Health is one of the most important parameters for ascertaining the quality of human life. Availability, accessibility and usability of sound healthcare system are essential requirements to meet the challenges in the field of Health. In Gujarat, 21 District Hospitals (DHs), a secondary level hospital and 13 hospitals attached with medical colleges, and one tertiary care hospital on Public Private Partnership (PPP) mode, are functioning at district level to provide preventive, promotive and curative healthcare services to the population. The performance audit on “Delivery of Healthcare Services in Government Hospitals at District Level” was conducted for the period 2010-15 during April and August 2015 and the following deficiencies were noticed -

1. Department had prepared a Five Year Plan for betterment of healthcare services in district level hospitals, however, the plan was not comprehensive as the current status of healthcare services of the hospitals vis-a-vis the requirement as per Indian Public Health (IPH) Standards was not identified. Further, the plan had no specific targets and enshrined timeframe to achieve the targets.
2. The sanctioned strength of all cadres of staff including doctors and nurses remained much below the IPH Standards in some test-checked DHs. The shortfall in the cadres of Specialist Doctors ranged between 29 and 77 per cent, and that of Medical Officers ranged between seven and 69 per cent vis-a-vis IPH Standards. The situation was alarming in DH Surendranagar, DH Godhra, DH Petlad and DH Vadodara where shortage in the cadre of Specialist Doctors was more than 60 per cent as compared with IPH Standards.
3. Availability of beds in DHs was neither as per IPH Standards nor in consonance with the requirements. Out of 13,833 beds available in district level hospitals, 10,645 beds were available in 11 districts to cater to a population of 3.55 crore and only 3,188 beds were available in remaining 22 districts to cater to a population of 2.49 crore. Shortage of beds in test-checked DHs ranged between 52 and 73 per cent. Audit observed instances of highly congested wards and patients lying on the floor; two patients were accommodated on one bed for transfusion of iron sucrose, and patients accommodated in the passageway due to non-availability of vacant beds.
4. Number of essential drugs viz. Amoxycilin, Diclofenac Sodium, Hepatitis B Vaccine, Injection Ceftazimide, Insulin, etc. were not available in the stock for more than four months in all test-checked hospitals. Resultantly, patients were forced to purchase medicines from the open market.
5. Instances of supply of Not of Standard Quality (NSQ) medicines by Gujarat Medical Services Corporation Limited (GMSCL) were noticed in test-checked hospitals. Most of the NSQ medicines were issued to the patients due to delay in receipt of sample testing reports.
6. Essential specialist services of General Medicines, Obstetrics and Gynaecology, Paediatrics, Orthopaedics, Radiology, etc. were either not available or partially available in all test-checked DHs except in DH Palanpur, due to vacant posts of Specialist Doctors.
7. Accident, Emergency and Trauma care services were either not available or were not equipped with essential equipment in test-checked DHs.
8. Intensive Care Units (ICU) meant to attend critically ill patients, were not available in DH Petlad, DH Surendranagar and DH Vadodara. In other test-checked DHs, only one or two ICU beds were fully equipped with life saving equipment to handle critical cases. The situation in test-checked Civil Hospitals (CHs) was also deplorable, as only five and nine ICU beds were fully equipped with life saving equipment as against 11 and 36 available beds in CH Bhavnagar and CH Vadodara respectively.
9. Availability of Gynaecologists, Paediatricians and life saving equipment are essential for delivery of maternal and child healthcare services. Audit observed instances of higher neo-natal and maternal deaths, vacant posts of Gynaecologists and Paediatricians, and lack of life saving equipment and beds in the maternity ward of test-checked DHs. Instances of patients accommodated on the floor were noticed in test-checked DHs.
10. The departments of diagnosis, imaging and blood banks are integral components of a hospital to provide healthcare services. Audit observed that equipment for conducting various tests were not available in the diagnosis and imaging departments in test-checked DHs. Blood bank/blood storage centres were either not established or remained non functional in test-checked DHs except in DH Godhra, DH Surendranagar and DH Himatnagar.
11. Referral management and infection control were not upto the mark in any of the test-checked DHs.
12. IPH Standards prescribed for quality assurance was either not followed or partially followed by the test-checked DHs.