Audit observed that the test-checked teaching Government Ayurved Hospitals (GAHs) and Government Homoeopath Hospital (GHH) had provided Out Patient Department (OPD) and In-Patient Department (IPD) services to more number of patients annually as against the minimum number of patients prescribed in the Regulations of Central Council for Indian Medicine (CCIM) and Central Council for Homoeopathy (CCH). However, following deficiencies were noticed during the course of Audit -

1. National Health Mission (NHM) and National AYUSH Mission (NAM) envisaged for mainstreaming of AYUSH by allocating AYUSH services at Primary Health Centres (PHCs), Community Health Centres (CHCs) and District Hospitals (DHs) however, Health and Family Welfare Department (H&FWD) could appoint AYUSH doctors on contractual basis in only 911 PHCs out of 1,474 PHCs, and no appointment of AYUSH doctors were made in 363 CHCs and 24 DHs in the State. The Doctors appointed in these PHCs could not provide the AYUSH services due to lack of coordination between the Commissionerate of Health and Directorate of AYUSH in establishing a mechanism for supply of AYUSH medicines through the Pharmacies and adequate facility of equipment/instruments. AYUSH hospitals were not available in eight out of 33 districts in the State.
2. Projects already planned were either not taken up or projects completed were not put to use which included projects planned for establishment of GAHs in two districts without facility of AYUSH services. Out of 15 wellness centres established in test-checked hospitals, seven centres were non-functional. Only average 3.97 per cent of budget provision of H&FWD was allocated for AYUSH during 2014-19. Government of Gujarat (GoG) could utilise only 56 per cent of Government of India (GoI) grant received under NAM. Facilities of Operation Theatres (OTs) were either not available or non-functional in 10 out of 15 test-checked GAHs. Instruments prescribed as per CCIM and CCH Regulations for OTs, laboratories and diagnostic units were either not available or found lying idle in the test-checked hospitals. Reducing trend in number of patients taking thalassemia treatment were found in test-checked thalassemia specialty clinics of test-checked hospitals due to absence of expert Vaidhya. Stock of 148 to 251 EDs were not available in 15 test-checked GAHs as of March 2019. Instruments/ equipment in some test-checked hospitals were found lying idle or in non-usable condition. Shortage of key posts such as Resident Medical Officers, Nurses, Vaidya Panchkarma and Pharmacist were noticed in test-checked GAHs and GHH. Out of 32 testchecked Ayurved and Homoeopathy dispensaries, five dispensaries were functioning without Medical Officer.
3. Full coverage of syllabus in AYUSH medical colleges was found doubtful, as actual teaching hours imparted for both theory and practical sessions were much less than the teaching hours prescribed under CCIM Regulations, 2016. Only 43 per cent students and 54 per cent students had prescribed 75 per cent attendance in theory and practical subjects respectively in test-checked Government Ayurved Colleges (GACs). Shortage of teaching staff (Professors, Readers and Lecturers) were observed in four out of six testchecked GACs. The above facts of not completing the prescribed hours of teaching, lack of required attendance of classes for students and shortage of teaching staff had adverse bearing on pass percentage of students in Bachelor of Ayurvedic Medicine and Surgery (BAMS) in the State as 45 per cent students had failed the examination. None of the test-checked colleges had the facility of teaching pharmacy and quality testing laboratory for providing practical training on preparation of medicines/drugs. Facility of in-house Central Research Laboratory (CRL) for Post Graduate (PG) course was not available in the two test-checked colleges which provided PG course.
4. Drugs manufactured in the two test-checked Government Ayurved Pharmacies were supplied without conducting quality tests. Co-operative Pharmacy at Odhav, Ahmedabad were manufacturing and supplying drugs without valid licence. None of the test-checked pharmacies were mentioning the expiry dates of medicines. Drug inspectors of test-checked districts had failed to conduct the prescribed inspection of all manufacturing units of Ayurved and Homoeopathy medicines. Out of 1,520 AYUSH drug samples tested during 2014-19, 87 samples were found of ‘Not of Standard Quality’ (NSQ). NSQ drugs were not recalled in 27 out of 30 cases test-checked and the drugs were found as consumed. Instances of delay in testing of drug samples and non-conduct of prescribed tests by Food and Drugs Laboratory (FDL) were noticed in audit. Existing allopathic drug inspectors and analysts of the State were notified for AYUSH by GoG in contravention of the provision of Drugs and Cosmetics (D&C) Rules which envisage for minimum Ayurveda, Siddha or Unani (ASU) qualification.
5. Even after lapse of more than six years, the Centre of Excellence (CoE) could not complete the five activities of research assigned to it. Research projects under NAM were not completed. Shortfall in inspection of AYUSH dispensaries by the District Ayurved Officers (DAOs) were noticed during 2014-19.