Bihar is the third most populous state in India accounting for 8.6 per cent of the total population of the country. The national average of governmental doctor nurse-midwife population ratio is 221 for one lakh population against which the State’s average was just 19.74. As per NITI Aayog, Bihar was placed at lowest ranking in key inputs/ processes domain which relates to availability of health systems, service delivery, accreditation etc. and third lowest in health outcomes domain which includes Still Birth Rate, Neonatal Mortality Rate, Under five Mortality Rate, Maternal Mortality Ratio (MMR), Total Fertility Rate (TFR), Low Birth Rate, Sex Ratio at Birth, immunisation coverage, institutional deliveries, tuberculosis cases and treatment success rate and HIV patients.

Despite the critical shortage of doctors, nurses and other paramedical staff in Bihar, there was no long-term strategic plan to assess the requirement of medical institutions for addressing the gap in availability of trained healthcare personnel. During the period from 2006-07 to 2016-17, Government of Bihar planned to establish 12 medical colleges, 113 nursing institutes and 33 paramedical institutes. However, the projects undertaken for construction of new medical colleges and subsequent capacity enhancement were excessively delayed. Projects taken up during 2007-08 (medical colleges at Madhepura and Bettiah, dental college at Nalanda and several nursing institutes) could not be completed even after a decade. Admissions were not undertaken in the last 10 years in four out of five Ayurveda colleges due to nonfulfilment of CCIM norms. Plans to increase seats in medical colleges could not materialise for want of adequate infrastructure and teaching staff. Despite the severe shortage of medical institutions in Bihar, even the existing institutes were running with vacant posts of teaching staff ranging from six to 56 per cent and non-teaching staff ranging from eight to 70 per cent, resulting in shortfall in teaching hours.

Deficient financial management was evident from savings of 25 per cent under the plan head during 2013-18, attributable to inordinate delays in construction projects. Audit observed instances of inadequate infrastructure like over-crowded classrooms and libraries, absence of laboratories, required equipment and books, and pathetic conditions in hostels which not only violated the norms prescribed by the regulatory authorities but also created an environment not conducive to academic pursuit. Rural internship to aspiring medical students suffered from various shortcomings thereby depriving the interns of a holistic exposure to the rural scenario and the capacity to function independently in the future.

Deficient monitoring and supervision of the medical institutions by the Department was evident as audit observed instances where students were granted admission on the basis of forged marksheets or by resorting to fraudulent practices as well as admission of students in excess of the sanctioned seats.