It is most likely that the national budget for the upcoming FY 2022-23 is going to be a slightly contractionary one given the existing geopolitical situation and economic realities and potentials of the country. However, any curtailing in the allocations for health sector will not be appropriate. Rather, allocations for this sector need to be further increased and of that increased allocation the largest share should be secured for primary healthcare. Recently publicized sixth report of the Bangladesh National Health Accounts (BNHA) says that of the total health expenditure in Bangladesh, 68 percent is coming out of the pockets of the citizens. 23 percent of that is borne by the government. The burden of out-of-pocket health expenditure on citizen can be reduced to a significant extent if public expenditure on primary healthcare can be increased. Speakers at a pre-budget online National Dialogue organized jointly by Bangladesh Health Watch, BRAC James P. Grant School of Public Health, BRAC University and Unnayan Shamannay opined so today (12 May 2022).

Among honorable Parliamentarians- Dr. Samil Uddin Ahmed Shimul (Chapai Nawabganj-1), Dr. Habibe Millat (Sirajganj-2), Dr. Pran Gopal Dutta (Comilla-7), Dr. A. F. M. Ruhal Haque, MP (Satkhira-3), Dr. Md. Abdul Aziz (Sirajganj-3), and honorable State Minister for the Ministry of Disaster Management and Relief- Dr. Md. Enamur Rahman (Dhaka-19) were present as discussants. Expert panelists at the online session were- Dr. Mushtaque Raza Chowdhury (Convener, Bangladesh Health Watch), Dr. S. M. Zulfiqar Ali (Senior Research Fellow, BIDS), and Dr. Syed Abdul Hamid (Professor, Dhaka University). Unnayan Shamannay Chair and former Governor of Bangladesh Bank- Professor Dr. Atiur Rahman presented the keynote paper, while Bangladesh Health Watch Budget Thematic Group Chair- Professor Dr. Rumana Haque moderated the session.

While presenting the keynote paper- Dr. Atiur urged to come out the practice of allocating 5 to 6 percent of the total national budget for health sector. He also pointed out that usually 25 percent of the health sector allocations go for primary healthcare. This should be increased to 30 percent in the coming fiscal year and raised to 35-40 percent within the medium term. Dr. Atiur further added that if the allocations for providing free-of-cost medicine for the people can be tripled then the out-of-pocket health expenditure can be reduced from 68 percent to 58 percent. Dr. Mushtaque Raza Chowdhury opined to establish a national commission to ensure quality primary healthcare is made available for all. Stating that the income-poor segments of Bangladesh’s population is being forced to spend 33 percent of their income for healthcare, Dr. S. M. Zulfiqar Ali emphasized on developing a health insurance program for these people.

Honorable State Minister for the Ministry of Disaster Management and Relief- Dr. Md. Enamur Rahman pointed out that the Government’s commitment to ensure quality healthcare for all is reflected through ensuring COVID-19 vaccination for 80 percent of the population within a short time. He believes if this efficiency can be replicated across the entire health sector, then it will be possible to ensure quality healthcare for all in the country.  Both Dr. Ruhal Haque and Dr. Habibe Millat emphasized on decentralization of the health sector management to improve service delivery. Md. Abdul Aziz, who is a member of the parliamentary standing committee on health and family welfare, emphasized on ensuring adequate services at the 493 Upazila Health Complexes across the country. He believes instead of trying to improve conditions of all these healthcare centers at once, government needs to take a ‘step by step’ approach. Dr. Pran Gopal Dutta, in his remarks, highlighted- the need to enhance capacity of the drug administration to ensure quality control of the medicine that are sold in the local markets and the need to allocate budget for universal health insurance.

Government and non-government stakeholders related to healthcare, media professionals and civil society representatives participated in the online discussion session.