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Item Performance Audit of Upgradation of Govt Medical Colleges in Maharashtra (Marathi Version)(CAG of India, 2020) CAG of IndiaA centrally sponsored scheme of “Strengthening/Up-grading of State Government Medical Colleges (SUSGMC)” through financial assistance for starting Post Graduate (PG) courses by creating PG seats for new PG courses and increasing PG seats of existing courses was launched by the Ministry of Health and Family Welfare (MoHFW), Government of India (GoI) at the end of the 11th Plan and the scheme had a validity period of entire 12th Plan period (2012-13 to 2016-17), further extended up to March 2019. The scheme funds were directly released to the GMCs by the MoHFW (GoI) on the basis of recommendations of the Technical Evaluation Committee (TEC) under Directorate of Health Services and after the approval of the Empowered Committee (EC). Based on the TEC visit to the GMCs between 13.09.2010 and 16.09.2010 and its recommendations MoHFW selected 11 GMCs (11.10.2011 and 26.12.2011), in Maharashtra for implementation of the scheme and approved a total fund of INR 345.79 crore with central share (75 per cent) of INR 259.34 crore and State share (25 per cent) of INR 86.45 crore. This amount was approved for starting PG courses by creating 116 PG seats in two GMCs and increasing 409 PG seats for 112 existing courses and creating 167 PG seats for 60 new PG courses in remaining nine GMCs by creating new capital assets, upgrading medical equipment and appointment of faculty. This performance audit was conducted to assess whether appropriate planning was done for effective and efficient implementation of the scheme, adequate funds were provided, monitoring was effective and envisaged outcomes of the scheme were achieved. Audit examined records in all 11 Government Medical Colleges and in the Directorate of Medical Education and Research, Government of Maharashtra for the period from 2011-12 to 2018-19.Item Performance Audit on Medical Education in Bihar (2013-2018)(CAG of India, 23-03-2021) CAG of IndiaBihar 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.Item Strengthening and Upgradation of Medical Colleges for Increase in PG Seats in Telangana(CAG of India, 26-03-2021) CAG of IndiaThe objective of increasing the Post Graduation seats and the commensurate increase in infrastructural facilities in the three identified medical colleges could not be fully achieved as the funds committed were not applied to the project.Item Non Functional Multidisciplinary Research Units in Telangana(CAG of India, 26-03-2021) CAG of IndiaFailure to meet the project milestones and pre-requisites as per GOI time schedule coupled with non-release of subsequent funds by GoI resulted in non-functioning of the MRUs. The objective of bridging the gap in the infrastructure in the Medical Colleges and promoting research in non-communicable diseases having impact on public health remained unachieved.Item Internal Control System in Medical Education Department in Andhra Pradesh(CAG of India, 2008) CAG of IndiaInternal Control is an integral component of an organisation’s management processes which is established in order to provide reasonable assurance that the operations are carried out effectively and efficiently, that financial reports and operational data is reliable, and that the applicable laws and regulations are complied with so as to achieve organisational objectives. A review of internal controls of the Medical Education Department in Andhra Pradesh during the years 2002-07 has shown that there was lack of discipline in Budget preparation, weak expenditure controls, poor implementation of Central/State financed schemes and disregard for the codal provisions as well as the instructions issued by Government/Director of Medical Education (DME). Internal Audit was ineffective. Overall, these adversely affected the quality of medical care to public and medical education to students.Item Non Completion of Para Medical College Building at Jodhpur in Rajasthan(CAG of India, 21-08-2020) CAG of IndiaImproper assessment of requirement and delays in execution of project resulted in non-completion of Para Medical College building even after lapse of seven years and incurring an expenditure of INR 3.89 crore, as well as failure in obtaining pending instalment of central grant amounting to INR 3.36 crore.Item Non Obtaining of Recognition from Rehabilitation Council of India for Paramedical Courses(CAG of India, 22-09-2022) CAG of IndiaThe Department initiated paramedical courses without obtaining recognition from Rehabilitation Council of India (RCI) which led to discontinuance of courses, adversely impacting the career prospects of enrolled students and resulting in infructuous expenditure of INR 1.40 crore incurred on infrastructure and equipment as well as blockage of unutilized funds amounting to INR 1.15 crore even after lapse of five years.Item Performance Audit on Medical Education Department in Jharkhand (2010-2015)(CAG of India, 15-03-2016) CAG of IndiaHealth care in the State faces acute shortage of doctors and para-medical personnel. To address this problem, initiatives taken by the Government to augment the medical institutions for producing trained medical personnel available for health services in the state prompted conduct of a performance audit on the Status of Medical Education System under the Allopath stream in Jharkhand covering the period of 2010-15. Some of the major audit findings are discussed below: 1. Establishment of three new Medical Colleges each in the Government Sector as well as under Public Private Partnership mode/private sector could not be achieved and even the meagre allotments of plan expenditure were surrendered which resulted in not achieving the annual target of 900 Under Graduate (UG) seats set by the Government in medical colleges in the State. 2. Not providing adequate funds in the budget resulted in not fulfilling the target of opening three paramedical courses as was envisaged in Annual Plan of 2011-12. So capacity augmentation of Para Medical Personnel for delivering better healthcare services could not be achieved. 3. Utilization of UG seats in Medical College was 1,279 against 1,390 sanctioned seats but in Post Graduate it was 708 against 959 sanctioned seats leaving 251 (26 per cent) vacant seats. This resulted in failure of the objective of State Government to increase the numbers of doctors/specialist doctors for induction into the health services. This could affect the provision of health services adversely in the State in the future. 4. In PMCH, Dhanbad admissions were made for additional seats during 2014-15 without approval of MCI due to which future prospects of students admitted to these additional seats remain uncertain. Further, PG courses in PMCH, Dhanbad could not be started due to acute shortage of faculty ranging between 53 per cent in 2010-11 to 60 per cent in 2014-15. The prospective students were denied the benefit of higher medical education. 5. Shortage of medical equipment in different departments of PMCH, Dhanbad ranged between 22 and 80 per cent. This could affect practical training of medical students and their education. 6. Medical equipment purchased using State plan and Centrally Sponsored Scheme fund worth ` three crore and ` 1.25 crore respectively were not put to use for want of reagents/technicians which led them being damaged or disused. 7. Due to shortage of faculty, actual teaching hours fell short of the prescribed minimum norms of MCI by 14 to 48 per cent in PMCH, Dhanbad which might have an adverse impact on quality of education. 8. Shortage of medical equipment ranged between 40 and 63 per cent in ANMTCs and GNMTC and was 72 per cent in the College of Nursing, Ranchi. Similarly, these were under staffed by 68, 72 and 89 per cent which might affect the quality of education imparted in the colleges. 9. Monitoring in PMCH, Dhanbad was deficient as only four meetings of the college council against the MCI requirement of 20 meetings were held during 2010-15. No inspection was done by higher authorities of the paramedical institutions. Inadequate monitoring may lead to shortage/irregularities being undetected and remedial measures not taken in time.Item Non Construction of General Nursing and Midwifery School in Baran District in Rajasthan(CAG of India, 21-08-2020) CAG of IndiaNon construction of GNM school building at Baran even after lapse of nine years due to lack of initiative by District Hospital Pratapgarh and Baran and lack of monitoring by the Directorate of Medical and Health Services defeated the very purpose of the grant sanctioned by GoI.Item Internal Control System in Goa Medical College and Hospital (1999-2004)(CAG of India, 2005) CAG of IndiaThe Goa Medical College and Hospital (GMCH) was established in 1842. It has a bed strength of 1000 in the main hospital at Bambolim, 80 beds at the TB Hospital at St. Inez and 20 beds at the Rural Health Centre, Mandur. A review of the internal controls in GMCH revealed that despite being the only Medical Training Institute in the State, the College and the attached hospitals did not have any Administration Manual of its own. There were huge savings under capital budget indicating weak budgetary control. Internal audit of the GMCH had not been carried out by the Director of Accounts. Some of the important deficiencies in financial and administrative controls are highlighted below. 1. There were savings in capital budget ranging from 15 to 55 percent during 1999-2004, due to weak budgetary control. 2. Receipts from patients in private wards were utilised for refunds without routing it through cash book and patients were discharged without recovery of hospital charges. 3. Stock account of receipt books received from Government Printing Press was not maintained by the Medical Records Section of GMCH. Twelve unnumbered receipt books were missing from the stock of Accounts Section. 4. Oxygen outlets installed at a cost of Rs. 8.59 lakh in two departments of GMCH were not put to use due to defective system of maintenance and upkeep of equipment. 5. The GMCH recruited contract labour for sweeping and security services in excess of the sanctioned strength. A sweeping contract was also extended irregularly. There were weaknesses in financial control on payment released to contract labour. 6. Unserviceable articles/equipment with purchase value of Rs. 65.90 lakh were lying undisposed. 7. System of internal audit was non existent in GMCH.