This Standalone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of secondary care (District-level Hospitals) and primary care (one CHC and one PHC of State Capital District) in the State of Sikkim covering the period 2014-15 to 2018-19. The Comptroller and Auditor General of India (CAG) has reviewed the provision of healthcare services by Government of Sikkim, at periodic intervals. The C&AG had earlier (Report No. 3 of 2011) reviewed the Functioning of Primary Health Centres (PHCs) and Community Health Centres (CHCs) of the State In this Performance Audit, we have focused on patient care given by the secondary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected DHs and various Services provided therein like Out-Patient and In-patient Services, Maternity Services, Emergency Services, Drug Management, Infection Control, Bio Medical Waste Management, Diagnostic Services, Fire control measures etc. based on pre-determined performance indicators/ criteria in the sampled district level and block level hospitals (CHC and PHC). We have adopted the Indian Public Health Standards (IPHS) guidelines as prescribed by Government of India which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings. Audit Objectives: The objectives of carrying out this Performance Audit of select district hospitals were to assess whether: i. adequate and essential resources - manpower, drugs, infrastructure, equipment, and consumables were available for effective functioning of the district hospitals; ii. timely and quality healthcare was delivered through line services like OPD, IPD, ICU, OT, trauma & emergency, etc. and diagnostic services; iii. support services like drug storage, sterilisation, hygiene, waste management, infection control, ambulance, power back-up/ UPS, etc. were aiding the line departments in providing a safe and sterile environment in the hospitals; and iv. adequate and timely healthcare services were available in selected services relating to maternal and infant care.