Tackling the Overlooked Pandemic of Antimicrobial Resistance: COmmunity Solutions To Antimicrobial Resistance (COSTAR)

 

 

Antibiotic resistance (ABR) arises when bacteria develop resistance to antibiotics. In other words, antibiotics are ineffective against them. It is a common myth that people or animals develop resistance to antibiotics, whereas, in reality, it is germs that become resistant antibiotics.

 

Vector illustration of superbugs.No gradients used. CMYK. Objects grouped for easy editing. Created with AI CS3.

When AMR becomes dominant in the health sphere of our daily life, it will pose a grave danger to the very existence of human and animal health. It is pervasive for us-humans and our domestic and wildlife animals to get sick due to different bacterial attacks and infections.

According to the UK Government-commissioned Review on Antimicrobial Resistance, by 2050, AMR might kill 10 million people each year. In 2019, an estimated 4.95 million fatalities were linked to bacterial AMR, and AMR caused an estimated 1.27 million deaths. The World Health Organization (WHO) has also raised its concerns about AMR, claiming that it might be the most serious threat to global human health and food security in the upcoming days.

To address this alarming issue, especially in the low-resource settings where community people have unrestricted accessibility to over-the-counter (OTC) antibiotics and have little or no knowledge regarding antimicrobial resistance, expansive community engagement is required.

 

ARK Foundation along with the University of Leeds has launched a new project titled “Community Solutions to Antimicrobial Resistance (COSTAR)” to address the alarming issue of AMR in Bangladesh. An online launching event was organized on March 13, 2022 to inaugurate the project. COSTAR, a joint initiative by the University of Leeds, ARK Foundation Bangladesh, HERD International Nepal, Chittagong Veterinary University (Bangladesh), Malaria Consortium, University of Liverpool, and the University of Western Australia, is being implemented in Bangladesh and Nepal. The project is being implemented with the support of UK Research and Innovation GCRF collective fund.

The aim of this project is to engage community through participatory approaches to tackle AMR.   The project has several interventions planned to exercise at the community level in Bangladesh and Nepal. The main component of the project is Community Dialogue Approach (CDA) which will be implemented based on two previously funded studies. to them.

 

Professor Rumana Haque, PhD, Executive Director of the ARK Foundation said in her welcome speech that Antimicrobial Resistance is a growing threat to both human and animal health. The irrational use of antibiotics among humans and animals further worsens the situation. Stressing on the economic impact of AMR, she mentioned a recent study that finds that Bangladesh can face almost BDT 788 thousand crores decrease in GDP by 2050 if AMR is not curbed now. She said that the COSTAR project would prevent antimicrobial resistance in Bangladesh through community dialogue approach (CDA) interventions.

Dr. A H M Enayet Hussain, Director General of Directorate General of Medical Education (DGME) Ministry of Health and Family Welfare, chaired the session. He expressed concerns over the misuse of antibiotics in Bangladesh and urged immediate multisectoral collaboration to tackle the growing antimicrobial resistance in Bangladesh

Dr. Khaleda Islam, Surveillance Lead of AMR Control Program, Fleming Fund, said that it is very important to trace the drivers and factors behind the irrational use of antibiotics at the household level and the decision-maker of using them. Dr. Tahmina Shirin, Director, Institute of Epidemiology, Disease Control and Researchstated that the trend of AMR is constantly rising all over the country for the past five years. The current data suggest that the AMR is rising not only in the hospitals but also in the communities. Motivating community people alone will not enable us to get rid of this problem. We need  revised and regulations to address the irrational use of antibiotic.  She stressed on the importance of increasing country wide effective surveillance mechanism in hospitals to address AMR.

Dr Abul Kalam from USAID addressed the importance of community engagement to solve issues like antibiotic resistance. He acknowledged the community involvement in achieving the country’s freedom in 1971 and said that community engagement has always been a great tool to Bangladesh’s armory. He hoped that COSTAR through its community engagement approach will succeed in tackling AMR in Bangladesh.

Dr. Nitish C Debnath, Country Lead, Fleming Fund, appreciated the multidisciplinary approach of the COSTAR project and hoped that this project will enable the researchers to generate better information.

Dr. Rebecca King, Principal Investigator of the COSTAR project said in her video message that COSTAR will  address the drivers of AMR in Bangladesh and globally in order to help protect antimicrobials and prevent deaths from preventable diseases for future generations.

Dr. Tim Ensor, Professor, University of Leeds, mentioned about the lack of evidence to design interventions to reduce the harmful consequences of AMR. The COSTAR project aims to understand what types of interventions through community engagement might help to address the health and the economic consequences of resistance.

All of the guests, the chair, and the chief guest applauded the initiative in the country and expressed that this project has the potential to become an impeccable example to follow for low-resource settings in the country.

 

Written by: Badruddin Saify, Research Assistant, ARK Foundation

News Links:

  1. https://www.tbsnews.net/economy/corporates/ark-foundation-launches-costar-address-antimicrobial-resistance-384628
  2. https://bangladeshpost.net/posts/concern-over-inefficacy-of-antimicrobials-in-bangladesh-81651
  3. https://sharebiz.net/%E0%A6%85%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%A8%E0%A7%8D%E0%A6%9F%E0%A6%BF%E0%A6%AE%E0%A6%BE%E0%A6%87%E0%A6%95%E0%A7%8D%E0%A6%B0%E0%A7%8B%E0%A6%AC%E0%A6%BF%E0%A7%9F%E0%A6%BE%E0%A6%B2%E0%A7%87%E0%A6%B0/

 

 

 

 

 

 

 

“10 percent increase in the price of cigarettes would reduce overall cigarette smoking among people by 7.1 percent”

Cigarette price increases are more effective in reducing cigarette demand among poorer people.  A recently conducted research study finds that the demand for cigarette responds less than proportionately to changes in cigarette price. Moreover, the study finds that an increase in cigarette price by 10 percent results in a 9 percent decrease of cigarette demand among poorer people compared to 3.9 percent among wealthier people. The findings came up in a recently conducted research study by ARK Foundation, Bangladesh and Tobacconomics based at the University of Illinois, Chicago.

A workshop was organized by ARK Foundation in collaboration with the Tobacconomics on  January 12, 2022 to share findings from two recently conducted research studies as a part of their commitment to accelerate progress on tobacco taxes in Low- and Middle-Income Countries. Bangladesh has one of the largest populations of tobacco users in the world. According to the Global Adult Tobacco Survey (GATS) 2017, overall cigarette smoking prevalence is 14 percent among adults and 28.7 percent among men.

SM Abdullah, Associate Professor of Economics at the University of Dhaka and researcher at the ARK Foundation, presented a paper which focused on the estimation of cigarette demand responsiveness against price using GATS 2009 and 2017 data. While sharing the research findings he said that a ten percent increase in the price of cigarettes would reduce overall cigarette smoking among people by 7.1 percent.

He also said that increasing the price of cigarettes reduces smoking participation and encourages smokers to smoke less. He suggested the government to introduce specific tax on cigarette and increase the price substantially to reduce cigarette smoking prevalence in Bangladesh. He also suggested adjusting the prices of cigarettes annually for inflation and income growth to reduce the affordability of cigarettes.

Another paper was presented in the event by Md. Nazmul Hossain, Assistant Professor of Economics at the University of Dhaka and researcher at the ARK Foundation. He said that Bangladesh has a very complicated multi-tiered cigarette tax structure which has made tobacco tax a less effective instrument to control cigarette smoking. “The significantly lower price, together with a lower excise tax for low-tier cigarettes, created a window of opportunity for the manufacturers to expand low tier cigarette market which resulted in lower tax revenues for the government”, he made the remark while sharing his research findings.

The research shows that the introduction of a new low-tier cigarette in FY 2019-20 has caused a significant revenue loss of 273.5 crore taka for the government. The research also finds that had the government imposed a policy combining an increase in the base price of low-tier cigarettes from 37 to 45 taka along with uniform ad valorem excise tax rate of 65% for all tiers, the government tax revenue would have been 1958.4 crore taka higher than the actual tax revenue in FY 2019-20. Mr. Nazmul strongly suggested increasing the base price along with an increase in the excise tax rate for low-tier cigarettes.

Professor Dr Rumana Huque, Executive Director, ARK Foundation led the research team in conducting these two studies. She said that, Bangladesh primarily needs to design and implement a specific tax structure to reduce the use of tobacco. She suggested increasing the price of cigarette so that it becomes unaffordable for the general people and also recommended stopping the purchase and sale of single stick cigarettes to reduce its consumption. “To dream of a tobacco free country by 2041 as per Prime Minister’s vision, we need to design and implement an effective tobacco tax policy as soon as possible” said Professor Rumana.

Dr Nasiruddin Ahmed, Former NBR Chairman, who was present in the workshop, said that the government’s share in the tobacco companies allows the tobacco industry to continously interfere in the policy making process. He called for collective action from all concerned stakeholders and recommended building up a national movement to reduce tobacco usage.

Dr. Sohel Reza Choudhury, Professor & Chairman, Department of Epidemiology & Research at the National Heart Foundation Hospital and Research Institute said that effective taxation is the most effective instrument in controlling tobacco. He applauded the conducted research studies and said that the findings would be extremely helpful in designing policies to reduce cigarette smoking among people.

Mr. Mostafizur Rahman, Lead Policy Advisor, Campaign for Tobacco Free Kids (CTFK-Bangladesh) focused on the importance of increasing cigarette prices and excise duties to reduce smoking prevalence in Bangladesh. He suggested creating widespread awareness about the harmful effects of cigarette smoking. He said that the findings generated from the studies would be helpful in forwarding advocacy campaigns against tobacco use.

Advocate Syed Mahbubul Alam Tahin, Secretary, Center for Law and Policy Affairs, said that the tobacco companies spread misinformation whenever there is a talk about increasing tobacco taxes. He also said that the companies use external as well as internal influence to interfere in the government decision making system. As a result, the government fails to devise effective strategies to control tobacco. He suggested bringing changes in the existing tax policies and recommended strong implementation of the tax laws to reduce cigarette smoking and tobacco usage.

The event was also joined by development workers, tobacco control advocates, academicians, students, policy makers, and media outlets.

Media Coverage:

https://www.tbsnews.net/bangladesh/health/10-increase-price-cigarettes-reduce-cigarette-smoking-71-356545

https://www.bd-pratidin.com/life/2022/01/13/730461?fbclid=IwAR3o8kVz7KghEj75iA9qaoMKi2dVJf7HeYx-mAckFwU4aSGar4WzUJ7XI5I

Stakeholder Engagement Meeting-Tobacco Control Capacity Programme (TCCP)

With 37.8 million adults consuming tobacco products, Bangladesh has one of the largest populations of tobacco users in the world. Although the overall prevalence of tobacco use among adults declined from 43.3 percent to 35.3 percent from 2009 to 2017, the overall prevalence of cigarette smoking is still very high and did not change at all over the period (GATS, 2017). According to the Global Adult Tobacco Survey (GATS) 2017, overall cigarette smoking prevalence is 14 percent among adults and 28.7 percent among men.

The high prevalence of tobacco use and cigarette smoking remains a major health concern for Bangladesh. As a part of its continuous effort to generate effective knowledge and evidence for advocating better tobacco policies, ARK Foundation, Bangladesh with the support of the Tobacco Control Capacity Programme (TCCP) organized a stakeholder engagement meeting to share research findings and gather further insights from the various stakeholders on the main research themes of the TCCP: Illicit trade in Tobacco for Bangladesh and Implementation of Article 5.3 of the Framework Convention on Tobacco Control (FCTC).

The workshop was helpful in circulating the recent evidences on the aforementioned issues and discussing possible interventions to reduce the illicit trade of such products. The workshop was attended by policymakers, health experts, development workers, academicians, policy advocates, and youths. They emphasized the importance of implementing evidence-based policies to reduce the prevalence of illicit trade and called for greater cooperation among all stakeholders to tackle industry interference in Bangladesh. The participants called for strengthened cooperation among all stakeholders and recommended stronger implementation of policies to achieve tobacco-free Bangladesh by 2041.

২৬ ডিসেম্বর আর্ক ফাউন্ডেশন নিম্ন এবংমধ্যম আয়ের দেশগুলোতে তামাকজনিত ক্ষতি কমানোর লক্ষ্যে গবেষণা সক্ষমতা বৃদ্ধি বিষয়ে একটি অংশীজন মতবিনিময় সভার আয়োজন করে। যুক্তরাজ্যের গ্লোবাল চ্যালেঞ্জস রিসার্চ ফান্ডের টোব্যাকো কন্ট্রোল ক্যাপাসিটি প্রোগ্রামের তত্ত্বাবধানে এই সভার আয়োজন করা হয়।
তামাক কোম্পানীর হস্তক্ষেপ বিষয়ে একটি গবেষণা প্রবন্ধ উপস্থাপন করেন আর্ক ফাউন্ডেশনের নির্বাহী পরিচালক এবং ঢাকা বিশ্ববিদ্যালয়ের অর্থনীতির অধ্যাপক ড. রুমানা হক।
অধ্যাপক রুমানা হক তামাক কোম্পানীর অবৈধ হস্তক্ষেপ বিষয়ে তাঁর প্রবন্ধে বলেন, গবেষণায় অংশগ্রহণ করা অধিকাংশ মানুষ মনে করেন যে তামাক কোম্পানিতে সরকারের শেয়ার থাকা তামাক নিয়ন্ত্রণে বড় বাঁধা হয়ে দাঁড়াচ্ছে।
তিনি বলেন, বাংলাদেশে তামাক নিয়ন্ত্রণ করতে হলে আর্টিকেল ৫.৩ এর অতি দ্রুত বাস্তবায়ন প্রয়োজন এবং একই সাথে বাস্তবায়নকারী সংস্থার সক্ষমতা বাড়ানো প্রয়োজন সভায় অবৈধভাবে সিগারেট উৎপাদন এবং বিক্রি বিষয়ে আরো একটি গবেষণা প্রবন্ধ উপস্থাপন করেন ঢাকা বিশ্ববিদ্যালয় অর্থনীতি বিভাগের সহযোগী অধ্যাপক এবং আর্ক ফাউন্ডেশনের গবেষক এস এম আব্দুল্লাহ।
তার গবেষণায় উঠে আসে বাংলাদেশের খুচরা দোকানগুলোতে যে পরিমাণে সিগারেট বিক্রি হয় তার প্রায় ৫.২% সিগারেট কোন না কোনভাবে তামাক নিয়ন্ত্রণের জন্য সিগারেট প্যাক সম্পর্কিত আইন লঙ্ঘন করে। তিনি আরো বলেন তামাক কোম্পানীগুলো দাবী করে তামাকের উপর কর বাড়ালে দেশে অবৈধ বাণিজ্য বেড়ে যাবে। কিন্তু সেটা যে সঠিক নয় তা এখন প্রমাণিত। কারণ প্রতি বছর সিগারেটের দাম বাড়লেও গবেষণায় দেখা যায় বাংলাদেশে অবৈধ সিগারেটের পরিমাণ খুবই সীমিত।
অনুষ্ঠানে বিশেষজ্ঞ আলোচক হিসেবে উপস্থিত ছিলেন জাতীয় রাজস্ব বোর্ডের সাবেক চেয়ারম্যান ডঃ নাসির উদ্দিন আহমেদ, স্বাস্থ্য অর্থনীতি ইউনিটের পরিচালক (গবেষণা) ড. মো. নুরুল আমিন ও সেন্টার ফর ল এন্ড পলিসি আফেয়ার্সের সেক্রেটারি এডভোকেট সৈয়দ মাহবুবুল আলম তাহিন।

Curbing tobacco market through reshaping regulatory policies

Rumana Huque | Published:  August 26, 2021 21:17:50

Bangladesh is currently the eighth-largest tobacco market in the world. Cigarette production is increasing at a rate of 2 per cent per annum. Bangladesh is one of the largest tobacco consumers in the world with 37.8 million adults aged 15 years and above. It means about 35.3 per cent of the country’s population is consuming tobacco products, according to the Global Adult Tobacco Survey (GATS) 2017.

However, there is a lack of proper monitoring and evaluation in terms of regulating the tobacco industry. The tax structure for tobacco products is also riddled with loopholes. In this context, it is extremely crucial to shed light on the policy lapses in the tobacco industry. The revision of the existing policies and proper enforcement of the policies can bring the tobacco market under control.

REDEFINING TOBACCO TAXATION MECHANISMS:

The taxation mechanism of all types of tobacco products highly matters as it influences the prices of the tobacco products in the market which has implications on public health and government revenue. In Bangladesh, there exists a very complex multi-tiered ad valorem tobacco -tax system. The price of cigarettes is determined according to four-tier cigarettes categorised by the government — premium, high, medium, and low. The tax base and rates vary based on the tiers.  Unfortunately, this differential tax mechanism fails to keep the tobacco market in check as it opens opportunities for product substitution, that is, a person can easily switch from a high or medium-tier cigarette to a low one since the price does not increase similarly across all tiers of the cigarette.

Currently, the retail price that the consumers have to pay to buy cigarettes in Bangladesh is much lower compared to many developing countries. Historically, the tax base of tobacco products in the country has been very low. This is especially true in the case of the low-tier cigarettes and smokeless tobacco products (SLT) such as zarda and gul. The current market structure of cigarettes reveals that around 84 per cent of the total cigarettes supplied in the country comes from the “Medium” and “Low” price slab and the rest 16 per cent is attributed to “High” and “Premium” price slabs. However, there has not been any change in the proposed price (BDT 39) and supplementary duty (SD) of the low-tier cigarette (57 per cent of MRP) in the proposed budget for the year 2021/22. The price and SD of the medium-tier cigarettes also remains the same as last year.

Though the prices of high and premium-tier cigarettes have been increased marginally, there is no change in the SD (65 per cent) compared to last year. This will have a limited impact on the consumption of expensive cigarettes. The prices and tax rates of biri, zarda, and gul have also not been changed in the proposed budget. Such a situation does not do much to dissuade consumers from the consumption of tobacco products. The taxation proposed in the budget will not reduce consumption of low and medium-tier cigarettes as no price and tax change have been essentially proposed. It also keeps the option open for high and premium-tier cigarette consumers to easily switch on to a medium or low-tier cigarette. And when consumers switch to cheaper brands in such a manner, the government also loses high levels of revenue.

Sometimes, the tobacco companies use this tier system to evade taxes. For example, a tobacco company can easily shut down a brand of a medium-tired cigarette and release a similar product under a different brand name in low tier by just changing the price marginally so they have to pay lower taxes. Many tobacco companies are evading taxes by taking advantage of the multi-tiered taxation system and lack of proper monitoring by the government.

NECESSITY OF STRINGENT GOVERNMENT POLICIES:

The government of Bangladesh has its share in a multi-national tobacco company and a number of government officials hold positions on the board of the company. This poses a clear conflict of interest. It also violates the WHO Framework Convention on Tobacco Control of which Bangladesh is a signatory. After the independence of Bangladesh, there were plans to nationalise the big industries which resulted in acquiring shares in the cigarette company. But since no such plans exist now, there is no point in having a share or government presence in tobacco companies.  If we want to impose stricter taxation on tobacco products, there is no alternative to curbing the influence of the tobacco industry on the government. They must stop consulting the tobacco industry about tobacco leaf pricing, divest its shares in the tobacco industry, and ban all forms of tobacco-related CSR programmes. The honourable prime minister of Bangladesh has set a goal that Bangladesh will be tobacco-free by 2040. The government has also started to levy a 1 per cent health development surcharge (HDE) on all tobacco products. The government is committed to reaching that goal but they need to do more.

It is of absolute importance that the government move towards a uniform specific tax structure and reduce the number of tax tiers. This simplifies the tobacco tax-system and makes it easy to administer. With a specific tax system, a regular increase in the price of tobacco will reduce consumption and generate high revenues. The consumption of tobacco cannot be controlled without significantly increasing prices of all types of cigarettes and other SLTs. The government should digitise the monitoring system by adopting unique identifiers (i.e.: barcodes) on the cigarettes and also provide adequate training to the personnel involved in the monitoring. These steps can play a crucial role in reducing tax evasion by companies. Similarly, there should be strict regulation and monitoring of  Biri and SLT products so they can’t evade taxes. Besides, the relevant authorities should also strictly monitor advertising strategies that tobacco companies undertake in the name of CSR activities.

Tobacco cultivation also poses a serious threat to the environment and causes serious diseases to the farmers. But the good thing is that the government of Bangladesh has drafted a tobacco cultivation control policy to limit tobacco farming. The policy targets to increase the production of food crops and dissuade them from tobacco farming. They plan to do so by giving them easy loans and incentives for fertiliser, seeds, and other farm inputs and equipment so that transition can be done easily to the cultivation of other types of crops.

CRAFTING SMARTER ANTI-SMOKING CAMPAIGNS:

Although the tobacco industry cannot market its products openly in any form of media due to existing tobacco laws, they have found smarter ways to promote or encourage smoking. We can often see characters in the movies and television shows smoking. It results in encouraging young people to indulge in cigarette smoking. The anti-smoking awareness programmes in the country are very traditional and mostly limited to human chains, rallies, and webinars. There are pictorial warnings about health hazards in the cigarette box. But it does not help much since it is allowed to buy single sticks and most people do not buy whole boxes. As such, they do not come across the warnings. The organisers of the awareness programmes and campaigns need to rethink their approach to combat these issues. Advocacy campaigns should be conducted to discourage filmmakers from showing smoking onscreen. To build national consensus regarding the harmful effects of smoking, social media platforms should be widely and smartly used. Youth idols can be engaged in making people aware of the deadly consequences of smoking. There should also be programmes to assist smokers to break free from their addiction. They should also make the most use of social media to amplify their message.

 

Dr Rumana Huque is a Professor of the Department of Economics, University of Dhaka and the Executive Director of ARK Foundation, Bangladesh

rumanah14@yahoo.com

Originally Published in The Financial Express Bangladesh

Health sector must focus more on budget implementation

 Rumana Huque and Tahmid Hasan | Published:  July 08, 2021 20:48:15 |

The national budget for the fiscal year 2021-22 (FY22) does not offer much for the public health sector of Bangladesh. However, it does not come as much of a surprise as the sector generally remains neglected in national budgetary allocations. Despite having one of the highest out-of-pocket health expenditures (74 per cent of total health expenditure) in the region, the budget share for the health sector of Bangladesh has been less than 1.0 per cent of Gross Domestic Product (GDP) for over a decade.

The country’s public health expenditure per capita is also the lowest in South Asia. The per capita health expenditure of Bangladesh is US$110. On the other hand, the average per capita health expenditure of South Asia is US$401. The health sector has received only 5.42 per cent of the total budget for FY22, and the share in terms of GDP is only 0.95 per cent. The allocation has been increased meagerly compared to the outgoing fiscal year. However, the allocated amount should have been much higher considering the health crisis prevailing in the country due to the pandemic.

The fragility inherent in the public health system of Bangladesh became more evident with the advent of Covid-19. We have seen how inadequate and incapacitated our health facilities are. The pandemic has exposed the dire situation of the government-run health complexes in the district and upazila levels. Still, necessary resources have not been directed towards the health sector. But the budgetary allocations are not our only concern.

Our health authorities have persistently failed to utilise even this meager amount of budget allocation. According to a report by the Implementation, Monitoring and Evaluation Division (IMED) of the government, the health sector is the lowest performer among the top 15 ministries in implementing the Annual Development Program (ADP). The Ministry of Health and Family Welfare (MOHFW) has been unable to spend 74 per cent of the ADP allocation in the first ten months of FY21. It shows the lack of capacity of the public health authorities in utilising the budget allocation efficiently.

For the FY22, we must primarily prioritise implementing the budgetary allocation more effectively. In the budget speech, the finance minister has mentioned a few priority areas for government expenditure in the health sector. However, many other important areas need attention from policymakers.

The country right now needs to focus on handling the Covid-19 situation better. Keeping in mind the second wave and many other waves that may hit us in the future, we need to prepare ourselves adequately. To tackle the Covid-19 transmission, it is of utmost importance that we vaccinate as many eligible people as possible, free of cost. As such, the government must focus on procuring vaccines from all available sources.

Although the budget mentions vaccinating 80 per cent of the population, it does not declare a specific allocation for the purpose. A block allocation of Tk 100 billion has been kept in the budget to manage emergencies like Covid-19. But proper utilisation of this block allocation remains a challenge due to procedural obstacles.

It has been more than one year since the pandemic struck us, but our effort towards increasing the number of hospital beds, ICU beds, and oxygen in public hospitals has been very little. Despite having time in our hands, we did not take much preparation to tackle the second wave. This is even more surprising as a large proportion of the health budget each year is spent on physical infrastructure development. We have suffered throughout the pandemic due to the unavailability of these resources. We need to effectively utilise our resources on an emergency basis for enhancing the numbers of physical infrastructures and supplies. We see some allocations for increasing oxygen supply and ICU beds in the proposed budget through donor-funded projects, but we also need to focus on the effective utilisation of these resources.

Besides, we also need to increase the number of health support staff to ensure rapid treatment of covid patients in the public hospitals and health complexes. The recent steep rise in the number of covid patients in the bordering districts exposes how outnumbered our health workers are in the district and upazila level health facilities. A combination of inadequate physical infrastructures and human resources has turned out to be a nightmare for these bordering areas. But the shortage in health allocation remains a primary challenge in increasing the number of health workers. Moreover, a proper health need assessment should be carried out in those areas so that funds can be utilised more effectively.

Mass awareness campaigns remain crucial to tackling covid-19. We have not seen any specific allocations for this purpose in the proposed budget. But necessary resources should be directed toward continuous campaigns like free mask distribution, awareness-raising etc. The emergency block allocation proposed in the budget can help to do so. Apart from Covid-19, it is also important that we focus on mental health services. Despite 17 per cent of adults suffering from mental health issues, our public spending for mental health services is only around 0.05 per cent of the total health budget or US$0.08 per capita.

We need to allocate more resources from our health budget to disseminate mental health services extensively. The mental health issues became more acute with Covid-19 significantly affecting us with lost lives, widespread job losses, reduced income, halted education, and so on. As such, it is high time we started giving attention to this sector through increasing human and physical resources along with mass awareness creation.

On average, we usually spend around 25 per cent of our health budget on primary health care services. Since most of the people visiting public hospitals mainly seek primary health care, there is a need to increase our expenditure in this sector. This will benefit people from lower-income levels by reducing their out-of-pocket health expenditures. To make health care services more accessible for people it is a must that we strengthen our health infrastructures through allocating more resources from the budget, or at least, to ensure utilisation of the allocated funds.

A growing concern regarding public health has been the over-the-counter sale of antibiotics. People are increasingly buying antibiotics from pharmacies without any prescriptions. The phenomenon is more common in rural areas. This puts the health of the public at great risk as the unnecessary usage of antibiotics makes people antimicrobial resistant. A survey jointly carried out by the Directorate General of Drug Administration (DGDA) and the WHO shows that antibiotics consumption in Bangladesh has increased by 30.81 per cent in the last two years. The MOHFW should use its budgetary resources to create mass awareness regarding the proper usage of antibiotics and antimicrobial resistance.

An allocation of Tk 1.0 billion was made for research and innovation in the outgoing fiscal year’s health budget. But most of it remained unused due to procedural issues. Similar allocation has been made this year as well for research and innovation. To ensure proper utilisation of this fund, we must work on easing the existing complex bureaucratic procedures. If utilised properly, this fund will help improve the quality of health services in the country.

Steps like tax breaks for establishing healthcare facilities in the rural areas, compensation for front-level health workers, R&D allocation, and emergency block allocations in the proposed budget are indeed praiseworthy. But all of this comes down to the implementation.

The limitations in our health structure have always been there. But it became clearer to us with the advent of Covid-19. We now know how vulnerable we are to emergencies. Besides, growing urbanisation and an increasing number of the elderly population along with the risks of sudden emergencies will create pressure on the health system soon. We need more resources, but only higher budgetary allocation cannot solve the problems. The fact that a quarter of the allocated budget in the health sector remains unutilised each year contributes to the finance ministry’s position on not increasing the share of the health budget. To ensure proper implementation of the budget, the MOHFW must strengthen its health governance system and ensure accountability at all levels.

Opinion piece by:

Dr Rumana Huque, Professor, Department of Economics, University of Dhaka and Executive Director, ARK Foundation. rumanah14@yahoo.com

Tahmid Hasan, Research and Communications Officer, ARK Foundation.

This was originally published in The Financial Express

https://thefinancialexpress.com.bd/views/opinions/health-sector-must-focus-more-on-budget-implementation-1625755694?fbclid=IwAR0PiiBISAsyVhQwl4I6nzgNzme1-sVq9xrGbr2uDw99V_OHWunkacBH1no

CLASS III awareness-raising animation video on Second-Hand Smoke (SHS) exposure


We are excited to launch the awareness video on the harmful impact of secondhand smoke (SHS) exposure intended to educate and sensitize tobacco users, policymakers, and local law regulators in Bangladesh, as part of the CLASS III (Children’s Learning About Second-hand Smoke) cluster randomized controlled trial (cRCT). This trial aims to prevent respiratory and other smoking-related illnesses in low-and middle-income countries (LMIC) by reducing children’s exposure to SHS. It is coordinated by the University of York and funded by The Medical Research Council (MRC), UK.

An animation video is created focusing on the harms caused by Second-Hand Smoke (SHS) exposure among the smoking population in Bangladesh. This video is a part of the activities planned in the CLASS III study.

The main purpose of this video is to create awareness about the impact of second-hand smoke as a threat to public health in Bangladesh. It is crucial to educate and sensitize the tobacco users, common public including children and parents, teachers, and stakeholders about the hazards associated with second-hand smoke and the ways to make homes ‘a smoke-free world’ for the children. A secondary purpose of this video is to generate awareness among and gain the support of wider stakeholders such as policymakers, local authorities, political figures and lawmakers, media personnel, charity-based organizations, and health care providers. We aim to do that through screening the video at organized meetings and conventions.

This is a collaborative work between ARK Foundation, Bangladesh, and the University of York, UK, and funded by the Medical Research Council (MRC).

Check out the animation by playing the video below: