Family Planning in Asia and the Pacific - International Council on ...

of additional workers both to fill exist<strong>in</strong>g vacant posts <strong>and</strong>to recruit additional staff, especially <strong>in</strong> <strong>the</strong> low-perform<strong>in</strong>gareas, <strong>in</strong> order to meet <strong>the</strong> needs of <strong>the</strong> <strong>in</strong>creas<strong>in</strong>g numberof eligible couples; (b) reth<strong>in</strong>k <strong>the</strong> role of DGFP <strong>in</strong>provid<strong>in</strong>g good-quality FP-related activities, as was <strong>the</strong>case until <strong>the</strong> early 1990s, ra<strong>the</strong>r than be<strong>in</strong>g <strong>in</strong>volved <strong>in</strong>various non-FP activities, <strong>the</strong>reby enabl<strong>in</strong>g DGFP toachieve its primary goal of <strong>in</strong>creas<strong>in</strong>g CPR <strong>and</strong> <strong>the</strong> use oflonger-act<strong>in</strong>g <strong>and</strong> permanent methods <strong>in</strong> br<strong>in</strong>g<strong>in</strong>g about<strong>the</strong> desired reduction <strong>in</strong> fertility; (c) enhance tra<strong>in</strong><strong>in</strong>gcapacity (NIPORT is primarily responsible for <strong>the</strong>tra<strong>in</strong><strong>in</strong>g of fieldworkers <strong>and</strong> paramedics, <strong>and</strong> undertakesprogrammatic research, both of which, <strong>and</strong> especially<strong>the</strong> former, has rema<strong>in</strong>ed largely underutilized) so thatprogramme personnel could receive <strong>the</strong> necessary tra<strong>in</strong><strong>in</strong>g;(d) improve staff morale through better job security, careerplann<strong>in</strong>g <strong>and</strong> compensation packages; (e) promote taskshift<strong>in</strong>gamong health-care workers; (f ) tra<strong>in</strong> supervisors<strong>and</strong> managers who could provide guidance to o<strong>the</strong>r staff;<strong>and</strong> (vii) stop mak<strong>in</strong>g frequent transfers of programmepersonnel.The government has decided to recruit 10,000 additionalFWAs, 655 additional <strong>Family</strong> Welfare Visitors (FWVs)<strong>and</strong> 400 additional doctors; however, <strong>the</strong> recruitmentprocess could take over a year to be completed at <strong>the</strong>earliest. After <strong>the</strong>y are recruited, <strong>the</strong>y need to go throughtra<strong>in</strong><strong>in</strong>g before <strong>the</strong>y can beg<strong>in</strong> <strong>the</strong>ir work. Regard<strong>in</strong>gFWVs, <strong>the</strong> <strong>in</strong>itial tra<strong>in</strong><strong>in</strong>g period is 18 months <strong>in</strong> duration,followed by 6 months of midwifery tra<strong>in</strong><strong>in</strong>g. Tra<strong>in</strong><strong>in</strong>gof o<strong>the</strong>r staff is also needed to build <strong>and</strong> enhance <strong>the</strong>ircapacity, especially those deal<strong>in</strong>g with behavioural changecommunications <strong>and</strong> procurement. The programmeshould address <strong>the</strong> issue of its <strong>in</strong>adequate tra<strong>in</strong><strong>in</strong>g capacityby tra<strong>in</strong><strong>in</strong>g its exist<strong>in</strong>g tra<strong>in</strong>ers; hire new skilled tra<strong>in</strong>ers;update its tra<strong>in</strong><strong>in</strong>g curriculum, protocols <strong>and</strong> manuals; <strong>and</strong>fully utilize its tra<strong>in</strong><strong>in</strong>g <strong>in</strong>frastructure <strong>and</strong> facilities. Also, itshould be ensured that <strong>the</strong> tra<strong>in</strong>ed staff are not transferredto perform o<strong>the</strong>r jobs, <strong>the</strong>reby not only reduc<strong>in</strong>g wastageof time <strong>and</strong> resources spent on tra<strong>in</strong><strong>in</strong>g but also improv<strong>in</strong>gprogramme implementation.Action should also be taken to ensure active participationof <strong>the</strong> m<strong>in</strong>istries concerned that are m<strong>and</strong>ated to carryout various population-related activities, <strong>and</strong> encouragegreater participation of communities, NGOs <strong>and</strong> <strong>the</strong>private sector <strong>in</strong> provid<strong>in</strong>g <strong>and</strong>/or shar<strong>in</strong>g <strong>the</strong> cost of FPsupplies <strong>and</strong> services.As previously noted, overall health expenditure is onlyabout 3 per cent of GDP, with a relatively smallerportion go<strong>in</strong>g to <strong>the</strong> FP <strong>and</strong> RH programme. Hence,<strong>the</strong> budgetary allocation to <strong>the</strong> overall health sectorneeds to be <strong>in</strong>creased, with a higher share earmarkedfor <strong>the</strong> FP <strong>and</strong> RH programme. However, <strong>the</strong> f<strong>in</strong>ancialperformance of <strong>the</strong> sector shows that, while on one h<strong>and</strong><strong>the</strong> sector has not been able to fully utilize its funds from<strong>the</strong> government <strong>and</strong> development partners because of itsweak implementation capacity, on <strong>the</strong> o<strong>the</strong>r <strong>the</strong> servicesit provides are underfunded; hence, additional fund<strong>in</strong>gis needed. This situation calls for a reexam<strong>in</strong>ation of <strong>the</strong>programme strategies along two l<strong>in</strong>es: (a) how to moreefficiently utilize <strong>the</strong> funds allocated by <strong>the</strong> government<strong>and</strong> development partners; <strong>and</strong> (b) how to <strong>in</strong>crease<strong>the</strong> f<strong>in</strong>ancial resource base for <strong>the</strong> programme. Hence,programme implementation capacity needs to be enhanced<strong>in</strong> order to ensure more efficient use of available resources<strong>and</strong> avoid leakages <strong>in</strong> <strong>the</strong> system, <strong>and</strong> <strong>the</strong>reby, improveprogramme efficiency (see also GOB, 2010f ). With regardto <strong>in</strong>creas<strong>in</strong>g <strong>the</strong> f<strong>in</strong>ancial resource base for <strong>the</strong> overallhealth programme, three sets of budget estimates have beenprepared for HPNSSP (2011-2016): (a) Tk. 41,440.12crore 7 (US$ 6,005.81 million), which is 2.5 times higherthan <strong>the</strong> estimated cost of HNPSP (2003-2011); (b) Tk.31,848.54 crore (US$ 4,615.73 million), almost double<strong>the</strong> size of <strong>the</strong> development budget of HNPSP; <strong>and</strong> (c)Tk. 25,702.00 crore (US$ 3,724.93 million), over 60 percent higher than <strong>the</strong> development budget of HNPSP(GOB, 2010e). The FP <strong>and</strong> RH programme is projectedto receive allocations of only 16 per cent, 21.6 per cent <strong>and</strong>22.2 per cent respectively under <strong>the</strong> high, medium <strong>and</strong> lowscenarios. In addition to <strong>the</strong> government, <strong>the</strong> HNP sectoris currently be<strong>in</strong>g supported by 16 development partners<strong>in</strong> <strong>the</strong> form of both pooled <strong>and</strong> non-pooled parallelfund<strong>in</strong>g. The three estimated HNPSSP budgets depicta picture of <strong>the</strong> total development budget outlay. Thegovernment is projected to share <strong>the</strong> burden of 35 per centof <strong>the</strong> resource requirement, <strong>and</strong> expects <strong>the</strong> developmentpartners to contribute <strong>the</strong> rema<strong>in</strong><strong>in</strong>g 65 per cent of <strong>the</strong>development budget requirement for implementation ofHNPSSP (GOB, 2010e). The support of developmentpartners will be aligned with <strong>the</strong> sector programme <strong>and</strong> itscomponents. They will f<strong>in</strong>ance part of <strong>the</strong> overall MOHFWprogramme <strong>and</strong> budget, <strong>in</strong>clud<strong>in</strong>g technical assistance.The pre-appraisal mission has identified, among o<strong>the</strong>rs,<strong>the</strong> follow<strong>in</strong>g steps <strong>in</strong> relation to <strong>the</strong> budget for <strong>the</strong> nextprogramme: (a) <strong>the</strong> total MOHFW budget requirementfor <strong>the</strong> programme (2011-2016) should <strong>in</strong>clude both <strong>the</strong>revenue <strong>and</strong> development budgets; (b) MOHFW willscrut<strong>in</strong>ize <strong>the</strong> operational plan budget submitted by <strong>the</strong>l<strong>in</strong>e directors <strong>in</strong> l<strong>in</strong>e with <strong>the</strong> goals, objectives, priorities<strong>and</strong> reform areas of <strong>the</strong> programme, <strong>and</strong> rationalize <strong>the</strong>total development budget requirements, based on realistic<strong>in</strong>creases <strong>in</strong> resource envelopes <strong>and</strong> <strong>the</strong> fund<strong>in</strong>g gap; <strong>and</strong>(c) based on <strong>the</strong> rationalized budget <strong>and</strong> availability offunds <strong>in</strong>dicated by <strong>the</strong> development partners, MOHFWwill suggest options for mitigat<strong>in</strong>g <strong>the</strong> fund<strong>in</strong>g gap, if any(GOB, 2010f ).120