When it comes to fund allocation in the annual budget, the health sector usually picks up the crumbs. This should not be the case, given the enormous social and economic implications of health. In fact, there is ample evidence to suggest ill health is one of the key reasons behind further pauperisation of low-income families. Lack of adequate health is one of the main reasons behind a person’s poor physical and intellectual development, adversely affecting his or her productivity. Despite the abundance of such evidence, health has remained one of the more neglected areas in the broad social development scene of Bangladesh. However, there have been some .efforts, promoted by donors, in recent years to provide well-targeted health and family planning services to the rural people in particular. One such programme was the Fourth Population and Health Plan (FPHP), which ended on June 30. 1998, and succeeded by the Health and Population Sector Programme (HPSP). But there are serious doubts about the success of FPHP and whether the HPSP would be implemented in an effective manner.

The World Bank, which coordinated the funding of the FPHP has already given a clear “thumbs down” to the fourth health plan. A Bank evaluation of the FPHP found implementation of the programme to have been unsuccessful in terms of developing institutional sustainability. The Bank found that the programme had failed to reach the real poor segment of the population who were the specific targets for service delivery. In addition, the programme had also failed to address the gender issue. Given failures in such broad but crucial areas, one would be entitled to wonder whether the 755 million dollars spent on the FPHP had been thrown down the drain.

What the government needs to do now is to evaluate the institutional problems, which caused such failures in the implementation of the FPHP. This is vital because the HPSP cannot afford to fall In the same manner. The HPSP is designed to effect a number of important reforms in the health sector, and ensure village-level delivery of primary -health care in a single package. This is too important to be allowed to fail through inefficiency at the implementation level. The government must delegate authority to the projects and decentralise the public health structure in order to increase efficiency and ensure accountability. Greater efforts need to be undertaken to ensure community participation in the health sector.