Health spending
JUNE is the month when a new round of annual budget statements is completed. The new round begins with the federal budget and ends with provincial budget statements.
This year’s federal budget has allocated Rs26.8 billion to the health sector. This allocation is slightly more than last year’s Rs25bn. Taking into account inflation, the new budget does not represent much of an increase. The allocated amount is to be spent on 20 long-running national health programmes such as hepatitis, malaria and tuberculosis control.
There is renewed emphasis on the polio vaccination programme given its growing importance for Pakistan’s image and the government’s abject failure to get a handle on this problem.
Where the provincial budgets are concerned, the Khyber Pakhtunkhwa government has pledged Rs8.28bn for the health budget which is to be spent on 67 ongoing projects and 26 new schemes. Apart from regular money pledged to malaria, tuberculosis and cancer control and treatment, Rs200m have been made available to encourage mothers to get their children vaccinated.
Prevention of disease is not the focus of the health budgets.
Likewise, money has been set aside to tackle the growing problem of malnutrition in the country. In addition, Rs25m has been assigned to the provision of free insulin injection for diabetes sufferers in the province. Though laudable, this paltry amount is too low for the huge number of people living with diabetes.
The Sindh government has allocated Rs43.58bn to health, which represents an increase of 20pc over the last year’s budget. This year’s budget focuses on the provision of drugs and medicines, hospital repairs and management of primary healthcare. In addition, Rs489m has been set aside for 458 mother and child healthcare centres as well as Rs1.76bn with a view to increasing the contraceptive prevalence rate from 30pc to 45pc in three years’ time. In the news coverage of the Sindh budget, measles does not figure as a budgetary priority despite its destructive reappearance in the province.
The Punjab government has allocated an amount of Rs121.8bn to the health sector, an increase of 20.43pc. The focus of the health budget is on improvement and the upgrading of primary, secondary and tertiary healthcare and the expansion of medical education. Nutrition programmes are set to be scaled up province-wide to tackle widespread malnutrition. Another good bit is the expansion of 24-hour emergency and obstetric and newborn care services in the province.
Further, the water and sanitation sector gets a hefty Rs17,118m. This is an important investment for its all-round preventive potential for many health-related problems that arise out of unsafe drinking water. Balochistan too has pledged Rs14.14bn to the health sector which represents an increase of 26pc over the previous year’s budget. The new budget focuses on vaccination, hepatitis control as well as on other ongoing schemes and provision of free medicines to poor patients.
Despite some good overall news on enhanced health-related budgetary allocations, four observations are in order here. First, this round of budgets shows an increase in health allocations over the previous budgets. The increased figure varies from province to province and from official to official in the province.
This increase appears to be one over the actual amount disbursed in the last budget. When looked at the projected increase against the under-utilised health budgets of the previous year, the picture of enhanced health appropriation looks less rosy.
We will only know how much budget increase has occurred in actual terms when we know whether the entire allocated amount has been disbursed and used. This is crucial not only to assess the government spending and implementing capacity but also to determine whether the projects and schemes for which enhanced allocation was assigned have met all the set targets.
Second, in all budgets the practice of allocating money to schemes has been maintained. This implies an approach to problem solving by throwing money at the symptoms rather than addressing the underlying causes. This needs to change in favour of looking at health problems in a new, more integrated fashion, combining a long-term vision with programme evaluations conducted regularly.
Third, all the budgets are heavy on the curative side of the health strategy. The prevention side does not seem to be at the heart of the budgets. This is reflected in the lower monetary allocation and lower policy salience of preventive public health issues in the budgets. This needs to be addressed in the next round of budgets.
Fourth, there seems to be considerable reliance on donor money in health budgets to meet growing demands, However, over time this reliance must be addressed and the donors’ current interest in the health sector used to build up locally sustainable health programmes underpinned by long-term vision.
The writer is an Islamabad-based development consultant and policy analyst.
Published in Dawn, July 14th, 2014