District Hospitals

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Avoidable Expenditure on Water Supply Contract for District Hospitals in Mizoram
(CAG of India, 16-02-2023) CAG of India
Directorate of Hospital and Medical Education (DHME), Health and Family Welfare Department, Government of Mizoram (GoM), Aizawl entered (May and December 2012) into Memorandum of Understandings (MoU) with a firm M/s Intergen Energy Limited (IGEL), New Delhi for installation of renewable energy and water treatment plant to supply water at nine Hospitals which include Referral Hospital, Falkawn and all eight District Hospitals of Mizoram. This was based on the suo-moto proposal submitted (February 2012) by the firm to GoM, for installation of Water Treatment Plant with solar power water pumping system to supply water on the basis of BOOT at the nine Hospitals. Audit observed that all Hospitals were getting water supplies on priority from Public Health Engineering (PHE) Department and there were no insufficiency in supply of water to the Hospitals reported, before or during the period of MoU with IGEL. Hence, engagement of IGEL was arbitrary and proposal of the firm was agreed to by the Department without ascertaining the actual need for water supply in the Hospital. Thus, expenditure of ₹ 0.50 crore for installation of Water Treatment Plants in five Hospitals and ₹ 4.80 crore on buy-back MoU in June 2019 totalling ₹ 5.30 crore was avoidable as there was no scarcity of water in the Hospitals prior to signing of agreement with the firm. Hospitals also did not report any issue in water supply during the stoppage of operation of the firm. Hence, there was a total avoidable expenditure of ₹ 5.30 crore in addition to committed liability of ₹ 4.20 crore against the balance payable on MoU on buy-back of equipment and water supplied. Further, Department, was supposed to terminate the MoUs on failure of IGEL to supply the required volume of water but entered into an unnecessary buy-back agreement.
Construction of Hospital and Medical College Buildings by PWD in Madhya Pradesh
(CAG of India, 25-12-2021) CAG of India
Audit observed deficiencies during execution of work not only led to excess payment and extra cost to work but affected quality of work as well. There were instances of adoption of incorrect rates, payment of transportation charges and excess payment on consumption of cement to the contractor. As a result, some parts of the works created extra financial burden on the Department, even though the quality of the work was not assured.
Delay in Establishing Govt Homeopathy College and Hospital in Ambala District
(CAG of India, 22-03-2023) CAG of India
Time over-run with three years delay in establishing Government Homoeopathic College and Hospital in Ambala District resulted in creating extra burden of INR 3.88 crore on the State exchequer apart from depriving the intended benefit to the General Public and students of the State. There was cost over-run of INR 3.39 crore and infructuous expenditure of INR 48.89 lakh due to failure of internal controls in finalisation of site.
Delays by Contractors in Construction of Health Infrastructure and Short Levy of Liquidated Damages in Karnataka
(CAG of India, 21-09-2021) CAG of India
The Chief Engineer, Health Engineering Wing levied nominal penalty for delays on part of the contractors in completing the works based on the recommendations of the Executive Engineers of the divisions. This resulted in short levy of liquidated damages of ₹ 14.63 crore besides extending undue benefit to the contractors.
Detailed Compliance Audit of Healthcare Services in Three District Hospitals in West Bengal
(CAG of India, 2021) CAG of India
This is a detailed compliance audit of healthcare services in three selected district hospitals in West Bengal for the five year period 2014-15 to 2018-19 (with observations on crucial aspects updated in 2019-20 and 2020-21). Apart from these three DHs, audit examination also encompassed records maintained at the H&FW Department and Directorate of Health Services (DHS), State Project Management Unit (SPMU) of NHM, Chief Medical Officers Health (CMOsH) of three Districts (Dakshin Dinajpur, Birbhum and Jhargram). Apart from assessing the level of compliance in district hospitals in providing health care service in a district to uniform standards introduced by Indian Public Health Standards (IPHS), comparison has also been made with some other relevant guidelines/ frameworks. The main objectives of this Detailed Compliance Audit were to assess whether comprehensive plans and strategies regarding the District Hospitals (DHs) have been developed and aligned with overall State Health Policy, if any, and health care requirements at the District level. Audit also aimed to ascertain whether provisions for line services (such as Out-Patient Department (OPD), In-Patient Department (IPD), Intensive Care Unit (ICU), Operation Theater (OT), maternity services, etc.) as well as support & auxiliary services (viz., diagnostic, diet, bio-medical waste management, etc.) conformed to standards envisaged by Indian Public Health Standards (IPHS). Audit also attempted to assess whether availability and management of resources of the District Hospitals (viz., drug, equipment, manpower, etc.) was in consonance with the relevant norms and standards.
Idle Expenditure on MCH Building at Konark in Odisha
(CAG of India, 03-04-2021) CAG of India
Construction of Maternal and Child Health building without making plan for its operationalisation led to idling of the building, thereby rendering the expenditure of ₹ 5.96 crore incurred on construction of the building idle.
Improper Planning Leading to Idling of Three Multi-Storeyed Buildings at RGGGH Chennai in Tamil Nadu
(CAG of India, 24-06-2021) CAG of India
Improper planning and failure to assess the actual requirements by RGGGH and DME led to idling of three structurally completed multi-storeyed buildings constructed at a cost of INR 55.33 crore thereby depriving critical care to the needy patients.
Non Completion of Maternal and Child Health Block in Kakinada District Hospital
(CAG of India, 25-09-2023) CAG of India
The construction of Maternity and Child Health block at Government General Hospital, Kakinada was stalled after incurring an expenditure of ০12.99 crore due to non-release of timely funds by Government of Andhra Pradesh received under National Health Mission from Government of India (GoI). Also, the intended purpose of providing maternity and child health care with requisite facility could not be achieved even after a lapse of seven years from the date of provisioning of funds by GoI and the expenditure made became wasteful.
Performance Audit of District Hospitals in Arunachal Pradesh
(CAG of India, 2020) CAG of India
This stand alone report of the CAG of India contains results of Performance Audit of District Hospitals in Arunachal Pradesh covering the period 2014-15 to 1018-19. In this Performance Audit we have focused on the patient care given by the primary and secondary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected District Hospitals and various services provided therein like Out Patient and In-Patient Services, Maternity Services, Emergency Services, Drug Management, Infection Control, Bio-medical Waste Management, Diagnostic Services, Fire Control measures etc, based on pre-determined performance indicators/ criteria in the sampled district level and block level hospitals (CHC & PHC). We have adopted Indian Public Health Standard (IPHS) prescribed by the Government of India and adopted by the Government of Arunachal Pradesh which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings.
Performance Audit of District Hospitals in Assam
(CAG of India, 2021) CAG of India
This stand alone report of the CAG of India contains Performance Audit of Select District Hospitals in Assam for the period 2014-15 to 2018-19. District Hospitals are set up for providing a plethora of services for preventive, diagnostic and curative health care to the people in the district, at an acceptable level of quality, and be responsive and sensitive to the needs of the people. The focus of the audit is to assess the role of the district hospitals in providing the envisaged health care services to the people in an affordable and timely manner to the expected quality standard. Audit Objectives: The objectives of carrying out an outcome audit of district hospitals were to assess: i. adequate and essential resources - manpower, drugs, infrastructure, equipment, and consumables were available for effective functioning of the district hospitals; ii. timely and quality healthcare was delivered through line services like OPD, IPD, ICU, OT, trauma & emergency, etc., and diagnostic services; iii. support services like drug storage, sterilisation, hygiene, waste management, infection control, ambulance, etc., were aiding the line departments in providing a safe and sterile environment in the hospitals; and iv. adequate and timely healthcare services were available in selected services relating to maternal and infant care.
Performance Audit of District Hospitals in Assam - Ahomiya Version
(CAG of India, 2021) CAG of India
This Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select District Hospitals in Assam for the period 2014-19. This report is in Ahomiya language. The C&AG had earlier (2016-17) reviewed the Implementation of Reproductive and Childcare Health under NHM of the State and major areas of concern viz., shortfall in infrastructure and health care professionals, out of pocket expenditure by patients, high maternal and infant mortality rates, etc., were highlighted and recommendations were accordingly made for consideration. During 2019, the CAG decided to carry out a Performance Audit of healthcare services being provided at District Hospitals across all the States to assess the availability of resources identified as essential by Indian Public Health Standards (IPHS) for District Hospitals and to evaluate the overall quality of healthcare services provided by these hospitals and in some selected domains. Audit Objectives: The objectives of carrying out an outcome audit of district hospitals were to assess: i. adequate and essential resources - manpower, drugs, infrastructure, equipment, and consumables were available for effective functioning of the district hospitals; ii. timely and quality healthcare was delivered through line services like OPD, IPD, ICU, OT, trauma & emergency, etc., and diagnostic services; iii. support services like drug storage, sterilisation, hygiene, waste management, infection control, ambulance, etc., were aiding the line departments in providing a safe and sterile environment in the hospitals; and iv. adequate and timely healthcare services were available in selected services relating to maternal and infant care.
Performance Audit of District Hospitals in Bihar
(CAG of India, 2021) CAG of India
This is a performance audit of functioning of District Hospitals in Bihar covering the period 2014-15 to 2018-19. This Performance Audit endeavors to assess overall health services being provided by District Hospitals in Bihar. Audit Objectives: This Performance Audit was undertaken to assess: 1. Whether comprehensive plans and strategies regarding District Hospitals have been developed and implemented effectively for ensuring availability of accessible, affordable and quality health services; 2. Whether Financial Management was efficient; adequate funds were made available timely and allocated funds were utilised optimally for providing prescribed healthcare facilities at the District Hospitals; 3. Whether adequate provisions for line services such as Out-Patient Department (OPD), In-Patient Department (IPD), Intensive Care Unit (ICU), Operation Theatre (OT), Maternity, Infection Control etc. and efficient support services like Registration, Diagnostic/Radiology, diet management, ambulance service, bio-medical waste, cold chain, power back up, etc. exist in District Hospitals and these services are being delivered in an efficient and effective manner; 4. Whether District Hospitals have adequate resources viz., human, infrastructure, drugs, consumables, equipment, etc. as per prescribed norms and are utilising these resources efficiently and effectively; and whether there is a system in place to manage disasters/mass casualty; and 5. Whether effective monitoring and regulatory systems have been put in place for ensuring delivery of quality healthcare to public.
Performance Audit of District Hospitals in Jharkhand
(CAG of India, 2021) CAG of India
This is a Performance Audit of District Hospital Outcomes in Jharkhand, covering the period 2014-19. This performance audit was carried out during 2019-20 with the objective of assessing the quality of medical services and patient care being provided by District Hospitals (DHs) in the State. In this outcome based audit, we have focused on patient care received at the DHs in the State. Various services like Out-Patient and In-Patient Services, Maternity Services, Diagnostic Services, Infection Control and Drug Management have been assessed on the basis of pre-determined criteria in the sampled DHs. We have also used pre-determined outcome indicators for assessing In-Patient Services. District hospitals being the pivotal point of the public health system in Jharkhand, influence the performance of the entire healthcare system. Despite a considerable increase in public health expenditure in the State during 2014-19, this performance audit revealed that the test-checked district hospitals (DHs) did not fare well on the outcome indicators relating to efficiency, service quality and clinical care capabilities.
Performance Audit of District Hospitals in Manipur
(CAG of India, 2021) CAG of India
This Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of tertiary care (Medical College & Hospitals), secondary care (District-level Hospitals), and primary care (one CHC and one PHC in selected districts) in the State of Manipur covering the period 2014-15 to 2018-19. In this Performance Audit we have focused on patient care given by secondary and tertiary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected DHs and various Services provided therein like Out-Patient and In-patient Services, Emergency Services, Drug Management, Infection Control, Bio Medical Waste Management, Diagnostic Services, Fire control measures etc. and select services of maternity and child care, Cancer and HIV/ AIDS, based on pre-determined performance indicators/criteria in the sampled hospitals. We have adopted the Indian Public Health Standards (IPHS) guidelines as prescribed by Government of India, which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings.
Performance Audit of District Hospitals in Meghalaya
(CAG of India, 2020) CAG of India
This Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of secondary care (District-level Hospitals) and primary care (one CHC and one PHC in selected districts), in the State of Meghalaya covering the period 2014-15 to 2018-19. In this Performance Audit we have focused on patient care given by the primary and secondary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected DHs and various Services provided therein like Out-Patient and In-patient Services, Maternity Services, Emergency Services, Drug Management, Infection Control, Bio Medical Waste Management, Diagnostic Services, Fire control measures etc. based on pre-determined performance indicators/ criteria in the sampled district level and block level hospitals (CHC and PHC). We have adopted the Indian Public Health Standards (IPHS) guidelines as prescribed by Government of India which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings. Audit Objectives: The objectives of carrying out this Performance Audit of selected district hospitals in Meghalaya were to assess whether: i. adequate and essential resources - manpower, drugs, infrastructure, equipment, and consumables were available for effective functioning of the district hospitals; ii. timely and quality healthcare was delivered through line services like OPD, IPD, ICU, OT, trauma & emergency, etc. and diagnostic services; iii. support services like drug storage, sterilisation, hygiene, waste management, infection control, ambulance, power back-up/ UPS, etc. were aiding the line departments in providing a safe and sterile environment in the hospitals; and iv. adequate and timely healthcare services were available in selected services relating to maternal and infant care and specialities like cancer care.
Performance Audit of District Hospitals in Mizoram
(CAG of India, 2021) CAG of India
This Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of secondary care (District Hospitals) and primary care (one Community Health Centre and One Primary Health Centre in each selected districts) in Mizoram for the period 2014-19. In this Performance Audit we have focused on patient care given by the primary and secondary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected DHs and various Services provided therein like Out-Patient and In-Patient Services, Maternity Services, Emergency Services, Drug Management, Infection Control, Bio Medical Waste Management, Diagnostic Services, Fire control measures, etc. based on pre-determined performance indicators/ criteria in the sampled district level and block level hospitals (CHC and PHC). We have adopted the Indian Public Health Standards (IPHS) guidelines as prescribed by Government of India which are a set of uniform standards envisaged to improve the quality of health care delivery in the country for benchmarking various audit findings. Audit Objectives: The objectives of carrying out this Performance Audit of select DHs are to assess whether: i. adequate and essential resources - manpower, drugs, infrastructure, equipment and consumables are available for effective functioning of the district hospitals; ii. timely and quality healthcare is delivered through line services like OPD, IPD, ICU, OT, trauma & emergency, etc. and diagnostic services; iii. support services like drug storage, sterilisation, hygiene, waste management, infection control, ambulance, power back-up/ UPS, etc. are aiding the line departments in providing a safe and sterile environment; and iv. the adequacy and timeliness of healthcare services relating to maternal and infant care, cancer, and HIV/ AIDS.
Performance Audit of District Hospitals in Nagaland
(CAG of India, 2020) CAG of India
This Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of secondary care (District-level Hospitals) and primary care (one CHC and one PHC in selected districts) in the State of Nagaland, covering the period 2014-15 to 2018-19. In this Performance Audit, we have focused on the patient care given by the primary and secondary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected District Hospitals and various services provided therein like Out-Patient and In-Patient Services, Maternity Services, Emergency Services, Drug Management, Infection Control, Bio-medical Waste Management, Diagnostic Services, Fire Control measures etc., based on pre-determined performance indicators/ criteria in the sampled district level and block level hospitals (CHC & PHC). We have adopted Indian Public Health Standard (IPHS) prescribed by the Government of India and adopted by the Government of Nagaland which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings. Audit Objectives: The objectives of carrying out this ‘Performance Audit of Select District Hospitals in Nagaland’ were to assess whether: i. Adequate and essential resources - manpower, drugs, infrastructure, equipment, and consumables are available for effective functioning of the DHs; ii. Timely and quality healthcare is delivered through line services like OPD, IPD, ICU, OT, trauma & emergency etc., and diagnostic services; iii. Support services like drug storage, sterilization, hygiene, waste management, infection control, ambulance, equipment etc., were aiding the line departments in providing a safe and sterile environment in the hospitals; and iv. the adequacy and timeliness of select healthcare services relating to maternal and infant care, cancer and HIV/AIDS.
Performance Audit of District Hospitals in Sikkim
(CAG of India, 2021) CAG of India
This Standalone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of secondary care (District-level Hospitals) and primary care (one CHC and one PHC of State Capital District) in the State of Sikkim covering the period 2014-15 to 2018-19. The Comptroller and Auditor General of India (CAG) has reviewed the provision of healthcare services by Government of Sikkim, at periodic intervals. The C&AG had earlier (Report No. 3 of 2011) reviewed the Functioning of Primary Health Centres (PHCs) and Community Health Centres (CHCs) of the State In this Performance Audit, we have focused on patient care given by the secondary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected DHs and various Services provided therein like Out-Patient and In-patient Services, Maternity Services, Emergency Services, Drug Management, Infection Control, Bio Medical Waste Management, Diagnostic Services, Fire control measures etc. based on pre-determined performance indicators/ criteria in the sampled district level and block level hospitals (CHC and PHC). We have adopted the Indian Public Health Standards (IPHS) guidelines as prescribed by Government of India which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings. Audit Objectives: The objectives of carrying out this Performance Audit of select district hospitals were to assess whether: i. adequate and essential resources - manpower, drugs, infrastructure, equipment, and consumables were available for effective functioning of the district hospitals; ii. timely and quality healthcare was delivered through line services like OPD, IPD, ICU, OT, trauma & emergency, etc. and diagnostic services; iii. support services like drug storage, sterilisation, hygiene, waste management, infection control, ambulance, power back-up/ UPS, etc. were aiding the line departments in providing a safe and sterile environment in the hospitals; and iv. adequate and timely healthcare services were available in selected services relating to maternal and infant care.
Performance Audit of District Hospitals in Tripura
(CAG of India, 2021) CAG of India
This Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select District Hospitals in Tripura for the period 2014-19. A Performance Audit on National Rural Health Mission (NRHM) covering the period 2011-2016 was featured in the report of the Comptroller and Auditor General of India (CAG) for the year ended 31 March 2016, Government of Tripura. During 2019, CAG decided to carry out a Performance Audit of healthcare services being provided at District Hospitals to assess the availability of resources identified as essential by Indian Public Health Standards (IPHS) for District Hospitals and to evaluate the overall quality of healthcare services provided by these hospitals in some selected domains. In this Performance Audit we have focused on patient care given by the primary and secondary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected State and District Hospitals and various services provided therein like Out-Patient and In-patient services, Maternity and Child Care services, Emergency Services, Drug Management, Infection Control, Bio-Medical Waste Management, Diagnostic Services, Fire control measures and select services of Cancer Care and AIDS Prevention and Treatment, based on pre-determined performance indicators/ criteria in the sampled district level and block level hospitals (CHC and PHC). We have adopted the Indian Public Health Standards (IPHS) guidelines as well as State norms as applicable for benchmarking various audit findings.
Performance Audit of District Hospitals in Uttarakhand
(CAG of India, 2021) CAG of India
This Report contains the results of the Performance Audit on ‘District Hospitals in Uttarakhand’, covering the period 2014-19. An attempt has been made in this Report to assess the outcome based quality of medical services and patient care provided in the District Hospitals. we have tried to evaluate the outcome, status and standards of delivery of healthcare services to the population. This report aims to inform, clarify, strengthen and prioritize the role of the Government in shaping health systems in Uttarakhand. The broad objectives of the performance audit were to assess whether: • Policy framework was robust enough to improve the quality of healthcare. • Adequate provisions for line services such as out-patient services, in-patient services, emergency services, maternity services, etc. were made and these services were delivered in an efficient and effective manner. • Efficient support services with regards to diagnostic services, maintenance of equipment, storage of drugs, dietary services, laundry services, etc. were present in hospitals. • Hospitals had adequate resources viz., human, drugs, consumables, equipment, etc. as per prescribed norms and these resources were utilised efficiently and effectively. • Norms and practices for hygiene, infection control, employee and patient safety were followed within the premises of hospitals.