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Item Performance Audit on Public Health Infrastructure and Management of Health Services in Himachal Pradesh(CAG of India, 21-12-2024) CAG of IndiaAs per National Family Health Survey reports, Health indicator1 of the State of Himachal Pradesh was better than national indicators for infant mortality rate, but poorer for sex ratio at birth for children in the last five years and average out-of-pocket expenditure per delivery in a public health facility. Considering the goals laid down in the National Health Policy (NHP), 2017 and experience in COVID-19 pandemic, a Performance Audit on “Public Health Infrastructure and Management of Health Services” in the State of Himachal Pradesh was conducted to assess the adequacy of financial resources allocated, availability of healthcare infrastructure, human resources, drugs, medicines, equipment and other consumables in the health institutions as well as efficacy in the management of health services in the State. The Performance Audit also covered the adequacy and effectiveness of the regulatory mechanism being enforced by the Government to regulate public/private health sector, schemes being implemented by Government of India through the State Government and overall linkage with the Sustainable Development Goal (SDG – 3). The audit was conducted for the period 2016-21 but wherever feasible, the data has been updated upto 2021-22 and in case of human resources, upto March 2023.Item Unfruitful Expenditure and Blocking of Funds on Non Functional SNCUs and SPVs(CAG of India, 23-09-2020) CAG of IndiaFailure of Health and Medical Education Department to procure the medical equipment for SNCU Sarwal over a period of more than two years, post staff for SNCUs Bhaderwah and Gandoh and make two solar power generators functional resulted in unfruitful expenditure of INR 122.18 lakh and blocking of INR 44.82 lakh. The envisaged services for care of newborns could not be ensured despite availability of funds and engagement of additional staff.Item Performance Audit on Public Health Infrastructure and Management of Health Services in Tamil Nadu(CAG of India, 10-12-2024) CAG of IndiaConsidering 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.Item Performance Audit of Public Health Infrastructure and Management of Health Services in Telangana (2016-2022)(CAG of India, 02-08-2024) CAG of IndiaThe Report contains significant results of the Performance Audit on Public Health Infrastructure and Management of Health Services in Telangana State, covering the period 2016-17 to 2021-22. The Performance Audit was carried out with a view to assess the adequacy of funding for health care, the availability and management of healthcare infrastructure and the availability of Drugs, Medicine, Equipment and other consumables. The Performance Audit also sought to examine the availability of necessary Human Resources at all levels, e.g., Doctors, Nurses, Paramedics etc., the implementation of various schemes of the Government of India including the assistance/grants/equipment received by the States and the State spending on Health and improvement of wellbeing conditions of people as per Sustainable Development Goal 3. Audit was conducted covering the period from 2016-17 to 2021-22 through a test-check of records in the Offices of the Secretary, Department of Health, Medical & Family Welfare; Managing Director, Telangana State Medical Services & Infrastructure Development Corporation; Commissioner, HM&FW and Mission Director, National Health Mission; Director of Public Health (DOPH); Director of Medical Education (DME); Commmissioner, Telangana Vaidya Vidhana Parishad, Director of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy; District Hospitals (DHs) in the State; other test checked healthcare facilities included Sub Centres (SCs), Primary Health Centres (PHCs), Urban Primary Health Centres (UPHCs), Community Health Centres (CHCs), Area Hospitals (AHs), Super Specialty Hospitals. Audit also covered Central Medicine Stores (CMSs); Hospitals of AYUSH; Pharmacies; Dispensaries and Government Medical Colleges with attached Teaching Hospitals in the test checked three Districts of Hyderabad, Mahabubnagar and Warangal. A Patients’ Survey, a Doctors’ Survey and a Joint Physical Verification of Health Institutions were undertaken during the course of the audit.Item Idle Expenditure on Construction and Upgradation of Two PHCs in Meghalaya(CAG of India, 19-03-2021) CAG of IndiaExpenditure of ₹ 12.35 crore on construction and upgradation of two Primary Health Centres proved idle as these centres were not made operational thereby, defeating the objective to provide curative, preventive, promotive and family welfare services to the targeted population.Item Idle Expenditure on Staff Quarters at CHC, Sarwan, Deoghar in Jharkhand(CAG of India, 27-08-2015) CAG of IndiaDue to failure of Department to ensure suitability of site in compliance of Electricity rules, 1956 and subsequent non-shifting of 33 KV electric wires, staff quarters remained unoccupied resulting in idle expenditure of ₹ 1.71 crore.Item Non Utilisation of District Training Centre for Women's Health Workers at Wazirpura Tonk Rajasthan(CAG of India, 06-03-2020) CAG of IndiaDistrict Training Centre with hostel facility for Women’s Health Workers, Wazirpura, Tonk was not utilized for 15 years since its completion and this resulted in unfruitful expenditure of INR 1.51 crore on its construction.Item Performance Audit on Public Health Infrastructure and Management of Healthcare Services in Tamil Nadu - Tamil Language Version(CAG of India, 10-12-2024) CAG of IndiaConsidering 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.Item Unfruitful Expenditure on Construction of Dharamshalas at District Hospitals and Community Health Centres in Rajasthan(CAG of India, 05-09-2018) CAG of IndiaLack of planning at the Department level and coordination with the district units resulted in unfruitful expenditure of INR 3.33 crores on construction of dharmshalas at District Hospitals and Community Health Centres.Item Performance Audit on Public Health Infrastructure and Management of Health Services in Maharashtra English Version(CAG of India, 21-12-2024) CAG of IndiaThe performance audit on “Public Health Infrastructure and Management of Health Services in Maharashtra” was conducted to assess the availability of human resources, drugs, medicines, equipment and adequacy and quality of healthcare infrastructure in the State. The funding and expenditure under central and centrally sponsored health sector schemes, adequacy and effectiveness of regulatory mechanisms and the improvement in the health and well-being of people as per Sustainable Development Goal-3 were also assessed. Audit was conducted for the period 2016-17 to 2021-22 through test-check of records at PHD and MEDD.
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