Department of Health, Medical and Family Welfare in State Governments
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Item Performance Audit on Functioning of PIU in Health and Family Welfare Dept in Gujarat (2014-2019)(CAG of India, 25-09-2020) CAG of IndiaProject Implementation Unit (PIU) was established (July 2002) as a Cell under the Health and Family Welfare Department (H&FWD) for implementation of post-earthquake redevelopment programme in affected areas of the State from the funds provided by the European Commission. On completion of works approved under earthquake redevelopment programme, H&FWD decided (February 2006) to continue PIU for carrying out the construction activities of the department and accordingly, transferred construction activities of Public Healthcare Facilities (PHFs) from Roads and Buildings (R&B) Department to PIU. Subsequently, Maintenance and Repairs (M&R) work of PHFs were also entrusted (May 2012) to PIU. During 2014-19, against available funds of INR 9,017 crore, PIU had incurred expenditure of INR 5,833 crore (65 per cent) on new construction and M&R works. The objectives of the Compliance Audit were to assess whether (i) institutional framework was established for proper functioning, (ii) norms prescribed for approval, tendering and execution of works were adhered to and (iii) funds provided for new construction and M&R works were properly accounted and efficiently utilized. To achieve the audit objectives, Gujarat Public Works (GPW) Manual, 1987, tender documents, Gujarat Financial Rules and instructions issued by State Government were adopted as criteria for evaluation. Audit examined the records maintained at the head office of PIU and eight district units. Selection of districts was done by adopting Probability Proportional to Size without Replacement method. Out of 805 works awarded during 2014-19 in the selected districts, 136 works and four out of six projects were selected on judgmental basis for detailed scrutiny. Joint physical verification of 94 buildings in the selected districts were also conducted to assess the quality of construction and maintenance. After performance audit, CAG of India arrived at the following conclusion: State Government entrusted (February 2006) new construction works and Maintenance & Repair (M&R) works (May 2012) of Public Healthcare Facilities to PIU without proper establishment. Government decision (October 2008) to convert PIU into Gujarat State Health Infrastructure Development Corporation (GSHIDC) to cope up with workload could not be implemented as of July 2020. Institutional arrangement of PIU was not found robust in terms of (i) framework of rules and procedures, (ii) quality control mechanism and (iii) accounting, auditing and funds management systems. PIU wrongly incorporated a special condition “free of cost construction of buildings for district units of PIU” and “supply of electronic gadgets”. This clause was neither consistent with basic principle of contracts nor implemented uniformly. Norms prescribed for approvals of works were not scrupulously adhered to, as 2,160 (33 per cent) out of 6,504 sanctioned works could not be undertaken due to non-allotment of clear sites. Designs and estimates for works were not prepared with due diligence. Tender procedure lacked transparency and fairness as provisions for invitation of tender, time for submission of bids, evaluation of pre-qualification bids, etc. were not adhered to. PIU incurred additional expenditure of INR 37.86 crore due to deficient design. Five buildings constructed at a cost of INR 196.94 crore were either not put to use or utilised partly. Quality Control (QC) was found deficient as 68 per cent of works were not inspected by QC teams. Financial management of PIU was not found robust due to deficient accounting system and not following Treasury Rules for management of funds.Item Integrated Audit of Health and Family Welfare Department in Mizoram(CAG of India, 2009) CAG of IndiaIntegrated audit of the Health and Family Welfare Department in Mizoram revealed poor budget, accounting and procurement procedures and non-implementation of various Centrally Sponsored Schemes. Some of these are highlighted below: 1. The Directorate of Hospital and Medical Education parked funds amounting to Rs. 2 crore in Civil Deposit for periods ranging from 4 to 30 months. 2. An amount of Rs. 30 lakh was drawn for electrification of buildings and fencing works, out of which, only 2.17 lakh was utilised for water connection, while the balance amount remained unaccounted for. 3. Unauthorised disbursement of Rs. 42.44 lakh led to probable misappropriation of funds by the Deputy Director (Nursing). 4. The Directorate of Hospital and Medical Education disbursed Rs. 16.59 lakh to a New Delhi based firm before issue of formal supply order and without ensuring delivery of stores.Item Performance Audit of Material Management in Health and Family Welfare Department in Tripura (1999-2004)(CAG of India, 2005) CAG of IndiaMaterials management in the Health and Family Welfare Department in Tripura was found to have been deficient. Procurement of medicines was not based on realistic assessment as requirement of medicines submitted by different health institutions was not supported by basic data. The system of health care in different health institutions in the State suffered due to delayed and reduced supply of medicines, supply of substandard medicines, and idling of machinery and equipment. Reasons for these deficiencies were attributable to lack of adequate planning and monitoring. Following are the main audit findings of this performance review: 1. Penalty of Rs. 18.34 lakh for delay in supplying medicines was not imposed on the suppliers. 2. Expenditure of Rs. 6.71 lakh incurred on purchase of mixture ingredients became unfruitful, as no mixture could be prepared by using these ingredients according to the formulation prescribed in the Pharmacopoeia. 3. Sub-standard medicines valued at Rs. 10.44 lakh purchased during 1999-03 were issued to the patients before receipt of drug testing reports. 4. Machinery and equipment worth Rs. 39.17 lakh were irregularly transferred to a society viz, Tripura Super Speciality Hospital Society. 5. Eighteen items of machinery and equipment purchased during 1996 to 2002 at a cost of Rs. 86.24 lakh remained non-functional (as of June 2004).Item Performance Audit of Functioning of Medical Department in Arunachal Pradesh (1995-2000)(CAG of India, 2001) CAG of IndiaThe performance review of functioning of Medical Department in Arunachal Pradesh, interalia, highlights defective budgeting, irregular deployment as well as utilisation of available manpower, thereby depriving a section of population of the state to avail the benefit of health care services, irrational deployment of Specialist and Dental Surgeons, establishment and running of 2 PHCs and 68 HSCs either with one Group ‘D’ staff or having no staff at all, extra avoidable expenditure of Rs.47.21 lakh for procurement of medicine at higher rates, procurement of X-Ray Machines before completion of infrastructure and absence of any system to monitor and evaluate the working of the Department as a wholeItem Performance Audit of Public Health Department in Goa (1999-2004)(CAG of India, 2005) CAG of IndiaThe Public Health Department provides health services through a network of hospitals, community and primary health centres, sub-centres, rural medical dispensaries, homeopathic and ayurveda clinics. The Secretary (Health), the Director and five Deputy Directors of Health Services, a Joint Director of Accounts, Director of Administration and a Vigilance Officer are the officials responsible for implementation of various programmes including Family Welfare and Reproductive and Child Health Care. A performance review of the functioning of the Health Department covering the period 1999-2004 revealed that though the Department had achieved the targets under the family welfare and various disease control programmes it was slow in upgrading its infrastructure and facilities despite availability of funds. Its efficiency was adversely affected due to severe manpower shortage. Monitoring of the key areas of the Department such as upgradation of facilities and utilisation of Central funds was also poor. Regulatory measures to ensure sanitary conditions of buildings were not adequately prescribed or implemented. The system of Internal Audit was weak.Item Performance Audit of Public Health and Family Welfare Department in Chhattisgarh (2001-2004)(CAG of India, 2005) CAG of IndiaThe Public Health and Family Welfare Department provides health services through a network of hospitals and health centres and implements various schemes to achieve the goals envisaged in the National Health Policy, 1983 and the National Population Policy, 2000. The expenditure on health care in the State was Rs. 646.90 crore during 2001-04. There was shortfall in creation of three-tier health infrastructure. The bed population ratio remained very low at 30 per lakh as against the all India Average of 92. Demographic goals of Family Welfare Programme were not achieved. Deficient financial management resulted in large savings and unnecessary supplementary grants while there were many shortfalls in providing services and equipment. Some key observations were as follows: 1. Targets fixed for achieving infant mortality rate, crude birth rate, and couple protection rate by 2000 were not achieved even in 2004. 2. Excess and irregular expenditure of Rs.1.11 crore on compensation, drugs, POL charges and motivation charges were incurred in excess of norms under FWP. 3. Grants-in-aid worth Rs. 1.47 crore from Empowered Action Group (EAG) fund was misutilised and equipments worth Rs. 84.09 lakh were lying idle. 4. X-ray machines worth Rs.2.08 crore were purchased but not put to use.Item Performance Audit of Internal Control System in Health Department in Bihar (2003-2006)(CAG of India, 2007) CAG of IndiaInternal control system is an integrated process by which an organisation governs its activities so as to give reasonable assurance for achieving the objectives of organisation. It consists of methods and policies designed to protect resources against loss due to waste, abuse and mismanagement. The Health Department was established with the primary objective of providing health care facilities. Evaluation of the internal control system in the department disclosed that Internal Control viz. financial control, expenditure control and operational control were not working and ineffective in the department. Budgetary control was poor as reflected in huge surrenders and savings. The Public Health programmes failed to deliver the intended benefit to the target population due to deficient implementation of the programmes. Internal audit mechanism was deficient as indicated by poor compliance to audit observations of internal audit wing and statutory audit. Monitoring and evaluation mechanism was non-existent in the department. Main audit findings are summarised below: 1. Budget estimates were not prepared on the basis of actual requirement which resulted into saving of Rs 1072.82 crore and lapse of Rs 497.16 crore during 2001-06. 2. 690 Drawing and Disbursing officers did not submit DC bills of Rs 136.43 crore during the year 2003-06 to AG (A&E). Only Rs 1.24 crore were utilised on purchase of medicines and equipments against available funds of Rs 10.06 crore provided under PMGY. 3. The expenditure of Rs 2.21 crore incurred on National Malaria Eradication Programme (NMEP) and control of Kalazar proved unfruitful due to non-spraying of DDT within prescribed time. 4. Internal audit observations containing monetary value of Rs 48.97 crore were noticed during 2001-06. Of this Rs 4.41 crore relates to defalcation, misappropriation and recovery. Paras involving Rs 0.04 crore only were settled during 2001-06. 5. The Department failed to properly monitor the execution of various schemes.Item Performance Audit of Health and Family Welfare Department in Himachal Pradesh(CAG of India, 2005) CAG of IndiaThis performance audit of Health and Family Welfare Department in Himachal Pradesh for the period covering 1999-2004 revealed that the main objective of Health and Family Welfare Department to provide “Health for all by the year 2000”, for which specific goals were set, was not achieved by March 2004 in respect of pre-natal and child mortality, effective couple protection, pregnant mothers receiving ante-natal services and delivery by trained attendants, etc. Review of certain aspects of working of the department revealed the following main points: ♦ Investment of Rs five crore in Himachal Pradesh Health System Corporation to improve infrastructure in health institutions could not achieve the intended purpose as no infrastructure was created. ♦ Of 3,276 vacant posts as of October 2003, all the posts under 19 categories remained vacant which affected the healthcare services in the State. ♦ Pre-service training courses for nurses and multipurpose health workers were not conducted after 2001-2002 and salary of Rs 78.13 lakh was paid to the training staff for the idle period. ♦ Fifty bed Mental Hospital constructed in Shimla at a cost of Rs 2.17 crore remained non-functional due to non-posting of psychiatrist and related staff. ♦ The State Government could not avail additional Central assistance of Rs 8.96 crore provided by the Government of India under Pradhan Mantri’s Gramodaya Yojna for strengthening rural health sector.Item Performance Audit of Store Management in Health and Family Welfare Department in Jharkhand(CAG of India, 2003) CAG of IndiaFunctional efficiency of health services is largely dependent upon the medical infrastructure available be it in the form of equipments, Hospitals, medicare or doctors. Stores management inclusive of equipments and medicines plays a vital role in providing modern facilities required for diagnosis as well as appropriate treatment. This performance audit of Store Management in Health and Family Welfare Department in Jharkhand revealed that: 1. Nearly 40 per cent medicines procured were purchased without assessment of actual requirement. 2. Medicines worth Rs 7.01 crore were purchased from private firms/ unauthorised agencies without inviting tenders/approval of purchase committee. 3. 18 out of 63 samples of medicines collected by Drug Inspectors were found to be substandard. 4. Equipments worth Rs 44.07 lakh were purchased without adhering norms. C.T. Scan machine was purchased by payment of extra cost of Rs 21.95 lakh. Equipments worth Rs 64.69 lakh were lying idle for want of repairs.Item Performance Audit of Internal Control System in Health Department in Manipur(CAG of India, 2008) CAG of IndiaInternal control system is a process by which an organisation directs its activities to achieve its objectives. Such a system consists of methods, systems and procedures for protecting resources from waste, loss, theft, misuse or mismanagement and provides reasonable assurance that the organizational goals and objectives are achieved. This performance audit presents an evaluation of the internal control system in the Health Department in Manipur for the period 2002-2007. The performance audit revealed deficiencies in its budgetary, financial, administrative and supervisory controls, non maintenance of basic records and non- reconciliation of expenditure. Internal audit arrangements were also deficient and unable to provide assurance against possibilities of financial irregularities. These lapses adversely affected delivery of primary health care services in the State.Item Performance Audit of Health, Medical and Family Welfare Department in Andhra Pradesh(CAG of India, 2011) CAG of IndiaThe Department of Health, Medical and Family Welfare in Andhra Pradesh is responsible for providing preventive and curative healthcare services to the people of the state. Its main functions include formulation and execution of health related schemes, construction of healthcare centres at various levels/ locations, procurement and supply of essential medicines to Government medical institutions, monitoring the functioning of Government run hospitals, medical colleges etc. In this compliance audit carried out during the year 2010-11, CAG of India reviewed the functioning of (i) Blood Banks and (ii) Trauma Care Centres. This performance audit also brought out cases of (iii) fraudulent drawal of pay and allowances and advances in a few Primary Health Centres and (iv) Utilisation of Medical equipment in two Government Medical Colleges.