since 1998, a policy decision in early March this year instructed the formulation of separate DPPs instead of processing the proposed 5th Health, Population and Nutrition Sector Development Programme (5th HPNSDP) for July 2024-June 2029.

Following the directive, DPPs are being prepared for several individual projects across critical areas, including those involving development partner funding, raising concerns about potential risks to comprehensive service delivery.

Among the newly proposed initiatives, the Directorate General of Health Services (DGHS) will implement the "Health and Nutrition Services Improvement and System Strengthening Project".

It aims to expand maternal health, nutrition, and immunisation services at field-level health centres, strengthen non-communicable disease (NCD) diagnosis and treatment at the primary care level, and ensure the availability of essential medicines.

Meanwhile, the Directorate General of Family Planning will carry out the "Climate-Responsive Reproductive Health and Population Services Improvement and System Strengthening Project for Results".

The project is designed to strengthen climate-resilient health systems and improve access, efficiency, and quality of reproductive, maternal, newborn, and primary health care services, with a focus on increasing the availability of trained midwives.

In the health and nutrition project, 45 out of 54 components have been proposed as block allocations.

Of the total project cost of Tk 151.24 billion, Tk 113.46 billion, or over 75 per cent, has been earmarked as lump sums.

The Planning Commission has objected to approving such large allocations without specific details, criticising the proposal for listing sectors without clearly outlining the type, quantity, or specifications of goods, services, or infrastructure to be procured or constructed.

The project proposes bulk allocations of Tk 62.13 billion for medical and surgical supplies, medicines, and vaccines without itemised breakdowns.

In response, the Commission has recommended that detailed lists be prepared based on the Technical Committee's report and that costs be itemised according to the Market Price Committee's findings, reveals PEC meeting minutes.

The meeting also advised that action plans be developed to gradually incorporate these procurement expenses into the government's operating budget.

"Around 60 per cent of the total budget has been allocated for medical and surgical supplies, medicines, vaccines, and related components, with funding also earmarked under the development partners' fund," said a Planning Commission officer.

However, in line with the health ministry's new policy, such recurring expenses should be incorporated into the operating budget, and this transition must be clearly outlined in the project's exit plan, he added.

The PEC also expressed concern over the proposed Tk 33.85 billion allocations for building construction across the two projects, noting that buildings are listed in the cost breakdown but not among the main project activities.

The committee recommended placing such construction in a separate infrastructure project and called for checks to avoid duplication with other projects.

It also sought justification for the proposed Tk 2.61 billion for consultancy services under the two projects, noting that the number of consultants and their remuneration should be revised based on the nature and scale of the work.

The meeting further instructed that detailed terms of reference (ToR) and a breakdown of the total consultancy fees be submitted separately.

jahid.rn@gmail.com