With the International Monetary Fund having refused to give a Letter of Comfort to Pakistan over ‘non-satisfactory performance’ last year, the Asian Development Bank (ADB) has stopped the release of the last tranche of millions of dollars to the provincial health sector meant to reduce the infant and maternal mortality, Pakistan Today has learnt.
The United Nations issued a set of Millennium Development Goals (MDGs) to all member states that they are supposed to achieve by the end of 2015. The provincial Health Department has been working on these goals through various programmes including the Punjab Health Sector Reform Programme (PHSRP) which identifies and proposes various issues to the department, which then implements the programme approved through its machinery.
Sources in the Planning and Development (P&D) said in 2008 the ADB offered $400 million aid for a three year programme to achieve the MDG 4 and 5 which deal with reducing child and maternal mortality respectively. Since it was a budgetary support programme, the Punjab government could retain half the aforementioned amount and include it in its financial pool, while the rest was transferred to districts to achieve the targets.
In 2009, the first tranche of $100 million was released, which equalled Rs 7 billion according to the then exchange rate. Of these, Rs 3.5 billion were transferred to the districts. In 2010, sub-programme 2 was negotiated and another $150 million were released to the provincial government. However, the sources said discrepancies surfaced regarding the implementation of the programme, as the districts were not spending the money strictly per the guidelines issued to achieve the MDGs. “Working groups were formed and very detailed district utilisation plans were developed for effective implementation of the programme and achieve the set goals,” they added. After the spadework, an amount of nearly Rs 7 billion were transferred to districts again with renewed focus on the primary health facilities including the Basic Health Units (BHUs) and the Rural Health Centres (RHCs).
However, the ADB has refused to release the last tranche of $100 million under Sub-programme 3. This has put extra burden on the health sector, which is already catering to increased salary package for doctors and nurses and epidemics such as dengue.
However, a senior officer in the Finance Department seeking anonymity further revealed that it is an attempt on the part of the ADB to “tighten” the noose around the provincial government because a budgetary support programme gives greater financial liberty to the government. “In budgetary support the donor releases entire amount and points out certain targets that are to be achieved. The rest of the money is given to the government to put to any use of their choice,” the officer said, adding that the World Bank had refused to give a Letter of Comfort to Pakistan, which in turn had led the ADB to slash the last tranche of the programme.
However, Punjab Health Sector Reforms Programme Project Director Farasat Iqbal said the Health Department had been working on achieving the MDGs independent of the ADB grant. “Only a few other countries have such detailed structure of primary health facilities as Pakistan, we only have to work on the management a bit, securing grants is not an issue,” Iqbal said. To a question, he said huge amount of money has been released to districts under very detailed guidelines recently and the effects of the grant will take time to show.
