Introduction
An appendix to the budget speech includes some very useful indications about the health of the nation. Here are some of those statistics:
These data tell a mixed story with some interesting variations. For example while the number of deaths per 1,000 of the population for infants (under 1 year) has declined significantly since 2006, the same measure for the under fives has remained almost constant. The percentage of the population that is severely malnourished has halved over the same period indicating a fall in the number from 3,043 persons to 1,556 persons. At the same time the number of persons who are moderately malnourished has fallen from 44,881 to 42,785, although it increased in 2010 when the economy reported favourable growth.
On the positive side too is the rapid growth in the number of doctors from 373 to 537. On the other hand the number of nurses in absolute terms has declined from 822 to 786, suggesting that the doctors now have fewer support staff with whom to work. Now that the government has taken a decision to import skills it is not unlikely that it may move to fill the many vacancies at this level in the health system.
Details of expenditure
Agency Details
It is important to note that there is other expenditure to fill in the wider picture. The Georgetown Public Hospital Corporation is a separate agency in the budget and for 2011 has an allocation of $4.14 billion, or 71% of the budget for the substantive ministry. Expressed another way, the GHPC is allocated 42% of the total allocation of these two budget agencies. It is also uncertain whether there is proper accounting for the considerable sums received from various donors for different projects and programmes, with the major one being the HIV and AIDS programmes.
Over the years Guyana has been a major beneficiary of donor funds for our HIV/AIDS programmes which sought to project us as one of the region’s most infected populations. We received hundreds of millions from several sources and particularly from the US. It is unclear whether these have been accounted for in accordance with the Fiscal Management and Accountability Act which would deem the grants public money to be accounted for through the Consolidated Fund.
Capital budget
The ministry’s capital expenditure for the year is projected at $845 million with the lion’s share being $523 million under Regional and Clinical Services. Of this one hundred and fifty million dollars ($150 million) has been allocated for the “provisions [sic] for preparatory studies and designs for a Specialty Hospital”! Is this for real and was this hospital not supposed to be a free deal arising out of the President’s recent doctoral visit to India? Just improving the doctor’s quarters at Skeldon is budgeted to cost $10 million while filing cabinets, a projector, a refrigerator and chairs will cost $3.5 million. Seems that at Health, the mandate is to go for the highest bidder.
This ministry is one of the most politicised ministries with two ministers and a permanent secretary as political appointees. It is also the ministry in which more than half the employees (683 out of 1233) are contract employees with implications for their independence and right to membership of a trade union which in the main would be the Public Service Union that has had a stormy relationship with successive PPP administrations.
Lack of accountability
Now even by the standards of the Audit Office, the ministry and to a lesser extent the GHPC have had serious accounting issues over the years. In 2009 a fire of unknown origin destroyed the main building and with it financial and other records. What the fire revealed was a pattern of non-compliance with requirements to circulate copies of contracts, Tender Board minutes and basic matters like pay changes.
The matter of financing the GHPC is clearly not consistent with the requirements of the Fiscal Management and Accountability Act in that the corporation has been receiving an appropriation rather than a subvention. The explanation given for the whole question of inadequate accounting and improper financing is far from clear, but we are told that the matter has been submitted to Cabinet for consideration. What is clear is that Cabinet has shown no urgency in complying with the statutory requirements.
Similarly, the GHPC, despite annual adverse comments by the Audit Office continues to spend moneys that should properly have gone to the Consolidated Fund, because the Board approved the expenditure.
Both the GHPC and the Ministry of Health continue to buy billions of dollars of drugs with scant regard for proper tender procedures, sometimes advancing hundreds of millions of dollars to the New Pharmaceutical Corporation for drugs received several months later. It is unclear why this lop-sided relationship has been allowed to continue when the transactions with the company cannot even be verified, and again the disrespect or sheer stupidity of the excuses is hard to understand. These transactions are reminiscent of the unlawful tax concessions given to the group of which this company is a key component.
But these are not all. The ministry fails to adhere to the FMAA in relation to unspent balances causing the national accounts to be overstated, and was unable to provide satisfactory evidence to support the purchase of some $20 million of fixed assets.
Conclusion
There seems more than mere financial lawlessness at this ministry of which one of the ministers had once famously said he would not hesitate to break the law in some circumstances. Earlier this week the Minister of Finance made a real show of calling in the police and the Audit Office at his ministry. Seems that the Ministry of Health can do with some real forensic auditing and those responsible be subjected to serious questioning.
Correction
In the Business Page last week, I mistakenly noted that Education’s share of the National Budget has declined from 10.6% in 2007 to 9.4% in 2010. In fact these percentages should have read 17.1% to 15.3%. I sincerely apologize for the error and the inconvenience caused.