Considering the importance of infrastructure and management of health services in ensuring a healthy nation and the priority accorded to health by both the Central and State Government, CAG took up this Performance Audit covering the activities during 2016-22. The objectives of this Audit were to assess the: (1) adequacy of the funding for healthcare, (2) availability and management of healthcare infrastructure, (3) availability of drugs, medicines, equipment and other consumables, (4) availability of necessary human resource at all levels, (5) effectiveness of implementing GoI schemes, (6) adequacy and effectiveness of the regulatory mechanisms for ensuring quality healthcare services and (7) achievements against Sustainable Development Goal (SDG) 3 targets. Major Findings More than 75 per cent of shortage was found in certain posts like in Block Extension Educator, Family Welfare Assistant/Educator, Lady Health Visitor, Maternity Child Health Officer etc., in the Directorate of Family Welfare. Recruitment of medical manpower lagged despite constituting a separate Board for recruitment of medical manpower. Further, large number of vacancies in the HCFs under the Directorate of Indian Medicine and Homoeopathy would not augur well for popularizing alternative medicines, which is a policy of Government. GPS devices were not used in 25 per cent emergency calls resulting in non-availability of the details of ambulances that were in the vicinity of the accident/emergency site on a real-time basis.
Thirty six per cent of total deliveries were performed through Lower Segment Caesarean Section (LSCS) during 2019-21 in Government HCFs against the all India average of only 14 per cent. There were non-supply/short supply of drugs to the hospitals. There were deficiencies such as procuring of short-expiry drugs, non-blacklisting of suppliers for deficiencies in supply, issues in quality control, etc. Lapses on the part of Tamil Nadu Medical Services Corporation (TNMSC) resulted in lifting of non-standard quality drugs for issue to the patients by Healthcare Facilities. The equipment at HCFs did not have a subsisting Annual Maintenance Contract (AMC). The Heads of the sampled hospitals did not monitor the performance of Bio-Medical Engineers and failed to furnish the list of equipment to TNMSC for arranging AMC. There were serious disconnect between the HCFs and the TNMSC in assessing the requirement and procuring only the required equipment resulting in procurement of unnecessary equipment. As against National Health Policy’s recommendation of earmarking eight per cent of the budget for health, Government spent only around five per cent of its budget for health. GoTN had no system to prioritise developmental activities based on gap analysis through formal facility survey. Huge unutilized funds, sanctioned for procurement of drugs and equipment, were held by TNMSC and Tamil Nadu Medicinal Plant Farms and Herbal Medicine Corporation Ltd (TAMPCOL). Due to the absence of a formal facility survey and gap assessment, GoTN could not prioritise the areas requiring development. The building constructed for the National Centre for Ageing was not commissioned for more than two years due to non-provision of required manpower and equipment. Janani Suraksha Yojana was not paid to 26 per cent out of all institutional deliveries in the sampled HCFs. Only 46 per cent of mothers who gave birth in Government HCFs in the State were provided transport to their residences by Government/outsourced vehicle under Janani Shishu Suraksha Karyakram. There was in-ordinate delay of 21 years in framing Rules under the Tamil Nadu Clinical Establishments (Regulation) Act, 1997, leading to slackness in monitoring the working of private medical institutions. Government healthcare facilities were not proactive in getting certified under National Accreditation Board for Hospitals and Healthcare Providers and National Quality Assurance Standards, leading to non-institution of systems for ensuring the quality of service.
GoTN did not monitor all the targets under SDG-3.