National Disease Control Programme (NDCP)
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Item Performance Audit of National Disease Control Programme in Kerala (1996-2001)(CAG of India, 2002) CAG of IndiaAs part of Health Care Services, the State Department of Health Services is implementing four National Programmes, viz. National Tuberculosis Control Programme, National Programme for Control of Blindness, National AIDS Control Programme and National Leprosy Eradication Programme. A review of the implementation of these programmes except National AIDS Control Programme was featured in the Report of the Comptroller and Auditor General of India for the year ended March 1987 (Civil), Government of Kerala. The report had not been discussed as of June 2001. The four programmes were reviewed in Audit during January - May 2001. The Revised National Tuberculosis Control Programme (RNTCP), a 100 per cent Centrally Sponsored Scheme, was implemented in the State covering all the 14 districts in three phases. A review of the scheme revealed low detection of TB cases due to low percentage of outpatients detailed for undergoing sputum tests, lack of infrastructure facilities for X-ray examination of sputum smear negative and extra pulmonary TB cases, shortage of microscopy centres and non-involvement of Medical College/ ESI/ Private hospitals and NGOs. The National Programme for Control of Blindness, a 100 per cent Centrally Sponsored Scheme was revised during Ninth Plan with the objective of reducing avoidable blindness due to cataract and other diseases to 50 per cent by 2002 AD. Possibility of achieving the above target was remote due to lack of infrastructure facilities for eye surgery, non-achievement of cataract surgery rate of 400 per 1 lakh population, non- functioning of eye banks and non-availability of trained eye surgeons in IOL. The National AIDS Control Programme launched by GOI in 1992 was intended to achieve maintenance of HIV@ prevalence rate below 1 per cent, reduction in blood borne transmission of HIV, creating awareness among youth, etc. The review revealed lack of infrastructure for starting new blood banks even in hospitals where equipment were supplied by National AIDS Control Organisation (NACO), delay in renewal of licence to blood banks leading to illegal functioning of blood banks, non-functioning of blood component separation units leading to lack of optimum utilisation of blood. The National Leprosy Eradication Programme (NLEP) introduced in 1982 envisaged a specialised form of treatment for leprosy known as Multi Drug Therapy (MDT). The review revealed that the NLEP activities introduced with a view to wiping out leprosy could not achieve the expected results despite the fact that the programme has been under implementation for more than 15 years mainly due to non-creation of required infrastructure facilities, lack of man power in critical cadres and lack of supervision and monitoring at all levels (Central, State, District and Unit level). The classification of district was wrongly made based on unrealistic Prevalence Rate (PR) calculated with reference to inadequate coverage of population and defective method of calculation of PR.Item Performance Audit of National Disease Control Programme in Mizoram (1996-2001)(CAG of India, 2002) CAG of IndiaThe review highlights failure of the state government to obtain and utilise the full amount of sanctioned grant of Rs.712.41 lakh from the Government of India during the years 1996-1997 to 2000-2001 under the National AIDS Control Programme, lack of proper monitoring in respect of National Leprosy Eradication Programme (NLEP), National Programme for Control of Blindness and National TB Control Programme for effective implementation of these programmes and shortfall in achievement of targets fixed for different components of these programmes. 1. To avoid the lapse of budget grants, Rs. 11.58 lakh and Rs. 7.38 lakh were drawn in advance of requirement and retained in Civil Deposit during March – September 1996 and March - June 1998 respectively. 2. Under NLEP, the state government incurred excess expenditure of Rs.12.00 lakh during 1996-1997 to 2000-2001, over the Central grant of Rs. 1.28 crore received during the period. 3. Department incurred an unauthorised expenditure of Rs. 11.27 lakh between 1996-1997 and 1999-2000 towards procurement and supply of consumables and equipment to Hospitals, Public Health Centres and Sub-Centres, without having blood bank facilities. 4. The DHS (AIDS Cell) incurred a total expenditure of Rs. 14.54 lakh for conducting training on AIDS programme in 39 locations during 1996-1997 and 1997-1998. But, no records/returns etc., had ever been obtained from any field level officers in support of conducting such training.Item Performance Audit of National Disease Control Programme in Odisha (1996-2001)(CAG of India, 2002) CAG of IndiaReview of implementation of the 'programme for prevention and control of diseases' covering (i) National Aids Control Programme (ii) National Programme for Control of Blindness and (iii) National TB Control Programme (NTCP) for the period from 1996-97 to 2000-2001 revealed several shortcomings. Instances of unspent funds, irregular utilisation of funds, pendency in submission of utilisation certificates, shortfall in achievement of targets, irregularities in purchase and supply of medicines, were common in all the programmes covered. Systems for monitoring and evaluation of the programmes were not in place and the programme objectives remained unachieved. In the Aids Control Programme equipment supplied to blood banks was not utilised/non-functional for 1 to 4 years. The shortfall in coverage under the Programme rendered the State's achievement figures doubtful. State Government was not able to report prevalence rate for blindness. In NTCP there were shortfalls in achievement of the targets and inaccurate reporting of data.Item Performance Audit of National Disease Control Programme in Punjab (1996-2001)(CAG of India, 2002) CAG of IndiaGovernment of India launched several centrally sponsored programmes for prevention and control of diseases, namely National AIDS Control Programme in 1992 and National Programme for Control of Blindness in 1976. A review on the performance of these programmes during 1996-2001 in Punjab State revealed the following : Highlights To contain the spread of the HIV infection in India and to strengthen India’s capacity to respond to the HIV/AIDS on long term basis, the Government of India (GOI) launched a hundred per cent Centrally sponsored National AIDS Control Programme in 1992. The review of the programme revealed several deficiencies in its management and implementation. The implementation was poor in the State as 82 per cent of the available funds remained unutilized during 1996-97. The achievements under sub-components of the programme were not substantial and in most of the cases targets were not fixed. The task of identifying high-risk groups remained ineffective as against the coverage of whole State, only 4 towns were covered and only base line data was compiled. Peer counseling, treatment of STIs and client programmes were virtually absent. The training programme was not complete in all respects as no training was given to medical and para-medical staff in the field. The National programme for control of blindness, a cent per cent Centrally sponsored programme, was launched in 1976 to achieve the goal of reducing the prevalence of blindness upto 3 per thousand of population by year ending 2000. The review of the programme revealed gross deficiencies in programme implementation. The achievements fixed for cataract surgery were inflated by 30 to 45 per cent. Funds released by Government of India (GOI) to Director Health Services (DHS) and DBCSs remained unutilized. There was a lack of monitoring and evaluation of the programme at State level.Item Performance Audit of National Disease Control Programme in Sikkim (1996-2001)(CAG of India, 2002) CAG of IndiaThe programme for Prevention and Control of Disease in Sikkim was characterised by non utilisation of funds, disproportionate establishment expenditure, lack of penetration of facilities to a better part of the State, non-accountal of drug and diversion of funds as under: 1. Revised National Tuberculosis Control Programme was not implemented in the State. 2. The Department was unaware of the total number of TB patients in the State and the programme was characterised by high drop-out rate. 3. The Department could not utilise the central financial assistance of Rs 20.52 lakh during 1996-97 to 2000-01 received for blindness prevention programme. 4. The Blindness Control Programme suffered from severe lack of infra structural capacity as three out of the four districts in the State did not even have any opthalmologist or ophthalmic assistant. 5. The District Leprosy Control Societies could not utilise Rs. 25.10 lakh during 1996-97 to 2000-01. 6. The major portion of expenditure (55 to 74 per cent) by the Leprosy Societies was on pay and allowances and other establishment related expenditure. 7. Anti Leprosy drugs valuing Rs. 9.30 lakh were not accounted for in the records of the Department. 8. Rs. 56.18 lakh could not be utilised by the Aids Cell/ Society as at the end of 2000-01. 9. All the blood-testing facilities were concentrated in the East District leaving the other districts without even the basic facility for detecting AIDS patients or HIV carriers.Item Performance Audit of National Disease Control Programme in Tamil Nadu (1996-2001)(CAG of India, 2002) CAG of IndiaTuberculosis and Blindness are two major diseases which are widely prevalent in the State. National Tuberculosis Control Programme was implemented in the State since 1962 to control Tuberculosis. A revised strategy called Revised National Tuberculosis Control Programme was implemented from 1993 with the objective of achieving cure rate of over 85 per cent through Directly Observed Treatment Short Course Chemotherapy (DOTS). The envisaged cure rate was not achieved in Chennai city and Cuddalore even during 1999-2000. The DOTS was not introduced in 7 districts and implemented late in 23 districts. There were shortfalls in sputum examination, anti-TB drugs were not available at times, follow-up of treatment was poor and treatment was discontinued mid-way in several cases. Inadequate sputum culture facilities and shortage of staff also contributed to poor performance. National Blindness Control Programme from 1976 and a World Bank Assisted Cataract Blindness Control Project from 1994 were being implemented in the State with the goal of reducing prevalence of blindness to 0.3 per cent by 2000 AD. As the physical targets for performing cataract surgeries were fixed by Government of India arbitrarily without taking into account all the parameters, the backlog of cataract surgeries in the State was 0.9 per cent as of March 2001 as against the envisaged rate of 0.3 per cent. The main reasons for the high prevalence rate were poor performance under Government Sector mainly due to less number of cataract operations performed by the surgeons and poor performance of Ophthalmic Assistants in mobilising and enrolling patients for surgeries, poor utilisation of funds under consumables, IEC activities and poor follow-up.Item Performance Audit of National Disease Control Programme in Tripura (1996-2001)(CAG of India, 2002) CAG of IndiaThe main objective of the programme for prevention and control of diseases remained unfulfilled for lack of effective planning. Inadequate infrastructural facilities and shortage of manpower coupled with failure to perform the prescribed duties by some of the crucial functionaries plagued the programme. Leprosy Eradication Control Programme suffered due to lack of re-constructive surgery facilities for rehabilitation of the leprosy patients. Following are the main audit findings: 1. Against the release of grants of Rs. 6.67 crore (including spillover funds of Rs. 0.46 crore) by the Government of India between 1996-97 and 2000-2001, Rs. 5.65 crore only was spent, as of March 2001. 2. As the number of sputa examined (67,124) had substantially been lower by 63 per cent than the target(1,81,070) for the years 1996-97 to 2000-2001, there remained the danger of a large number of sputum positive cases going undetected every year. This resulted in the chain of transmission of tuberculosis virtually remaining unbroken. 3. Against 78,525 sputa required to be examined in 20 Peripheral Health Institutions of the District Tuberculosis Centre, Agartala, during 1996-2001, a target for examination of 59,500 sputa was fixed, out of which 28,706 sputa were actually examined indicating a shortfall of sputum examination by 63 per cent with reference to the norm. 4. Supervision of peripheral health institutions by District Tuberculosis Centres fell much short of prescribed standards. Against the requirement of 244 visits per year in 61 PHIs, the visits actually paid were 77 and 101 during 1999-2001. 5. 4,910 suspected leprosy cases identified during Modified Leprosy Elimination Campaign in 1998-99 were not brought under treatment due to lack of bacteriological testing facilities. Further, leprosy patients were released from treatment without identifying their Bacterial Index. 6. Against the requirement of 30,000 cataract operations by 4 District Mobile Eye Units during 1996-2001, a target of 26,000 operations was fixed; of this, 13,723 operations only were carried out. 7. Against the total number of children (1-6 years) ranging from 1,91,640 (1996-97) to 2,14,500 (2000-2001), the number of children covered by vitamin A solution ranged from 76,024 to 96,784, indicating a coverage of 37 to 49 per cent only. 8. The performance of Family Health Awareness Campaign was very poor. Against the targeted population ranging from 5.64 lakh to 7.74 lakh in 24 Health Institutions, actual attendance in the camps ranged from 4 to 5 per cent and the STD patients covered by treatment ranged from 18 to 29 per cent of the cases identified. 9. Five Blood Banks in the State claimed by the Department to have been modernised were found not to have been actually modernised as only 11 items of equipment out of 40 major items were provided to the blood banks. Spreading of HIV infection from the infected persons was allowed to continue unchecked as persons afflicted with HIV/AIDS were neither informed of the disease, nor treated and provided with counselling, as envisaged in the programme.Item Performance Audit of Prevention and Control of Diseases Programme in Arunachal Pradesh (1996-2001)(CAG of India, 2002) CAG of IndiaThe review highlights failure of the State Government to utilise Central assistance of Rs.1.44 crore (National TB Control Programme – Rs. 0.20 crore, National Programme for Control of Blindness – Rs. 0.40 crore and National Aids Control Programme – Rs.0.84 crore), non-implementation of Revised strategy for National Tuberculosis Control Programme (RNTCP), non-establishment of eye bank, unnecessary blockade of fund, shortfall in achievement of targets fixed for different components of these programme and lack of proper monitoring of implementation of these programmes. Main audit findings are summarised below: 1. Against total releases of Rs. 5.03 crore (Rs. 0.27 crore RNTCP, Rs. 0.58 crore NPCB and Rs. 4.18 crore NACP) by the Government of India, Rs. 3.59 crore were utilised during 1996-2001 leaving Rs.1.44 crore (29 percent) unspent. 2. Under RNTCP, none of the 4 DTCs could start functioning due to delay in formation of societies. 3. Under NTCP, in 7 out of 13 districts in the State, no DTCs were established. Even the 6 functional DTCs were not provided with all the essential equipment. 4. Unproductive expenditure of Rs.8.71 lakh due to non-functioning of the State TB Training Demonstration Centre at Naharlagun. 5. Nine districts with a population of 5.45 lakh were deprived of the benefit of district mobile eye units (DMUs) due to non-appointment of eye specialist etc. for 4 districts and non-sanctioning of the DMUs for 5 districts. 6. Shortfall in achievement in cataract surgery during 1996-2001 varied from 35 to 73 per cent. 7. No eye bank was established either in the Government sector nor by NGOs. 8. Unnecessary locking up of fund of Rs.13.00 lakh for purchase of 6500 wall clocks for distribution/display to different hostels/schools prior to selection of NGO. 9. Doubtful expenditure of Rs.7.19 lakh for procurement of consumables, reagents etc.Item Performance Audit of National Disease Control Programme (NDCP 1996-2001)(CAG of India, 2002) CAG of IndiaThere is no single framework of National Disease Control Programme as such. It is a cluster of programmes encompassing a wide range of major diseases which have commenced at different periods of time and with different methodologies and approaches. All such programmes contribute eventually to the efforts of the Government to treat, prevent and control major diseases like Cataract Blindness, Tuberculosis, Leprosy and Acquired Immune Deficiency Syndrome (AIDS) in the country. Schemes relating to two of these major diseases, namely Blindness and Tuberculosis were selected in audit for review by the CAG of India, mainly because these diseases are geographically more wide-spread, the programmes have been in operation for a long period, using large sums of resources and have undergone significant policy changes over time. Section I deals with National Programme for Control of Blindness (NPCB) and Section II deals with National Tuberculosis Control Programme (NTCP).