Health budget cut runs counter to reform ambition

The education and health sectors have historically been neglected in government budget allocations, resulting in excessive commercialisation and high out-of-pocket expenses for citizens. Many had high hopes that the interim government would break this trend by prioritising these two critical sectors through increased funding and meaningful reforms. Unfortunately, that hope now appears to be fading as allocations for both education and health are set to decrease in the upcoming fiscal year. Compared to the current fiscal year's Annual Development Programme (ADP), funding for education will be reduced by approximately 30 billion taka, while the health sector will see a cut of around 25 billion taka.

The funding cut for the health sector comes at a time when the Health Sector Reform Commission is advocating for an increase in health spending to 15 per cent of the national budget and 5 per cent of GDP. This recommendation reflects the magnitude of systemic investment needed to revitalise the country's ailing health sector.

Yet, it is perplexing that the government is moving in the opposite direction. . Although the reform proposals have yet to be formally approved, the government could have at least signaled that, starting this year, health and education would be treated as priority sectors.  If the current government ignores the reform commissions' recommendations, chances are high that all the well-meaning proposals, no matter how promising, will be shelved and forgotten under future political administrations.

The Health Sector Reform Commission, headed by National Professor Dr. AK Azad Khan submitted a fairly comprehensive report to Chief Advisor Dr Muhammad Yunus just two weeks back. The commission has put forward a bold and ambitious set of measures aimed at transforming the country's healthcare system into a more inclusive, accessible, and pro-people framework. At the heart of the Commission's recommendations is a call to recognise primary healthcare as a legally enforceable fundamental constitutional right, to be provided free of cost. It is unfortunate that, even after 54 years of independence, the state has failed to ensure basic rights such as healthcare for all citizens.

Although Article 15 of the Constitution enshrines food, clothing, shelter, education, and medical care as fundamental rights, there is no legal mandate to enforce it, rendering the basic rights largely ornamental. Recognising primary healthcare as a legal right, therefore, would mark a significant step forward, especially at a time when social disparities have been increasingly undermining equal access to these basic services.  However, legal recognition alone is not enough. Such a shift demands concurrent investments in healthcare infrastructure, staffing, training, and logistics to become meaningful in practice.

To support this transformation, the Commission recommends making union-level health and family planning centres into fully functional primary healthcare centres, attended by at least two MBBS doctors and other necessary staff. In urban areas, equivalent facilities are to be established at the ward level. Once implemented, the people will receive free primary treatment at these facilities at ward or union levels. Facilities at this tier will function as referral points in the proposed system. According to the Commission's plan, a structured referral mechanism would direct patients with more chronic or acute conditions to Upazila or district-level hospitals.

The commission also proposes providing initial essential medicines ree of cost, then at subsidised prices from pharmacies at public healthcare facilities to be established under a National Pharmacy Network. Equally important is the proposed exemption of VAT on medicines for life-threatening and chronic conditions such as cancer, diabetes, hypertension, and essential antibiotics, which would significantly benefit low-income populations.

However, without sufficient budgetary support, even the most well-intentioned policies will remain nothing more than words on paper. Over the past decade, health sector budgetary allocations have remained stagnant at around five per cent of the national budget. Compounding the issue, the Ministry of Health has consistently failed to fully utilise its allocated funds. This lack of budget implementation capacity has often been cited as a reason for slashing allocation for health. Without enhancing the government's ability to plan, execute, and monitor spending effectively, increased allocations alone will not yield improved health outcomes. Deep-seated issues like corruption, administrative inefficiency and political interference must also be addressed for any reform measure to succeed. At the same time, good governance and oversight are essential to ensure that increased spending translates into improved outcomes for citizens.

Meanwhile, concerns about the feasibility of the Commission's proposals were raised during a recent webinar hosted by the South Asian Network on Economic Modeling (SANEM), titled "Health Reform Commission Report: Quick Fixes or Transformation?" Leading health economists pointed out that the report lacks a phased, time-bound roadmap. It offers limited guidance for policymakers on sequencing reforms, estimating costs, or identifying financing strategies. While the recommendation to increase health spending to 5 per cent of GDP is laudable, it would remain ambitious without a clear mechanism to fund such an expansion. They said the report does not address crucial options such as national health insurance, public-private partnerships (PPPs), or diaspora contributions-recourses that could help close the funding gap without unduly burdening taxpayers.

Bangladesh's healthcare sector stands at a pivotal crossroads. The country has made notable progress in several development indicators, yet the health sector continues to lag-not due to a lack of potential, but because of a lack of sustained priority. This trend must be reversed. A healthy population is not only a matter of social justice but also a cornerstone of economic productivity and national development. A universal healthcare system cannot be built on a fragile fiscal foundation. The government must take the Health Sector Reform Commission's recommendations seriously and act with urgency and commitment. Health is not a luxury-it is a fundamental necessity that must be enshrined and upheld in the national development agenda.

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