FY21 budget: Are we channelling funds to where they matter most?

As Bangladesh struggles to contain the exponential increase in COVID-19 cases, there was a much higher degree of anticipation than what usually prevails before the finance minister unveils the proposed national budget for the upcoming fiscal year. This year, a plethora of experts from various fields were in consensus that these unprecedented times require 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 Tk 292.4 billion proposed for the health sector is 23 percent higher than the revised allocation for the last 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 percent of GDP, which is one of the lowest government health expenditure in the world. Moreover, nearly 40 percent 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.

Finance Minister AHM Mustafa Kamal has proposed to allocate a lump sum of Tk 100 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 important 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 healthcare for about 50 percent 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 they can also play a major role in patient tracking, promoting hygiene and spreading vital preventive messages that often do not reach rural and marginalised 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 percent of water sources in community clinics were non-functional. Moreover, the National Hygiene Survey 2018 finds that nurses and other staff in 23 percent health facilities did not have both water and soap available for handwashing, which put both caregivers and patients at risk. This underscores the importance of investing to improve water and handwashing facilities in community clinics and make them better equipped as potential hubs in COVID-19 response.

Although the outbreak has spread throughout the country, it is mostly concentrated in few urban areas that are centres of economic activities. Dhaka city, Narayanganj, Gazipur and Chattogram account for almost two-thirds of all confirmed cases. The budget should have ensured that the city corporations in these areas have sufficient resources to prevent further spread of the outbreak. As offices and marketplaces have reopened, city corporations have to play a more active role in ensuring that preventing measures are properly practised in public spaces. The very minimum measures are to arrange handwashing facilities, implement physical distancing and use 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 healthcare in community clinics, the urban poor suffer from a lack of access to healthcare 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, which makes 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 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 provided with sufficient budgetary resources.

Lastly, there are major concerns about 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 organisations are involved in disseminating prevention messages. It is crucial that these messages are in line with 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 to 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 allocates adequate resources for key areas such as hygiene promotion, strengthening local healthcare facilities and provisions 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 actions and right investments now can save countless lives and resources by the time the next proposed budget is announced.

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Hasin Jahan is Country Director, WaterAid Bangladesh.

Zarif Iftekhar Rasul is Strategic Support Officer, WaterAid Bangladesh.