Health Sector Reforms Programme

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https://resourcerepository.azimpremjiuniversity.edu.in/handle/apurr/107

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    Performance Audit of Health System Development Project in Uttar Pradesh (2000-2003)
    (CAG of India, 2004) CAG of India
    The UP Health System Development Project (UPHSDP), an externally aided project, aimed at bringing about structural and qualitative changes in the health sector so as to transform it into a modern, responsive and accountable system to provide high quality, affordable and integrated health service. The project is to be implemented during December 2000 to December 2005 at a cost of Rs. 478.07 crore (reimbursable Rs.411.11 crore and State share Rs.66.96 crore). Audit scrutiny revealed that the implementation of the project was unsatisfactory as even after half of the period prescribed for implementation was over, physical and financial progress in many critical areas were lagging behind the target. The monitoring mechanism was not effective. Indications were towards time overruns and resultant cost overrun culminating into delays/ denial of the benefits envisaged in the project to the targeted beneficiaries.
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    Performance Audit of State Health Systems Development Project in Karnataka
    (CAG of India, 2004) CAG of India
    The Karnataka Health Systems Development Project (Project) was launched in April 1996 with the assistance of World Bank at an estimated cost of Rs.546 crore to strengthen the secondary level of health care by providing in-patient and out-patient care with diagnostic and treatment facilities that were not available at the primary level. The project was to become operational by the end of 2001-02. Due to slow progress, however, the implementation of the project was extended by two years. The project is expected to be completed by March 2004. The performance audit of the implementation of the Karnataka Health Systems Development Project covering the period 1996-97 to 2002-03 revealed that lack of planning in the execution of civil works resulted not only in cost and time overrun but also reallocation of funds for civil works at the cost of other components of the project. Deviations to original plan of procurement, distribution and poor utilisation of equipment coupled with non/short procurement of drugs and deficiencies in deployment of doctors affected adversely the delivery of health care services. Ineffective functioning of referral system in the first referral hospitals and non-implementation of IEC strategy also affected adversely the delivery of medical services and achieving the envisaged objective of the project.
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    Performance Audit of Andhra Pradesh Health Sector Reform Programme
    (CAG of India, 2015) CAG of India
    Government implemented a Department for International Development (DFID) supported Health Sector Reform Programme (APHSRP) during July 2007 to June 2010. APHSRP was within mission period of National Rural Health Mission (2005-12) and most of the outputs and key reform measures initiated by the State Government under APHSRP were aspirations outlined in NRHM. This performance audit was taken up to assess whether reforms in health sector initiated in 2007 and key policy changes enunciated by Government to achieve the outputs outlined in reforms have been implemented effectively in terms of • creation of adequate infrastructure and other envisaged services to facilitate access to quality and responsive health services; • setting up institutional mechanisms for community participation; • optimal efficiency in health care delivery system, including manpower planning through improved governance and management of health sector; and • strengthened financial management systems. Major Audit Findings: The primary objective of health reforms of improving accessibility to health care facilities in rural and tribal areas largely remained unfulfilled. Norms prescribed for infrastructure, manpower and equipment were not complied with. Positioning of ASHAs and providing adequate drug kits to them was not given adequate attention. There were shortages in both medical and paramedical staff, especially personnel skilled in specialised branches of medicine at primary, secondary and tertiary health care centres. The objective of Fixed Day Health Services programme of providing medical facilities to habitations beyond three kilometres from SCs/PHC was partially fulfilled. Release of funds under emergency response is based on actual expenses as per SoEs and there was considerable variation in number of vehicles operated as per CFW and database. Replacement/refurbishment of vehicles was delayed. Implementation of Aarogyasri suffered from several deficiencies. Several inconsistencies were noticed in database like non-matching of ration cards with Civil Supplies data, claims exceeding pre-authorised amounts, etc., indicative of lack of proper internal controls and validation controls for effective implementation of online IT application. Further, due to non-operationalisation of Health Management Information System (HMIS), the envisaged objective of effective control/monitoring of financial as well as physical activities remained unfulfilled. Procurement was marked by delay in supply of drugs/surgicals from suppliers. Monitoring of drug control including licensing functions was ineffective. Thus, the key reform measures initiated by State Government with regard to health sector have not translated into desired levels of action, resulting in the envisaged outputs not being achieved.