Rural Health Services

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https://resourcerepository.azimpremjiuniversity.edu.in/handle/apurr/296

The delivery of primary health care is the foundation of Rural Health Care System and forms an integral part of the National Health Care System. In this collection, you will find CAG of India's performance audit of Rural Health Care Services.

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Now showing 1 - 7 of 7

Performance Audit of Rural Hospitals and Primary Health Centres in West Bengal (1999-2004)
(CAG of India, 2005) CAG of India
Healthcare is provided to rural people through a network of sub-centres, primary health centres (PHCs) and rural hospitals (RHs). There were huge shortages in numbers of RHs and PHCs as compared to the norm in West Bengal. Only 31 per cent of doctors available were working in rural areas to serve 72 per cent of the population. Specialist services were not provided in RHs. Most of the sub-centres were functioning without adequate infrastructure and health assistants (Male). Indoor treatment was not provided in most of the PHCs. Supply of medicines to RHs and PHCs was highly inadequate. In the PHCs, even routine treatment in out patient department was not provided. Main audit findings are presented below: 1. During 1999-2003, scheme fund of Rs 8.73 crore were not released by the department for development of health care services. The department also failed to utilise 52 per cent (Rs 111.52 crore) of plan funds. 2. As compared to national norms, only 20 per cent of RHs, 61 per cent of PHCs and 78 per cent of SCs were established against requirement while in the test-checked districts shortage of RHs ranged between 76 and 95 per cent and for PHCs it was between 32 and 50 per cent except in Bankura. During 1999-2004, only 10 PHCs were set up in the State. 3. Basic minimum health care services were not provided due to failure in providing requisite instruments, labour rooms, laboratory, electricity, toilet, etc. in sub-centres and PHCs. 4. In four selected districts, 27 per cent of sanctioned posts of MOs, nurses and other para medical staff remained vacant as of March 2004. Out of 236 PHCs, 177 PHCs were functioning with only one MO each against the norm of minimum two and 54 PHCs remained non-functional for one to five years for want of MOs. 5. Only 31 per cent of doctors were deployed in rural areas to serve 72 per cent of total population leading to wide disparity between urban and rural areas. Against 20712 health assistants needed for the sub-centres at village level only 14155 (68 per cent) were available. 6. Bed occupancy in test-checked 11 RHs and 12 BPHCs ranged between five and 63 per cent during 1999-2004. Low bed occupancy was noticed inall the test-checked RHs and BPHCs due to inadequate facilities, lack of doctors and non-operational Out Patient Departments. Further, out of 1013 beds in 182 PHCs of selected districts only 46 beds in five PHCs were functional. In the health centres, patients suffering from even routine ailments like fever, diarrhoea and vomiting were denied treatment in out patient department and referred to district or sub-divisional hospitals. Surgeons and anaesthetists were not deployed in fully equipped 15 OTs. 7. Equipment costing Rs 52.67 lakh was lying idle in the health centres for want of adequate infrastructure. 8. Medicines were procured without indents or assessment of requirement. In test-checked seven RHs and four BPHCs of two districts supply of medicines fell short by 24 to 47 per cent. 9. Four Zilla Parishads incurred expenditure of Rs 2.08 crore by diverting funds from the Pradhan Mantri Gramodaya Yojana. Furniture and medicines valuing Rs 14.91 lakh and Rs 34.79 lakh respectively remained unutilised due to imprudent purchases. 10. In the State, coverage of eligible couples adopting family planning measures was 33.62 per cent against the target of 60 per cent while in test-checked districts it ranged between 21 and 50 per cent. 11. During 1999-2003, out of 8.40 lakh childbirths in three test-checked districts 6.75 lakh deliveries were non-institutional and the incidence of child death increased two fold during 1999-2003.
Performance Audit of Dispensaries for the Welfare of Backward Areas in Chhattisgarh (1997-2002)
(CAG of India, 2003) CAG of India
The scheme aimed at providing medical facilities to predominantly tribal areas of the state. Though an amount of Rs.17.90 crore was spent in two years (2000-02) the development of health infrastructure in these areas was far from satisfactory inasmuch as even the first phase of construction of Community Health Centres (CHCs) were not completed resulting in nonextension of radiological/ operation facilities etc. Acute shortage of specialists prevailed in District Hospital (DH) (20-65 per cent) and in CHCs (28 to 60 per cent) resulting in low percentage of bed occupancy in CHCs. Twenty eight per cent Primary Health Centre (PHC) remained without doctors. Some of the significant observations are as under: 1. The budget provision fell short by 53 per cent of the actual requirement. 2. For providing basic medical care in rural areas only 114 Community Health Centres were established as against the requirement of 170. 3. 4 hundred beded hospitals and one upgradaded (hundred to three hundred) bed hospital remained incomplete after incurring an expenditure of Rs. 3.90 crore. 4. Extra cost of Rs 19.61 lakh was incurred on irregular purchase of medicines. 5. Minimum and Maximum stocks of life saving medicines for prevention of epidemics were not fixed. Store keepers were not trained in inventory control. 6. Under Jeevan Jyoti Scheme expenditure incurred was not commensurate with physical performance.
Performance Audit of Rural Health Services in Bihar (1999-2004)
(CAG of India, 2005) CAG of India
The objective of primary health care is to provide basic health services at the door steps of rural people through a network of Sub-Centres (SCs), Primary Health Centres (PHCs), Additional Primary Health Centres (APHCs) and Referral Hospitals (RHs). The major components of primary health care are (i) health education to the community, (ii) maternal, child health and family welfare, (iii) curative services, (iv) maintenance of demographic services (v) prevention and control of local epidemics and (vi) implementation of national health programmes. This performance audit of Rural Health Services in Bihar covering the period 1999-2004 revealed that Rural health care units failed to provide basic minimum services and bring about improvement in referral linkages. The health care services in rural areas of the State were grossly inadequate. Shortage of medical officers and paramedical staff ranged upto 95 per cent. There were huge shortages of health care units compared to the GOI norms. Infrastructural facilities such as buildings, drinking water, electricity, labour room facilities, equipment and diagnostic facilities were lacking in most of the health units.
Performance Audit of Rural Health Services in Uttar Pradesh (2002-2007)
(CAG of India, 2008) CAG of India
The Rural Health care delivery system comprises Community Health Centres (CHCs), Primary Health Centres (PHCs) and Sub Centres (SCs) in rural area to provide curative and specialised health facilities to rural population. A performance audit of the activities relating to Rural Health Services in Uttar Pradesh for the period 2002-03 to 2006-07 revealed following deficiencies in delivery of health care services to the rural people. 1. Budget estimates were prepared without any proposals from Chief Medical Officers (CMOs) leading to inflated estimation and surrender of Rs. 953.24 crore of which Rs. 840.50 crore (88 per cent) related to provision for vacant posts during 2002-07. 2. Health indicator targets under Family Welfare programme were not achieved mainly due to poor anti-natal care, lower institutional births or births through untrained personnel and non-supply of iron folic acid tablets. Medicines costing Rs. 40.43 crore were distributed without testing their quality. 3. Japanese Encephalitis prone districts were not adequately covered by vaccination, fogging and spraying operations due to short availability of vaccines and insecticides. 4. Revised National T.B Control programme was implemented in the State without ensuring availability of T.B clinic buildings in 18 districts and District Tuberculosis Officers in 14 districts. There was 7 to 30 per cent shortfall in sputum positive detection rate due to non-establishment of Microscopic Centres in 17 per cent CHCs. 5. There was shortfall of 22 per cent, 17 per cent and 72 per cent vis-a-vis GOI norms in the number of SCs, PHCs and CHCs in the State. Ninety CHCs, 762 PHCs and 3,205 SCs in the test checked districts lacked necessary facilities and 58 CHCs and 79 PHCs remained underutilised during 2002-07. 6. There was shortage of 19 per cent in medical staff and 23 per cent in para medical staff in seven test checked districts. Besides, 39 doctors were absent unauthorizedly for the last one to ten years. 7. Anti Rabies Vaccine and Electrical Sterilisers were purchased at higher rates which resulted in extra expenditure of Rs. 2.53 crore. 8. Monitoring of implementation of the progrmme was deficient.
Performance Audit of Rural Health Services in Mizoram (2000-2005)
(CAG of India, 2006) CAG of India
This performance Audit of Rural Health Services in Mizoram for the period 2000-01 to 2004-05 revealed that the delivery of rural health care services was only partial in the State because of the failure of the Government to make the health centres functional with requisite medical and paramedical staff, irrational deployment of manpower and the non functioning of the PHC and SCs. Excess establishment of health centres, blocking and irregular diversion of funds, idle X-ray technician due to non functioning of X-ray machine, injudicious and unproductive expenditure also adversely affected the delivery of health care services to the rural population. The impact of implementation of the programme was not evaluated and no monitoring system to oversee performance was in existence.
Performance Audit of Primary Healthcare Services in Rural Areas in Andhra Pradesh (1999-2004)
(CAG of India, 2005) CAG of India
The objective of ‘Primary Healthcare’ is to provide the basic health services to the doorsteps of rural people through the network of Sub-centres (SCs), Primary Health Centres (PHCs) and Community Health Centres (CHCs). The major components of primary healthcare are (i) Health Education to the community, (ii) Maternal and Child Health and Family planning, (iii) Curative services, (iv) Maintenance of demographic statistics, (v) Prevention and control of local epidemics, and (vi) Implementation of National Health programmes. This Performance Audit of Primary Healthcare Services in Rural Andhra Pradesh revealed that primary healthcare in rural areas was not adequate in the State. Only 22 per cent of the doctors were in place to serve 73 per cent of the population in rural areas. There was huge shortage of medical officers, paramedical staff and health workers. Specialist services were not provided in the Round the clock PHCs. Performance of the Mobile Medical Units was very poor. National Filaria Control Prgramme was altogether neglected in rural areas. The incidence of malaria in tribal areas continued to be very high. Infant mortality rate was very high.
Performance Audit of Rural Health Services in Arunachal Pradesh (2001-2006)
(CAG of India, 2007) CAG of India
The delivery of primary health care is the foundation of Rural Health Care System and forms an integral part of the National Health Care System. In Arunachal Pradesh, health care services in rural areas are provided through a network of Health Sub-Centres (HSC), Primary Health Centres (PHCs) and Community Health Centre (CHCs). The programme is funded by the Central and the State Governments. This performance audit of Rural Health Services in Arunachal Pradesh for the period 2001-2006, highlights irrational establishment of rural health centres, irregular deployment of medical and paramedical staff, poor outturn of indoor patients, cases of diversion of funds, injudicious/unproductive expenditure and idle outlay, which adversely affected the delivery of health care services to the rural population. Main audit findings are presented below: 1. There was irrational and excess establishment of rural health institutions in contravention of norms. 2. There was idle stock of health care kits worth Rs.41.19 lakh. 3. Rupees 27.72 lakh pertaining to rural health care services was diverted to urban health services. 4. Rupees 25.71 lakh was paid to a supplier on the basis of fictitious stock entry before actual receipt of the medicines.

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