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Item Performance Audit of Four Major Public Hospitals in Delhi (2001-2006)(CAG of India, 2007) CAG of IndiaA performance audit of the functioning of four major public hospitals in Delhi was conducted to assess their performance in terms of providing proper medical care by efficient use of available resources and infrastructure. The hospitals reviewed were Lok Nayak Hospital (LNH) and Deen Dayal Upadhyay Hospital (DDUH) under the Government of Delhi, Hindu Rao Hospital (HRH) under the Municipal Corporation of Delhi and Charak Palika Hospital (CPH) under the New Delhi Municipal Council.Item Performance Audit of Seven National Institutes of Pharmaceutical Education and Research(CAG of India, 2020) CAG of IndiaThis is a performance audit of seven National Institutes of Pharmaceutical Education and Research (NIPER). The Government of India set up the National Institute of Pharmaceutical Education and Research (NIPER) at Mohali as per the provisions of the NIPER Act, 1998 to nurture and promote quality and excellence in pharmaceutical education and research. Subsequently, in the year 2007, the NIPER Act was amended and accordingly in August 2007, the Union Government granted in-principle approval to set up six new NIPER at Hyderabad, Ahmedabad, Kolkata, Guwahati, Raebareli and Hajipur which started functioning from 2007-08. A test check of records was carried out to assess whether the Governance structure prescribed under the Act is in place and adequate infrastructure facilities, faculty, technical and administrative staff for the NIPERs was available, to achieve the objectives envisaged under the Act. The audit criteria were derived from the NIPER Act and related statutes and manuals, minutes of the Board of Governors (BoG) /Steering Committee meetings, agreements signed between NIPER and respective State Governments, Memorandum of Understanding (MoU) signed between mentor Institutes and MoCF and relevant records of the seven NIPERs and DoP/MoCF.Item Avoidable Expenditure on Water Supply Contract for District Hospitals in Mizoram(CAG of India, 16-02-2023) CAG of IndiaDirectorate of Hospital and Medical Education (DHME), Health and Family Welfare Department, Government of Mizoram (GoM), Aizawl entered (May and December 2012) into Memorandum of Understandings (MoU) with a firm M/s Intergen Energy Limited (IGEL), New Delhi for installation of renewable energy and water treatment plant to supply water at nine Hospitals which include Referral Hospital, Falkawn and all eight District Hospitals of Mizoram. This was based on the suo-moto proposal submitted (February 2012) by the firm to GoM, for installation of Water Treatment Plant with solar power water pumping system to supply water on the basis of BOOT at the nine Hospitals. Audit observed that all Hospitals were getting water supplies on priority from Public Health Engineering (PHE) Department and there were no insufficiency in supply of water to the Hospitals reported, before or during the period of MoU with IGEL. Hence, engagement of IGEL was arbitrary and proposal of the firm was agreed to by the Department without ascertaining the actual need for water supply in the Hospital. Thus, expenditure of ₹ 0.50 crore for installation of Water Treatment Plants in five Hospitals and ₹ 4.80 crore on buy-back MoU in June 2019 totalling ₹ 5.30 crore was avoidable as there was no scarcity of water in the Hospitals prior to signing of agreement with the firm. Hospitals also did not report any issue in water supply during the stoppage of operation of the firm. Hence, there was a total avoidable expenditure of ₹ 5.30 crore in addition to committed liability of ₹ 4.20 crore against the balance payable on MoU on buy-back of equipment and water supplied. Further, Department, was supposed to terminate the MoUs on failure of IGEL to supply the required volume of water but entered into an unnecessary buy-back agreement.Item Unfruitful Expenditure Due to Non Functional Trauma Hospital at Khellani Jammu and Kashmir(CAG of India, 23-09-2020) CAG of IndiaFailure of Health and Medical Education Department to make the Trauma Hospital Khellani functional through posting of necessary staff and provision of laboratory/ diagnostic facilities, operation theatre, blood bank and ambulance etc., has rendered the investment of INR 394.59 lakh unfruitful.Item Performance Audit of National Rural Health Mission (NRHM) in Jammu and Kashmir(CAG of India, 2009) CAG of IndiaGovernment of India launched (April 2005) the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the basic health-care delivery system. The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, decentralization and district management of health programmes, community participation and operationalising community health centres into functional hospitals. The performance audit review of implementation of NRHM in Jammu and Kashmir showed that the status of health profile of the State has been quite encouraging vis-à-vis the performance indicators available for the country. These can be further improved if there is proper fund management/utilisation and various sectors involved are covered in conformity with the guidelines issued for implementation of the Programme. There are large gaps in planning as well as implementation of the Mission activities in the State even after four years of launching the programme. This is evidenced by the findings that no new health centre was put in place, essential services and amenities were not available in many centres and there was critical shortage of technical manpower. Maternal and child health programmes have not made much headway. Planning, implementation and monitoring of the programme through participation of NGOs and community-based organisations was nonexistent.Item Performance Audit of District Hospitals in Manipur(CAG of India, 2021) CAG of IndiaThis Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of tertiary care (Medical College & Hospitals), secondary care (District-level Hospitals), and primary care (one CHC and one PHC in selected districts) in the State of Manipur covering the period 2014-15 to 2018-19. In this Performance Audit we have focused on patient care given by secondary and tertiary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected DHs and various Services provided therein like Out-Patient and In-patient Services, Emergency Services, Drug Management, Infection Control, Bio Medical Waste Management, Diagnostic Services, Fire control measures etc. and select services of maternity and child care, Cancer and HIV/ AIDS, based on pre-determined performance indicators/criteria in the sampled hospitals. We have adopted the Indian Public Health Standards (IPHS) guidelines as prescribed by Government of India, which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings.Item Procurement of Disposables at Higher Cost in Karnataka(CAG of India, 09-12-2020) CAG of IndiaFailure of the Karnataka Institute of Medical Sciences, Hubballi to finalise its tender for procurement of disposables within the scheduled time resulted in re-tendering and additional expenditure of INR 1.18 crore.Item Performance Audit of National AIDS Control Programme in Bihar (1998-2003)(CAG of India, 2004) CAG of IndiaNational AIDS Control Programme aimed at reducing the spread of HIV infection and strengthening the country's capacity to respond to HIV/AIDS on a long term basis. Implementation of the programme in the State suffered mainly due to absence of proper monitoring mechanism. Physical progress in the components of targeted intervention for high risk groups and prevention of HIV/AIDS among low risk groups was either nil or marginal except in the case of condom promotion. Blood banks lacked basic infrastructure facilities. No community centre was set-up for low cost AIDS care. Institutional strengthening was weak. Inter-sectoral collaboration was absent. Thus, the intended objective of reducing spread of HIV infection and strengthening country’s capacity to respond to HIV / AIDS on a long term basis was not achieved to a large extent. Main audit findings are summarised below: 1. During 1998-2002 due to poor spending only 46 per cent (Rs 11.14 crore) of funds allocated (Rs 24.27 crore) by GOI were released. Excess expenditure of Rs 0.49 crore during 1999-2003 on awareness campaign was incurred by diverting funds from different components. Against an allocation of Rs 15.00 lakh relating to civil works, AIDS Control Society advanced Rs 1.17 crore to District Magistrates in March 2003 for construction of rooms for blood banks without approval of NACO. 2. Physical progress in the components of targeted intervention for high risk groups and prevention of HIV/AIDS among low risk groups was dismal during 1998-2003. Lack of mandatory equipments like air conditioners and elisa readers in blood banks rendered the blood banks ineffective. 107 equipments supplied by NACO to 15 blood banks for their modernisation were non functional as the blood banks had no operational license from appropriate authority. Even in seven licensed blood banks 168 equipment supplied by NACO were lying idle. 3. Low cost AIDS care was not initiated in the State as no community care centre was set-up. 4. Intersectoral collaboration was non-existent. Level of awareness development was low and no society was formed at district level for effective implementation of the programme. 5. The number of AIDS cases which was 10 in 1998-99 increased to 63 in 2001-02. 6. There was absence of effective monitoring mechanism of the programme. The reports on the impact analysis of the programme done by ORG Centre (May 2000) and World Bank Mission (May 2002) were not available with the state Government.Item Excess Payment to Contractors on IFMS at Eight Super Speciality Hospitals in West Bengal(CAG of India, 25-03-2022) CAG of IndiaWest Bengal Medical Services Corporation Limited made an excess payment of INR 4.93 crore to three contractors for Integrated Facility Management Services in eight Super Specialty Hospitals during March 2018 to August 2020, as it allowed payment in excess of carpet area in deviation from bid documents.Item Performance Audit on Drugs and Cosmetics Act in Gujarat (1997-2003)(CAG of India, 2004) CAG of IndiaThe Drugs and Cosmetics Act 1940 (Act) is a Central Act to be implemented by all the States. The Act along with the other associated Acts and the rules made thereunder regulate the import, manufacture, distribution, sale and clinical research of drugs and cosmetics. In Gujarat, huge shortage of Drug Inspectors adversely affected the functioning of the Drugs and Cosmetics Act and the menace of spurious drugs continued to prevail. No follow-up action was taken to withdraw the drugs declared as not of standard quality from the market. The licensing system was ineffective and the DCA did not maintain proper record. Monitoring at State level was poor. Thus the objective of prevention of the menace of spurious drugs to eliminate the danger to human life had not been achieved. Following are the main audit findings: 1. Inadequate strength of technical staff weakened the enforcement of the Administration and diluted regulatory functions. 2. There was sharp increase in pendency in the cases of prosecution. 3. Sales of drugs without complying with the conditions of licences were noticed. 105 sales licences were issued to pharmacies without registered pharmacists to supervise sales in contravention of the provisions of the Act. Shortfall in inspections ranging from 54 to 69 per cent (manufacturing units) and from 63 to 77 per cent (selling units) was noticed. Two Blood banks with serious deficiencies collected 5948 units of blood. Real magnitude of spurious/Not of Standard Quality drugs sold in the market could not be assessed due to inadequate sampling. Under-utilisation of capacity of the laboratory resulted in delay in testing and follow up action. Inordinate delay in despatch of the drug samples to the testing laboratory resulted in delayed declaration of NSQ drugs. Delayed declaration of NSQ drugs resulted in selling of NSQ drugs before they could be withdrawn. 4. Sub-standard drugs worth Rs.68 lakh purchased by CMSO and ESIS were not replaced.