Provincial administrations received only 50-60 percent of the budgetary allocations every year for the health sector and this brought about a situation where they had to depend on limited financial resources to improve and maintain better health facilities, an audit report reveals.
“The financial allocation of Rs 2,299 million for the health sector had been distributed in nine provinces without consideration of the spread of rural and estate population. Even though the total allocation for the rural hospital development was Rs. 5000 million in 2021, only Rs.3,350 million had been released for that,” according to the performance audit report carried out by the National Audit Office.
The audit assessed how the government had strengthened the health system’s capacities to forecast, prevent and prepare for public health risks and disaster management mechanisms in keeping up with Sustainable Development Goals (SDG). The report also revealed how the authorities failed to take adequate measures and were unprepared for possible health emergencies in the future.
Among the key discrepancies found in the audit report are: Relevant amendments had not been done to the Quarantine and Disease Prevention Ordinance as approved by the previous Cabinet, the Sustainable Development Policy is still at draft level, and the National Disaster Management Plan (2021-2030) has not been finalised till the audit was carried out in April.
The National Action Plan for Health Security (NAPHS 2019-2023) had been prepared in collaboration with the main stakeholders based on the gaps identified during the Joint External Evaluation (JEE) and other routine evaluations. However, the audit observed that eight main stakeholders were unaware of the NAPHS.
In terms of the NAPHS, it is mandated to conduct National IHR Steering Committee Meetings twice a year for monitoring and evaluation but this meeting has not been held in 2020 and 2021. “The National Health Council, which is an important platform to discuss health issues at the highest level, has not been assembled since 2004. The National Health Development Committee is the intermediate level of the health sector but only one meeting per year had been held during the year 2020 and 2021. The Health Development Committee which helps to discuss health-related matters, but it had been assembled only once in 2020. National Council for Disaster Management meetings had not been held since 2010,” the report found.
For the implementation of the plan, Rs 3.8 billion (3,807 million) had to be provided through the government’s Consolidated Fund and foreign funds to some 29 relevant institutions but only 14 of them responded to the audit. Accordingly, they were unable to fully implement all activities of the said plan for which they had to be responsible.
The financial provisions made for the health projects as required target of the SDGs were different from the Public Investment Programme (PIP 2021-2024) and the required financial resources allocated in the annual budget were Rs. 2,443.2 million less in 2021 and Rs.10,156.2 million less in 2022 causing delays in achieving the targets in the relevant projects.
The report stressed that necessary amendments had not been made to the Animal Disease Act No. 59 of 1992 in the areas of zoonotic diseases, antimicrobial resistance, antimicrobial usage, antimicrobial residues and food safety by 2022.
“Antimicrobial resistance plan had not been implemented at the expected level due to lack of funds. Further, biosecurity surveillance and monitoring programmes had not been started in commercial livestock and poultry farms. The relevant parties had not taken actions to develop legislation to ensure strict oversight and enforcement of unauthorised over-the-counter sale of antibiotics….”
Sunday Times 12.08.23