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Governance Challenges in the Health Sector: Towards Effective COVID-19 Vaccine Delivery

Project title: Governance Challenges in the Health Sector: Towards Effective COVID-19 Vaccine Delivery.

Since the first COVID-19 case was identified in March 2020, Bangladesh has suffered from various waves during which both morbidity and mortality showed increasingly higher rates. The number of deaths and infected reached its highest peak during the latest wave in June-August 2021. Given that only about 10% of the initial target, which is 80% percent of the total population i.e. about 140 million, has been fully inoculated so far on the one hand, and the overall governance challenges that exist in COVID-19 response programmes on the other, Bangladesh still remains at a high risk of even higher COVID-19 related mortality and morbidity in future. Lack of awareness and full adherence to safety measures by the public, emergence of new variants, lack of preparedness in responding to urgent health care needs particularly during waves, and above all, high prevalence of corruption and irregularities in response programmes are considered as some of the major contributing factors increasing such risks. Although Bangladesh was among the countries that initiated early COVID-19 vaccination programme, due to lack of appropriate planning and alleged corporate interest that influenced decision to procure from a single source, supply of vaccine stumbled within a few months and the government had to engage in a frantic effort to procure it from various alternative sources. The progress of vaccination programme thus slowed down delaying achievement of the target of fully inoculating 80% of the population.  

Given above, ensuring an equitable, transparent and corruption free delivery of vaccine has become a major concern. Given the huge demand for vaccination vis-à-vis a low level of stock has increased the risks and opportunities manifold for corruption and irregularities that include nepotism in the distribution, bribery, black marketing, and delay in sending SMS etc. According to various media reports, vaccines with very limited supply like Moderna are being sold in the black market at a high price. The Chinese vaccine (Sinopharm-BBIBP-CorV) which is available relatively in higher quantity for public vaccination programme is also being sold though at a lower price. It has also been reported that right on the heart of the capital of the country an unauthorized center was selling vaccines stolen from the government’s “Mass Inoculation Porgramme”. Meanwhile, more than 20 million people have got registered who are now waiting for 1st dose of vaccine.

Although the reports on corruption and irregularities are sporadic, many consider it indicating only one aspect of the governance challenges surrounding government’s vaccination programme. Findings of studies conducted on COVID-19 response programmes by Transparency International Bangladesh (TIB) indicate a number of governance challenges that have potential adverse impacts on equitable, transparent and corruption free delivery of vaccines. It is observed that various governance deficits including corruption and mismanagement exist in the vaccination programme. More specifically, it has failed to bring some professionals and more risk prone, disadvantaged population under its coverage on a priority basis, and the access to vaccination remain more skewed towards urban-centred privileged sections of the society. The online-based vaccine registration system itself remains as a barrier to those who do not have access or skill to use Internet, the vaccination centers lack women-friendly facilities and participation by women is still low compared to men. Moreover, discrimination in vaccine distribution on the basis of area, class, age and occupation, etc. exists, and absence of proper planning have been accentuating governance challenges in the programme indicating possible adverse impacts on equity, inclusiveness, efficiency and effectiveness.

In this context, the project “Governance Challenges in the Health Sector: Towards Effective COVID-19 Vaccine Delivery” has been undertaken by TIB with support from Transparency International, UK with the aim to ensure that the COVID-19 vaccine is delivered in an equitable, transparent, and corruption free manner. The project will try to ensure that the government policy makers remain aware of the risks and are able to ensure that the right people are not prevented from being vaccinated due to corruption. The evidence generated by the project will also inform international stakeholders to help them undertake relevant advocacy initiatives at their level.  The major activities of the project include vulnerability assessment, national and district level supply and distribution assessment, facility assessment, stakeholder analysis, tracking of vaccine procurement and distribution from national to local levels, community level monitoring, and household level surveys to generate hard evidence for effective local and national level advocacy for a more equitable and transparent vaccine programme planning and implementation. There will also be a campaign for community awareness building on rights and entitlement on COVID-19 vaccine, preferably in collaboration with organizations/platforms working for marginaliged population groups. Orientation to community people will be done to assist them to get online registration for COVID-19 vaccination. TIB will conduct advocacy meetings with respective health authorities to ensure corruption reporting mechanisms, routine publication of delivery information, and other issues based on identified gaps advocating for taking corrective measures.

This is a nine-month project with a possibility of no cost extension for three more months up to August 2022 considering fluctuating COVID-19 situation that might delay implementing some of the project activities. The total budget of the project is BDT 14,211,610 (approximately € 120,000).