Public Health

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Introduction

In an era of rapid technological advancements and shifting demographics, the significance of public health has never been more pronounced. The Comptroller and Auditor General (CAG) of India's comprehensive report on public health meticulously examines the nation's healthcare landscape. It sheds light on healthcare infrastructure, service delivery, and the effectiveness of public health policies.

With India's uniquely diverse and sizable population, the public health sector faces complex challenges and opportunities. This report objectively assesses strengths and weaknesses within the system, aiding stakeholders and policymakers in shaping the future of public health.

The report explores vital aspects such as healthcare access, medical service quality, disease prevention, financing, and the fusion of modern medical advancements with traditional practices. By scrutinizing resource allocation, initiative impact, and transparency, this audit enhances efficiency and accountability in the public health sector.

Moreover, the report emphasizes the interconnections between public health, socioeconomic development, and overall well-being. It underscores collaborative efforts among government agencies, healthcare providers, researchers, and communities to address challenges and leverage opportunities in an evolving healthcare landscape.

Navigating health infrastructure, policies, and practices, this report acts as a guiding compass, directing us toward evidence-based solutions for citizen health and well-being. By deepening understanding of the public health system, this audit empowers stakeholders with knowledge to drive meaningful reforms, leading India to a healthier, more resilient future.

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Now showing 1 - 20 of 346

Avoidable Excess Expenditure in Procurement of MRI Scanners in Tamil Nadu
(CAG of India, 19-10-2022) CAG of India
Lapses on the part of heads of three Government hospitals caused delays in site identification for installation of MRI scanners. This resulted in an avoidable expenditure of INR 1.12 crore and delay of over one year in commencement of MRI scan services to needy patients.
Avoidable Excess Expenditure on Upgradation of Linear Accelerator in Chhattisgarh
(CAG of India, 25-07-2015) CAG of India
Up-gradation of Linear Accelerator with Image Guided Radiation Therapy system by inviting fresh tender and overlooking the available valid rate led to avoidable excess expenditure of ₹ 52.88 lakh.
Avoidable Expenditure Due to Non Execution of AMC for MRI Machine at Shillong Meghalaya
(CAG of India, 19-12-2019) CAG of India
Due to non-execution of Annual Maintenance Contract for maintenance of MRI machine, the Department incurred an avoidable expenditure of INR 1.50 crore towards its repair besides depriving the patients the benefit of its services for almost three years.
Avoidable Expenditure of Health Insurance Premium of RSBY in West Bengal
(CAG of India, 25-03-2022) CAG of India
Due to failure in exercising proper check, H&FW Department made extra payment of INR 10.20 crore towards premium of Rashtriya Swasthya Bima Yojana (RSBY).
Avoidable Expenditure on Central Excise Duty by Karnataka Drugs Logistics and Warehousing Society
(CAG of India, 06-07-2018) CAG of India
Karnataka State Drugs Logistics and Warehousing Society failed to insert specific clause in the tender/contract document for availing concession on Central Excise Duty. This resulted in avoidable expenditure of INR 76.55 lakh towards purchase of ambulances.
Avoidable Expenditure on Procurement of Medicines in Goa
(CAG of India, 29-01-2021) CAG of India
Delay in finalisation of tenders by Goa Medical College and Hospital for the year 2016-17 resulted in avoidable extra expenditure of INR 10.75 crore on procurement of medicines through local purchase.
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.
Blocking of Funds and Non Establishment of Spinal Injury Centre in Jammu and Kashmir
(CAG of India, 23-09-2020) CAG of India
Departmental failure to take timely action for utilisation of amounts received from the Government of India (GoI) for setting up of the Spinal Injury Centres not only resulted in blocking of INR 3.04 crore, but also deprived the poor patients of the benefits of the scheme. There is also a risk that due to non-utilisation of the funds, the amount received by the State Government may have to be surrendered to the GoI.
Compliance Audit Comments on All India Institute of Medical Sciences
(CAG of India, 2010) CAG of India
This compliance Audit comments on All India Institute of Medical Sciences (AIIMS) brings out two pertinent issues: 1. Short recovery of water charges 2. Non Recovery of Building and Other Construction Workers' Welfare Cess. With regard to both these compliance audit paragraphs, the matter was referred to the Ministry in June 2009, but the reply was awaited as of February 2010.
Compliance Audit of Procurement of Medicines with Special Emphasis on Quality Aspect in Assam (2013-2016)
(CAG of India, 31-03-2017) CAG of India
Timely supply of drugs is necessary for the purpose of ensuring quality medical services to citizens. This involves an efficient procurement and distribution system as well as sound logistics management. The Director of Health Services (DHS), Government of Assam (GoA) procures medicines for distribution among 26 District Hospitals, 13 Sub-Divisional Hospitals, 108 Community Health Centers, 852 Primary Health Centers, 358 Ayurvedic Dispensaries, 75 Homeopathic Dispensaries and six Medical College Hospitals. Medicines are procured from Small Scale Industry (SSI) units through the Assam Small Industries Development Corporation (ASIDC) Ltd., and firms approved by the State Medical Stores Purchase Committee (SMSPC) through a process of open tenders at rates fixed by the Technical Committee and approved by the SMSPC. In emergency situations (epidemics, floods, earthquakes etc.), medicines are purchased at the Directorate level at institutional (market) rates. The Drugs Controller of the Department is responsible for overseeing the quality control aspect of procured drugs through the Drugs and Cosmetics Act, 1940 in the State. The Drugs Controller is assisted by a Joint Drugs Controller, a Deputy Drugs Controller, eight Senior Inspectors and nine Inspectors. The Compliance Audit of ‘Procurement of medicines with special emphasis on quality aspects’, covering the period from 2013-14 to 2015-16 was taken up to analyse the efficiency of the system of procurement and distribution of medicines in Assam. This compliance audit showed that absence of adequate funding and an established procurement policy, in conjunction with a weak internal control mechanism, resulted in lack of financial discipline and short supply of medicines, as also supply of sub-standard medicines. Not-observing of storage norms, non-eceipt/ delayed receipt of laboratory test reports, also defeated the purpose of maintaining the quality of drugs being supplied to health care units.
Compliance Audit on Cancer Institute in Lucknow
(CAG of India, 22-09-2022) CAG of India
There were significant deficiencies and delays in implementation of the project. The inflated estimates combined with not preparing of the justification statement resulted in excess expenditure of INR 64.60 crore on the project. Construction of Cancer Institute was incomplete (November 2021) even after lapse of more than four years from the scheduled date of completion due to delay on the part of Uttar PRadesh Rajkiya Nirman Nigam and construction agency resulted in denial of full benefits to the intended beneficiaries of the project, viz. cancer patients and research students.
Compliance Audit on Functioning of Govt Blood Banks in West Bengal
(CAG of India, 04-07-2016) CAG of India
The functioning of blood banks in the State has scope for improvement in many aspects. There is an emergent need for setting up more blood banks in the State and for enhancing the capacity of the existing ones to bridge the gap between requirement and actual supply. Moreover, the blood bank network was not distributed evenly among the districts with blood bank/ BSUs not being available in rural areas. It was also a matter of serious concern that 53 out of 58 blood banks managed by the State Government do not have valid licenses. The basic tenet of providing safe blood, blood components and blood products was also compromised due to the absence of quality assurance mechanism in most blood banks. Quality aspect was further undermined by irregular supply of Elisa Reader, cross matching of blood by staff other than Medical Officers, ineffective calibration of equipment, absence of AMCs, etc. Performance of the blood banks as regards component separation was sub-optimal. There were instances of losses/ wastages of whole blood units, blood bags, test kits and reagents due to deficient inventory management. There were significant deficiencies in the blood bank automation software leading to possibility of pilferage of bloods/ kits. In the absence of interconnectivity among blood banks, available blood stocks in one blood bank could not be utilised by others in need, leading to wastage of stock. Deficient maintenance of records on the particulars of sero-reactive donors leaves possibilities of carriers of such deadly viruses remaining unaware and untreated. Non-compliance of the rules and inadequate monitoring by Drug Inspectors resulted in several deficiencies. Human resources management also calls for attention as 32 per cent Medical Officers and 20 per cent Medical Technologists attached to 17 test-checked blood banks did not have training on blood transfusion. Department of Transfusion Medicine was not established in nine Government MCHs of the State, neither was the separate cadre for Blood Transfusion Service created.
Compliance Audit on Implementation of Chief Minister's Health Insurance Scheme
(CAG of India, 24-06-2021) CAG of India
An audit of ‘Implementation of Chief Minister’s Comprehensive Health Insurance Scheme’ revealed that there was no mechanism for verification/ periodic updation of family income and exclusion of ineligible families. Marginalised categories like orphans, migrant workers and Sri Lankan refugees were not adequately enrolled as a suitable system was not put in place. Quality of medical care could not be fully ensured due to non-insisting of the mandatory NABH accreditation. Instances of delayed pre-authorisation showed an increasing trend leading to delay and possible denial of treatment to needy patients.
Compliance Audit on Implementation of Pre-Conception & Pre-Natal Diagnostic Techniques (Prohibition of Sex Selection) Act in Jharkhand (2014-2017)
(CAG of India, 27-12-2018) CAG of India
Human resources management As per information provided by the PCPNDT Cell of National Health Mission, 250 (36 per cent) out of 702 genetic/ ultrasonography (USG) centres in 19 out of 24 districts of the State as on March 2017, engaged 227 unqualified doctors (38 per cent) out of total 599 doctors employed in total USG centres in the State without any qualified doctors on their panel. Of these, 87 USG centres engaged 81 MBBS doctors without any experience or training, 163 USG centres appointed 146 MBBS doctors, who, though having one year experience/ six months training, had not cleared the mandatory Competency Based Evaluation (CBE). In the test-checked districts, 126 unqualified doctors working in 136 USG centres conducted 59,959 sonography during 2014-17 of which, 604 were done by 56 inexperienced and untrained MBBS doctors in 61 USG centres. In five out of 24 districts, 18 radiologists were registered with 71 USG centres during 2014-17, each radiologist working in between three to six USG centres, violating Government of India stipulations of a maximum of two USG centres per radiologist. Recommendation The Department should initiate appropriate action against (i) unqualified doctors performing sonographies, (ii) USG centres who permit such unqualified doctors to perform sonographies, and (iii) DAAs who registered such USG centres despite their not having qualified doctors. (Paragraphs 2.2.2.2 and 2.2.2.3) Monitoring and inspection for implementation of the Act The State government had not constituted Sub-district Appropriate Authorities in any of the sub-divisions even after more than two decades of enactment of the Act. Further, there was delay of two years in reconstitution of State Supervisory Board and State Advisory Committee for reviewing, monitoring and supervision of the implementation of the Act at the State level. These shortcomings prevented implementation of the recommendations of State and Central level committees such as restricting qualified doctors to work in a maximum of two ultrasound clinics in a district, setting up online grievance/complaint portal for receiving complaints, inspecting ultrasound clinics by State Level Monitoring committee, tracking online form F, geographic information system (GIS) mapping of USG centres etc. This also resulted in failure to monitor and inspect implementation of the Act as evident from non-maintenance of essential records for conducting sonography of pregnant women in 2,257 cases, sonography conducted without referral slips of registered medical practitioners in 979 cases, engagement of radiologists other than the registered radiologists in 14 USG centres. Recommendation The Department should establish Sub-district Appropriate Authorities at the earliest to strengthen the institutional arrangements to fulfil the mandate of the Act and ensure strengthening of supervisory and advisory committees. (Paragraphs 2.2.4.2 and 2.2.4.3) The State Inspection and Monitoring Committee (SIMC) neither carried out any field visit nor inspected any USG centre during 2014-17. The District Appropriate Authorities (DAA) conducted only three per cent (244 out of 8,608 inspections) of targeted inspections in the State during 2014-17. In test checked districts, inspections by DAAs were only to the extent of two per cent during 2014-17 (96 against required 5,060 inspections). Audit verification of records of nine USG centres (whose inspections by the concerned DAAs had revealed no irregularities) revealed deficiencies such as non-maintenance of basic records by the centres, USGs conducted by unqualified doctors, unavailability of backup of images, absence of name, registration number and qualification of radiologist on the display board etc. Recommendation The Department should ensure required numbers of inspections by SIMC and DAAs and shall take appropriate action against those DAAs whose inspections of the nine USG centres did not reveal the irregularities noticed by Audit. (Paragraph 2.2.4.7 (i) & (ii)) Joint physical inspection of 72 USG centres by Audit and Departmental officials revealed several violations, including 21 USG centres functioning illegally due to their delayed renewal and approval, non-maintenance of vital records in 61 per cent of 3,717 cases for conducting sonography of pregnant women, absence of referral slips of registered medical practitioners in 26 percent of 3,717 cases for doing sonography, non-submission of monthly reports by USG centres in 65 per cent cases etc. Recommendation The Department should ensure regular inspection of USG centres to prevent violations of the Act, and take appropriate corrective action. (Paragraph 2.2.4.7 (iii)) The Department has not completed till date (May 2018) development of online grievance/ complaint portal and comprehensive website for information on implementation of the PCPNDT Act even after more than three years of instructions (May 2015) by Government of India. Resultantly, not a single complaint was recorded in the Department against violation of the Act, as noticed by Audit. Recommendation The Department should develop and make operational the website and ensure that online grievance redressal system is functional at the earliest. The website should carry information about the status of the redressal along with the authority with whom it is pending. (Paragraph 2.2.4.9 (i))
Compliance Audit on Procurement and Distribution of Drugs, Medical Consumables and Equipments by Odisha State Medical Corporation
(CAG of India, 03-04-2021) CAG of India
Odisha State Medical Corporation Limited (OSMCL) is an independent procurement agency for the Department of Health and Family Welfare (H&FW), Government of Odisha. The key functions of OSMCL are timely procurement of quality medicines, surgicals, equipment, instruments, furniture, etc., through fair, transparent and competitive bidding process. Audit of procurement and distribution of drugs by OSMCL for the period 2016-19 revealed the following: • There was inordinate delay ranging between five and seven months in the finalisation of annual procurement plans for drugs and medical consumables and six to 17 months in respect of Equipment, Instrument and Furniture (EIF). Delay in finalisation of procurement plan impacted the procurement process and supply of drugs and medical consumables to health institutions. (Paragraph 2.1.2) • Against the indented/ approved quantity of 692.97 crore units, OSMCL could supply 336.94 crore (49 per cent) units of drugs and medical consumables to health institutions during 2016-19. Non-supply of indented quantity resulted in non-availability of essential drugs in health institutions which resorted to local purchase at higher costs and stock out of essential and critical drugs. (Paragraph 2.1.3) • Out of 3,471 Purchase Orders (POs) placed for supply of drugs and medical consumables, 791 (23 per cent) POs were partially executed and 252 (7 per cent) POs were not executed at all, which led to less supply of drugs and consumables to the health institutions. (Paragraph 2.1.4) • Deficiencies in stock management led to expiry of 349 kinds valued at ₹4.18 crore during April 2017 to May 2019. Expiry of drugs was due to ineffective monitoring of indents, distribution, consumption, stock position of drugs through e-Niramaya software. (Paragraph 2.1.6) • Short supply of drugs and medical consumables by OSMCL led to the health institutions procuring these items locally incurring extra expenditure. During 2018-19, test checked health institutions had incurred extra expenditure of ₹98.12 lakh (44 per cent) in procuring medicines worth ₹2.24 crore. (Paragraph 2.1.7) • OSMCL could procure only 43 per cent EIF against the approved quantity during 2016-19. As of June 2019, 19 per cent of the procured EIF had not been installed and were lying unutilised with different indenting agencies. (Paragraph 2.1.8) • Quality test reports of 22 per cent drug samples were received with a delay ranging between 16 and 244 days due to which the drugs received remained quarantined without supply to health facilities. Instances of non-replacement of sub-standard drugs by the suppliers were also noticed. (Paragraph 2.1.10) • Monitoring of distribution of drugs and medical consumables through the online inventory management system (e-Niramaya) was not adequate and effective. Lack of monitoring at the level of H&FW Department/ State Drug Management Unit/ OSMCL/ health institutions ultimately resulted in shortage of essential drugs and wastage of government resources due to expiry of unused drugs, supplied in excess. (Paragraph 2.1.13)
Compliance Audit on Procurement and Utilisation of Equipments in District and Taluk Hospitals in Karnataka
(CAG of India, 09-12-2020) CAG of India
Equipment to all the hospitals, as assessed, was not supplied resulting in non-achievement of the objective of the Government to establish ICUs in all district and taluk hospitals. ICUs established at a cost of INR 98.71 lakh in five test checked taluk hospitals and one district hospital were not functional. Besides, the non-utilisation of various equipment resulted in non-availability of clinical/diagnostic services to the patients.
Compliance Audit on Procurement of Machines Equipments and Accessories for Dental Institute RIMS Ranchi
(CAG of India, 04-08-2022) CAG of India
The Rajendra Institute of Medical Sciences (RIMS), Ranchi is an autonomous medical institute of the Government of Jharkhand (GoJ) under the administrative control of the Health, Medical Education & Family Welfare Department (the Department). A Dental Institute, with a capacity of 50 annual intakes in Bachelor of Dental Surgery (BDS) course, was started from the Academic year 2017-18 in RIMS for which 176 types of dental equipment worth ₹ 37.17 crore was procured. On the request of the Secretary of the Department, audit of procurement of equipment for Dental Institute, RIMS was conducted between July 2019 and May 2020 for the period 2014-15 to 2018-19 to assess whether the tendering process was regular and equipment were procured economically. Main audit findings are summarised below: 1. Against an original proposal of ₹ 5.80 crore for procurement of dental equipment as approved by the Governing Council, the Director, RIMS submitted detailed budget of ₹ 9.29 crore to the State Government. However, RIMS procured dental equipment valued at ₹ 37.17 crore during 2014-19 which was 400 per cent of the budget. 2. In a tender invited in January 2016, technical and financial evaluation was not done on combined scoring pattern as per terms of the NIT giving weightage to the technical qualification and financial offers without recording any reasons. The purchase and technical committees approved the lowest rates from the rates quoted by technically qualified bidders without giving scores at any stage. Against this tender, 20 items valued at ₹ 18.52 crore were procured. 3. Though instructed by the Health Minister, the Director, RIMS neither crossverified the compliance submitted by the accused supplier nor surveyed the market price or procurement price of similar equipment in other medical institutions prior to payment of outstanding bill of ₹ 5.40 crore and further procured equipment valued ₹ 11.40 crore from the same supplier without obtaining the approval of the Health Minister. 4. The Finance and Accounts Committee did not decide the tenders though required under the Regulations of RIMS. Instead two different committees (Purchase Committee and Technical Committee) having no defined role in the Regulations were entrusted with the decision of tender by RIMS. 5. There was absence of uniformity and transparency in technical evaluation of bids besides arbitrariness in deciding technical qualification in favour of a bidder with respect to procurement of basic and advance dental chairs, mobile dental van and 15 other items valued at ₹ 25.70 crore. 6. RIMS incurred avoidable expenditure of ₹ 14.25 crore on procurement of dental equipment (Chairs, Mobile dental van and RVG) compared to the rates given in the budget estimates. 7. Attachments and accessories with basic dental chairs, advanced dental chairs and Mobile Dental Van were either missing or of lower specifications. Two out of ten supplied Radiovisiography systems were of different model. RIMS also failed to impose penalty of ₹ 2.37 crore for delayed supply. 8. Dental equipment worth ₹ 12.02 crore supplied to the Dental Institute was not found entered in inventory and was thus fraught with the risk of misuse. 9. Equipment worth ₹ 1.94 crore purchased (August 2016) for laboratory and the operation theatre (OT) was found lying idle in the store as laboratories and OT had not been set up as of May 2020. Disinfectants worth ₹ 17.85 lakh purchased in August 2016 for use in the OT had expired.
Compliance Audit on Public Health Infrastructure and Management of Primary Health Services in Tripura
(CAG of India, 2023) CAG of India
The present Subject Specific Compliance Audit (SSCA) covers the primary health care services which provide health facilities at village and block levels. The SSCA also provide a holistic view of improvement of necessary infrastructure, created for meeting emergencies related issues and service delivery by the sampled health institutions for the period 2016-17 to 2021-22. Though services of specialist doctors were to be made available in the CHCs as per the IPHS, no specialist service was available in the CHCs in the State except in CHC, Kherengbar where Obstetrics & Gynecology service was available only for twice a week. CHCs were serving like higher bedded PHCs only. Diagnostic services like Radiology, ECG, Ophthalmology, etc. which were required to be available in the CHCs as per the IPHS were missing. Quality assurance in the Laboratory Services as mandated under the IPHS was not done. Emergency and Trauma Care service was virtually absent in the sampled health centers. A large number of essential drugs were not supplied to the health institutions and stock out rate of the available medicines was high. HSCs are responsible for providing ANC service to the pregnant woman including the outreach services to the people under them, failed to provide the desired service. As a result, more than 20 per cent of the registered PWs did not receive four ANC check-ups during 2021-22. Hospital support services, viz. dietary service, laundry, and linen service, etc. were in operational in the sampled health facilities without any standard operating guidelines from the Government. FSSAI license was not obtained by any of the sampled health facilities. Health care facilities were running without any safety clearance from the Fire Department and posing a major fire threat to the patients. Hospital Infection Control Committee was found to have been formed in five out of the nine sampled health centres and failed to deliver any specific road map and plan to control hospital infection. Sampled Health Facilities were found in not adhering to the Bio Medical Waste Management Rules. The CHC, Kumarghat had low bed occupancy and an alarmingly high referred out rate of 194 per 1,000 indicating that this hospital had struggled to provide quality services. Similarly, PHCs, Ganganagar and Champaknagar were also struggling to provide good services to the patients as reflected with the high Referral Out, LAMA and Absconding rate. Grievance redressal mechanism was not available. Large funds earmarked for dealing with the pandemic situation in the State remained unutilised. Two Directorates did not surrender funds of ₹ 8.97 crore despite no immediate requirement. Progress on ramping up of health infrastructure with the focus on Paediatric care units was slow despite availability of funds. There was no reduction in the expenditure on oxygen cylinders despite the installation of PSA plants, as these plants largely remained unutilised. Assets created, were found idle and are to be re-distributed on the need basis while expired VTMs were found in use for conducting of RTPCR test to detect the presence of virus. State is lagging behind in achieving the SDG -3 indicators in six out of the ten targeted areas in comparison to the national achievements against those indicators. Spending on the health sector was not at the desired level as envisaged in the National Health Policy, 2017. Though monitoring mechanism was designed and developed, regular monitoring was not done, due to which the impact assessment could not be done.
Compliance Audit Paragraph on Irregular Purchase of Medicines & Equipment in Bihar
(CAG of India, 01-08-2013) CAG of India
Irregular purchase of medicines and equipment in violation of State Health Society's prescribed procedures resulted in excess payment of Rs 1.33 crore. This irregular purchase also resulted in imparting undue favours to those private suppliers.
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.

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