The 2020-21 budget falls well short of expectations
As Bangladesh struggles to contain the exponential increase in Covid-19 cases, there was a much higher degree of anticipation than what usually prevails beore the finance minister unveiled the proposed national budget for the upcoming fiscal year.
A plethora of experts from various fields were in consensus that these unprecedented times required an unconventional budget. It was expected that the government would use this opportunity to bolster the overwhelmed health sector.
Also, given the increased relevance of hygiene in protecting human health during disease outbreaks, the water, sanitation, and hygiene (WASH) sector hoped that the government would deviate from the norm and pay due attention to hygiene promotion in the fight against Covid-19.
As we have seen, despite Covid-19 naturally being a recurring theme in the budget, the budget unfortunately falls well short of these expectations.
The Tk292.4 billion proposed for the health sector is 23% higher than the revised allocation for this fiscal year. The government increasing the health sector allocation is indeed a welcome move.
However, questions remain as to whether this allocation is enough. The total allocation for health and family welfare translates to just 1.3% of GDP, which is one of the lowest government health expenditures in the world.
Moreover, nearly 40% of the allocation for the Health Services Division will be spent on wages and administrative expenses. This would leave fewer resources available for more pressing matters related to Covid-19.
The finance minister has proposed to allocate a lump sum of Tk100 billion to fulfil Covid-19 emergency requirements. However, the budget is lacking on specifics on how this amount would be spent.
What is more concerning is that we do not see any clear indication of how this would fit in with the National Preparedness and Response Plan formulated by the government for Covid-19. This response plan identifies handwashing as an important element of risk communication.
Although the budget speech mentions the need to prevent similar outbreaks in the future, the need to substantially improve handwashing and hygiene behaviour remains unacknowledged in the budget. This may undermine the necessary investments towards ensuring good hygiene practices, which is one of the most effective preventive measures against Covid-19.
Another major shortcoming is that there is no visible plan or directive to invest in strengthening local health facilities like community clinics.
Community clinics are the primary source of health care for about 50% of the population. As such, they have immense potential to be transformed into Covid-19 information and support hubs. These hubs can not only conduct testing but can also play a major role in patient tracking, promoting hygiene, and spreading vital preventive messages that often do not reach rural and marginalized populations.
Transforming community clinics into potential information and support hubs would require a high level of service delivery and capacity building. Research indicates that the service quality and patient satisfaction in the service depends on provisions of proper WASH facilities.
However, a nationwide assessment of community clinics revealed that 49% of water sources in community clinics were non-functional. Moreover, the National Hygiene Survey 2018 finds that nurses and other staff in 23% of health facilities did not have both water and soap available for handwashing, putting both caregivers and patients at risk. This underscores the importance of investing to improve water and handwashing facilities in community clinics and making them better equipped as potential hubs for responding to Covid-19.
It is worth noting that although the outbreak has spread throughout the country, it is mostly concentrated in a few urban areas that are centres of economic activity. Dhaka city, Narayanganj, Gazipur, and Chattogram account for almost two-thirds of all confirmed cases.
The upcoming budget should ensure that the city corporations in these areas have sufficient resources to prevent further spread of the outbreak. As offices and marketplaces reopen, city corporations will have to play a more active role in ensuring that preventive measures are properly practised in public spaces.
The very minimum is arranging handwashing facilities, implementing physical distancing, and using masks in places with large gatherings, such as bus terminals, and kitchen markets.
City authorities can ill afford to forget about the floating urban poor. While their rural counterparts can avail primary health care in community clinics, the urban poor suffer from a lack of access to health care and other essential services.
The current pandemic has already caused a number of poor people to fall back to extreme poverty. In addition to cash transfers, the urban poor would need special provisions such as masks and soaps so that they too can practise the preventive measures, which are even more important given the congested nature of slums and low-income communities.
One of the most vulnerable groups among the urban poor are street children who mostly remain outside the purview of official relief schemes. Many street children scavenge through waste and generally wander in public places, making them more exposed to the virus.
They also may not have the means to buy and maintain masks, and lack access to and knowledge of handwashing. It is the responsibility of relevant city corporations and municipalities to arrange for necessary provisions, and particularly set up handwashing stations where street children can frequently wash their hands with soap. This would again require local authorities to be allocated with sufficient budgetary resources.
Lastly, there are major concerns regarding how risk communication is being implemented. Risk communication, which is the dissemination of vital information to enable target groups to make informed decisions, is one of the six priority areas outlined in the National Preparedness and Response Plan.
At present, a wide variety of public and private organizations are involved in disseminating prevention messages. It is crucial that these messages are in line with the established health directives of the government.
At times, there are also conflicting messages and information from various ministries and divisions. This is an area where the Ministry of Information can play a major role. The ministry is mandated to serve as a bridge between the people and the government in terms of disseminating official information of the state.
However, they do not seem to have any meaningful contribution in spearheading a well thought out communication campaign as of yet. Designing such a communication campaign should now be among the priorities of the government.
Going forward, it is essential that the government allocate adequate resources to key areas such as hygiene promotion, strengthening local health care facilities, and providing for the urban poor. It is equally important to ensure that ad hoc Covid-19 response activities are replaced with harmonious and thoroughly planned interventions in line with the response plan.
Like most other countries, we may have been late in responding to the crisis. But proper action and right investments now can save countless lives and resources by the time the next proposed budget is announced.
Hasin Jahan is Country Director, WaterAid Bangladesh. Zarif Iftekhar Rasul is Strategic Support Officer, WaterAid Bangladesh.