Strengthening the country's healthcare sector is one of the key priorities of the present government. Budgetary allocation for the sector has been doubled in the current fiscal year. The government has also pledged to gradually raise health spending to 15 per cent of the national budget, or five per cent of GDP, in line with international best practices. While this is encouraging, concerns remain about whether the health authorities will be able to utilise the additional resources effectively. A recent report published in this newspaper paints a worrying picture. It reveals that the Ministry of Health and Family Welfare managed to spend only Tk 14.84 billion, or 32.86 per cent, of the revised development budget allocation of Tk 45.12 billion in FY2025-26. Such poor implementation capacity raises serious questions about whether a larger budget alone can deliver better healthcare services unless the long-standing weaknesses in project execution and budget implementation are addressed.

The Ministry of Health and Family Welfare has consistently been one of the worst performers in ADP implementation. The reasons behind this dismal budget implementation are neither new nor unknown. According to the report, weak institutional capacity, complex bureaucratic procedures, an overly centralised decision-making process and the appointment of inexperienced project directors are responsible for delay in project implementation. Moreover, many implementing agencies lack financial and administrative autonomy, requiring them to seek approvals from the ministry, which is often time-consuming. Moreover, faulty project design, delayed procurement and complexities in land acquisition further hinder implementation. There are also allegations that officials of some implementing agencies deliberately delay project execution to inflate costs. However, none of the factors identified here is new. It is unfortunate that the authorities couldn't address these chronic shortcomings all these years.

This chronic underperformance in budget implementation is not merely a statistical concern; it has a direct bearing on the quality of treatment in government hospitals and the public's access to affordable healthcare. Funds that could have been used to modernise hospitals, recruit additional doctors, equip healthcare facilities with essential medical equipment, increase the supply of free medicines and improve service delivery are being surrendered due to poor implementation capacity. Thus the overall score in the country's healthcare sector stands in stark contrast to what is needed and has been planned, and what has actually been achieved so far. Bangladesh has the lowest per capita health expenditure among South Asian countries, leaving citizens to shoulder a significant portion of healthcare costs from their own pockets. Repeated studies have shown that high out-of-pocket medical expenses push millions of families into poverty.

So, while enhancing budgetary allocation is necessary, equally important is strengthening institutional capacity to absorb and utilise additional funds more effectively. To this end, the government must prioritise reforms to overcome the bottlenecks in project implementation. Earlier, the Planning Commission proposed several pragmatic measures to improve ADP implementation capacity, including creating a pool of trained project directors, introducing certification courses on project management, strengthening feasibility studies and making risk assessments and peer reviews mandatory. It also recommended addressing delays in land acquisition and utility relocation by ensuring ownership verification, acquisition plans, no-objection certificates and environmental clearances before project approval. Overall, all-out measures must be taken to ensure that allocated funds translate into tangible improvements in healthcare services and make a meaningful difference in the lives of ordinary citizens.