Last year, the National Planning Commission and the Ministry of Finance issued a directive to the Ministry of Health and Population to send most of the health budget to local and provincial governments.

The Health Ministry directed its agencies to follow the instructions, saying the provincial and the local governments would look after healthcare services in the new federal set-up.

Up to 90 percent of the health budget was allocated to provincial and local level governments, hoping that those agencies would implement programmes.

However, when provincial governments, especially the Province 2 government, announced the budget, health officials were surprised.

“There was little priority to health programmes; funds were also not earmarked as per the budget allocated by the

Health Ministry,” Dr Bibek Kumar Lal, director at the Epidemiology and Disease Control Division, told the Post. “We hoped that they will be serious towards health programmes and understand the sensitivity of the matter.”

Implementation of the programmes is even dismal, as the Ministry of Social Development of Province 2 has been found to have transferred the health budget to other sectors—construction works—instead.

The ministry transferred budget allocated for mental health programmes, cardiovascular disease, leprosy, hydrocele surgery, lymphatic filariasis, training of health workers, child health and immunisation programmes, urban health programmes, and construction of primary health care centres.

The budget for these purposes has been transferred to and utilised for the construction of school infrastructure, organising sports events, providing funds to clubs and local organisations, construction of cremation facilities, and community buildings, which do not fall under the ambit of the Social Development Ministry.

Province 2 is far below in the human development index.

According to the National Demographic Health Survey-2016, neonatal mortality rate in the province is 30, whereas the national average is 21; infant mortality rate is 43 in the province while the national average is 32; under-five mortality rate is 52 against the national average

of 39.

Likewise, the prevalence of anaemia among children aged six months to five years is 58 against the national average of 53; the prevalence of anaemia among women aged between 15 years and 49 years is 59 while the national average is 41.

Similarly, only 65 percent children of the province have received basic vaccination, while the national average is 78 percent; birth delivery rate in health care facilities is 45 percent while the national average is 57 percent; women aged 15-19 years, who are currently

pregnant are, 27 percent in the province but the national average is 17.

Moreover, children under five who are stunted are 37 percent while the national average is 36 percent. All the health indicators in the province are lowest compared to other parts of the country.

Arjun Kumar Neupane, an under-secretary at the budget division of the Provincial Ministry of Economic Affairs and Planning, said that Minister for Social Development of Province 2 Nawal Kishor Sah refused to implement the budget, saying that healthcare was not a priority.

When contacted, Minister Sah defended his decision.

“By transferring the health budget to development works, we have not committed any crime,” Sah told the Post over the phone. He said that his ministry had not even been able to spend the health budget allocated by the federal government (Ministry of Health and Population).

“The health budget was prepared by a staffer, who even did not have the knowledge about the priority of my ministry,” he said.

But Lal said the budget was allocated with certain objectives. According to Lal, none of the national commitments on health and Sustainable Development Goal targets would be achieved if the provinces failed to take health issues seriously.

Former health secretary Dr Sudha Sharma said health budget should not be transferred to construction works.

“Health facilities of Province 2 are overcrowded; a lot of women are giving birth at homes, risking the lives of both mothers and newborns, and several other health issues of the province need to be addressed,” said Sharma.

Sharma said the Ministry of Health and Population should also caution the provinces about the seriousness of health issues to prevent the repetition of such problems in the coming years.

“Prosperity will not come in the country by transferring health budget to construction works,” Sharma added.