Health infrastructure: budgetary allocation in three Khyber Pakhtunkhwa districts neglected: study

The budgetary allocation for repair, operations and maintenance of the equipment and health infrastructure in the three districts of Khyber Pakhtunkhwa totally neglected.

According to search study on 'Budget Analysis of Health department', conducted by Centre for Governance and Public Accountability (CGPA) in three district of KP, include Mardan, Peshawar, and Swabi revealed that huge neglect for the repair and maintenance of the equipment and health infrastructure in the district health budgets in the three districts.

A total of Rs 19,108.77 million estimated for the current financial year for the health sector in Khyber Pakhtunkhwa, an phenomenal increase of almost 150 per cent, compared to Rs 7646.44million, allocated in last fiscal period 2012-13. However, the study said the increase does not coincide with district health budgets. In 2012-2013, total revised budgets for health sector in Swabi, Mardan and Peshawar districts was Rs 1584 million, which increased to Rs 1723.7 million in 2013-2014 estimated budgets, with only 8.8 percent increase over the last year, the study said.

It was further revealed that the per capita health expenditure of the district is around Rs 240 which is very low. The per capita spending of the district on health in 2013-14 for Peshawar, Mardan & Swabi are Rs 229, Rs 223 and Rs 268 respectively. This shows a steady rise from the per capita expenditure of the districts on health in the year 2011-12. The pattern prevails throughout the province. The first and foremost problem of the health sector is lower budget allocation in the budgets despite the fact that in KP Comprehensive Development Strategy, health sector was the priority sector for the provincial government.

In all three districts health budgets, it said that a major chunk of health budgets goes to the employee's related expenses. The mere comparison of 2011-12 with the year 2013-14 brings home the fact that percentage share of salary has increased and it has gained more than 10 percentage point (82 to 92) over the 3 years. Whereas the budgets of other heads have been compromised; eg operating expenses decreased from 17% in 2011-12 to 8% in 2013-14. The budget of assets, repair & maintenance and grants is almost frozen over the last 3 years. Again, given the rate of inflation, the budget allocations in assets, repair and maintenance and grants have actually deceases over the last 3 years. This is an alarming situation. Failure to allocate more budgets in repair and maintenance heads may have turned health facilities dysfunctional. However, the study said the need is to accompany these expenses with expenses in other sectors to support the large presence of human resource base.

The organisation said the basic finding is the very low level of overall allocation to the health sector in the three most populated districts of Khyber Pakhtunkhwa, stressed the need is to raise the overall budget so that the outcome sets in the comprehensive development strategy be achieved. The province is still below on the MDGs in the health sector and only a greater allocation can achieve those objectives by 2015. Overall the district budgets on health show an increase over three year period but that is just enough to cater for inflation and not enough for growth in population. It was noted that while making the budget, previous year budget was increased/decreased evenly. No exercise is done to determine the actual needs of health facility, the survey said. It was also noticed that the posts of doctors are lying vacant while every year Finance Department allocate budget for these vacant posts. The district health officers need to be more proactive in sharing health budgets. CGPA faced many hurdles in reaching district budget books.

In all the three districts under study, almost 90% of the district health budget goes to the General Hospital Services thus leaving not much money for EPI, Mother and Child Care, Drug Control and other health facilities. Lower budget allocation to the Mother and Child Care centres restrict the government health facility to offer only a week special activity in a whole month. The budget should be increased as most of the patients are children and their mothers.

On the expenses side, the major chunk (almost 90%) goes to the salaries of the employees. We recommend these expenses should be complemented with expenses on Repair and Maintenance to improve efficiency of the doctors. The allocation of health budget for Peshawar has been inconsistent. Though it gained an average increase of 10% between 2011-12 and 2013-14, it does not match with the increasing population and its needs in the district. Lack of medicine at BHUs and other government hospital at the village level is a major concern and the doctors in-charge were complaining as patients only visit government health facility if free medicines are available.