Bangladesh Health Sector
Golam Mostafa Jibon: Reckless rising of costs in different programs’ projects under the health sector has become cause of concern as a section of unscrupulous officials of the sector is not following the cost chain.
The trend of unbridled spending on different programs’ projects in this sector is going on for long without any resistance.
Sources said, the health sector has plagued by irregularities. Unbridled spending of money in the name of various training programs under the Clinical Contraceptive Services Delivery Program (CCSDP) is now pointing the sign of anomalies. But, there is none to see the matter or stop the inconsistencies.
Allegation has found that about 3 to 600 percent more than money has been spent against the targeted expenditure sanctioned against per head.
Per capita allocation was Tk 16,766. But Tk 1,11,931 has been spent, which is 6.67 times more than the prescribed cost.
At least 19 vehicles including Mobile Clinic cum Ambulance have remained inoperative due to lack of maintenance.
The Planning Commission’s Implementation, Monitoring and Evaluation Division (IMED) said, all documents and information of the Operational Plan (OP) in Clinical Contraceptive Services Delivery Program (CCSDP) especially procurement, training, contraceptives, MSR drugs, medical equipment collection and use are not being systematically stored. The department has expressed concern and dissatisfaction with the progress and implementation of the project.
Dr. Nurun Nahar Begum, Line Director of CCSDP said, “The training is done in the field level according to the circular of the ministry. We pay fund according to the needs. We however, will look into the inconsistencies that have been found.”
Planning Commission and the Ministry of Health sources said, the ECNEC meeting held on March 21 in 2017 approved the fourth health, population and nutrition sector program for implementation through 29 operational plans in four and a half years at a total cost of Tk 1,15,486.36 crore.
The e-Clinical Contraception Services Delivery Program was taken under the most expensive that program of the country, which cost was estimated at around Tk 1,498.42 crore. It is scheduled to end by June in 2022.
Basic training is provided to increase the capacity of physicians under the OP program to enhance the capacity of family planning service providers. Out of 1,050 people, 338 people were given training till June 2020. About 97 percent of the estimated expenditure on basic and refresher training has already been spent. The per capita cost for this training was fixed at Tk 16,766. But Tk 1,11,931 has been spent against each, which is 7.8 times more than the prescribed cost.
Although, it was mentioned that 520 people would be trained in the local training sector, but none has been trained so far. The estimated cost for overseas training for 300 people was determined at Tk 10.80 crore. During the corona pandemic till June 2020, at least Tk 5,12,84,000 has been spent for the overseas training of 16 people. According to the statistics, about Tk 3.60 lakh has been spent against per head.
But, the cost has been shown there at Tk 4,42,103. Additional Tk 82,103 has been spent here against each person.
Tk 2.4 crore was allocated for 4,920 people in the regional workshop sector. Of them, around Tk 1.38 crore was spent till April against 815 people. Although, it was supposed to cost at Tk 4,162 per head, it has been shown to be Tk 17,000. Additional Tk 12,838 has been spent here against per person. Thus, around 309 percent additional money has been spent here against each.
According to CCSDP, Tk 62,392 was spent against per person for the PPFP Training in the Paramedics sector in the financial year (FY) 2017-18.
Tk 39,325 was spent against similar training in the next FY 2018-19.
In the last FY 2019-20, the per capita expenditure was shown at Tk 24,387. In other words, about 155 percent more was spent per capita in the FY 2017-18 than in the FY 2019-20.
According to the OP, a total of Tk 6 crore was allocated for 5,000 people in the training sector from 2017 to 2022, where Tk 12,000 was fixed for per person.
But, about 520 percent more than the estimated allocation has been spent against each in FY 2017-18.
Around 227 percent additional money has been spent in 2018-19 and 103 percent more has been spent in 2019-20.
Similarly, for training of paid volunteers, Tk 10,047 has been spent against per person in FY 2017-18 and Tk 11,271 against per person in FY 2018-19.
The number of participants in the FY 2019-20 was not mentioned, but the cost was shown at Tk 28.37 lakh.
All the Mobile Clinic cum Ambulances handed over to this operational program under HPNSDP are in a state of disrepair.
Out of 23 vehicles, 16 vehicles including 12 Jeeps and four ‘Mobile Clinic cum Ambulance’ have been lying inoperative due to lack of proper maintenance.
In addition, out of 19 Jeeps handed over from HPNSDP, 12 Jeeps are lying idle, where every Jeep was bought for Tk 90 lakh for the quality improvement team. The Mobile Clinic cum Ambulances are: Regional Supervisors, FPCST-QAT, Dhaka, Chattogram, Rangpur and Barisal.
IMED said, there are absentia of effective coordination with the Department of Health and other ministries in providing postpartum family planning services.
Lack of proper monitoring and implementation activities is hampering the achievement of OP targets. In the four years and four months from January in 2017 to April in 2021, the economic growth of CCSDP’s OP is 18.72 percent. With the remaining 55.48 percent semi-progress, all OP activities are expected to be completed by June 2022.
On the other hand, under the service procurement package, the expenditure for 20 study activities has been fixed, but work order for only one study has been given that to be conducted till April 2020.
Officials from the Department of Family Planning in the City Corporation area are not directly involved in providing services. However, CCSDP’s OP is providing services through various NGOs.
There was an allocation of around Tk 145.4 crore for the purchase of medical equipments. But, the financial progress till April in 2021 was Tk 181.62 crore, which is more than the allocation.
IMED officials said, they had repeatedly asked the CCSDP authorities about the number of supplied furniture, supplying dates and locations, but they did not provide any details.
Besides,, no training has been given to the doctors to increase the capacity to provide long-term and permanent family planning services in the FY 2020-21.
Continuing the additional expenditure in the training sector, much more than the estimated cost per person has been spent on organizing one-day Orientation Course on PPFP.
While contacted, Pradeep Ranjan Chakraborty, Secretary of Implementation Monitoring & Evaluation Division (IMED) said, “We have informed the concerned ministries and departments with our report. They are taking action on the issues. Hopefully, these errors will gradually come down to zero.
Nasima Begum, Secretary of the Socio-Economic Department of the Planning Commission, said, “We review the matter, whenever a project or program comes to us for extension of time and duration.”
Replying to a query over cost details, CCSDP Line Director Dr Nurun Nahar Begum said, “The draft IMED report has not been finalized yet. Why did they publish such draft report? Training programs are not held here. These are done in different districts and upazilas in the field level according to the circular of the ministry. They send the demand of expenditure to us. We give them money in the light of their needs.”
“There were some inconsistencies in the report. However, we do not know where they got this information from. They have sought our statements over the issue. We will give, when we get the report. We have to match our information with that report,” she added.
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