After more than 25 years of operation, the Health, Population, and Nutrition Sector Programme (HPNSP) came to an end last year under the interim government. Established in 1998 under the health ministry, HPNSP managed basic health, nutrition, and family planning services nationwide. Concern arises regarding the sustainability of the achievements made during the program’s long tenure and the unresolved health sector issues in Bangladesh. To find a solution, it is essential to revisit the inception of the initial Health and Population Sector Programme (HPSP) and extract valuable lessons for the future.
During the 1980s and 1990s, many low- and middle-income nations, including Bangladesh, undertook health sector reforms due to demographic shifts, changing disease patterns, economic changes, and financial constraints that exposed weaknesses in public health systems. Bangladesh’s health ministry oversaw approximately 128 donor-funded projects during this period, each with its own objectives, procurement processes, reporting criteria, and financial arrangements. This fragmented approach led to resource inefficiencies, common duplication, and development priorities influenced more by donors than a cohesive national strategy, hampering government ownership and long-term planning.
To combat these challenges, the Bangladeshi government initiated the Health and Population Sector Programme (HPSP, 1998-2003) as the first phase of HPNSP, under the Sector-Wide Approach (SWAp). Subsequent phases included the Health, Nutrition, and Population Sector Programme (HNPSP, 2003-2011), the Health, Population, and Nutrition Sector Development Programme (HPNSDP, 2011-2017), and the Fourth Health, Population, and Nutrition Sector Programme (2017-2024). SWAp introduced strategic planning through a national health investment plan, translating priorities into long-term investments. This led to the creation of multi-year Programme Implementation Plans (PIPs), operationalized through detailed operational plans (OPs) encompassing activities, outputs, and budgets, with funding drawn from the Annual Development Programme (ADP). The introduction of three-year rolling expenditure ceilings in 2006-07 linked strategic planning with medium-term fiscal management, maintaining the sequence of PIP-OP-ADP planning.
SWAp reshaped Bangladesh’s health sector from a fragmented collection of donor projects into a unified, government-led program, enhancing national ownership, coordination among partners, reducing duplication, streamlining procurement and financial management, and introducing integrated planning, monitoring, and budgeting. The approach boosted institutional capacity and contributed to advancements in maternal and child health, immunization, and overall health system governance.
Nevertheless, planning within SWAp proved intricate, requiring extensive documentation, consultations, and approvals involving various entities, strengthening accountability but limiting flexibility to address emerging health challenges promptly. Despite sector planning unification, the separation of development and operating budgets persisted, hindering aligned infrastructure investments with staffing and operational resources, resulting in fragmented implementation. Additionally, incomplete integration and partial donor harmonization underscored the need for further improvements in governance and service delivery.
The restricted scope of SWAp within the health ministry overlooked the diverse healthcare landscape in Bangladesh, excluding local governments, private providers, and NGOs from sector planning, hindering comprehensive health system governance. Despite achievements in disease-specific programs, persistent fragmentation and overlapping operational plans impeded integrated service delivery, necessitating enhanced coordination and collaboration across healthcare sectors.
Institutional fragmentation exacerbated by SWAp’s structure resulted in parallel management systems with blurred responsibilities, complicating coordination between development activities and routine service delivery. The discontinuation of SWAp revealed its value, highlighting the challenges in planning, financing, and procurement during the transition period, emphasizing the importance of preserving successful aspects while addressing shortcomings through future institutional transformations.
Moving forward, reforms should shift from program management to institutional overhaul, promoting inclusive planning involving government, private healthcare providers, local institutions, civil society, and patients, with decentralized decision-making. Enhanced coordination between development investments and operational expenditures is vital for improved efficiency, accountability, and service delivery. The success of these reforms should be measured by the quality, timeliness, and affordability of healthcare services, aligning with the evolving health challenges faced by Bangladesh and the need for a more integrated, resilient, and people-centered healthcare system in the future.