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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 Failure to Claim Refund of Customs Duty Exemption by the Firm(CAG of India, 04-04-2018) CAG of IndiaJawaharlal Institute of Postgraduate Medical Education and Research, Puducherry failed to claim refund of customs duty exemption availed by a firm on imported equipment resulting in loss of ₹ 1.08 crore.Item Performance Audit of Procurement and Distribution of Medicines in Assm (2002-2007)(CAG of India, 2008) CAG of IndiaHealth care services to the people of Assam have been a priority item in the planning of social services by the State Government. Distribution of medicines through the health care units viz. hospitals, community health centres, primary health centres and dispensaries are an integral part of providing health care. A performance review of procurement and distribution of medicines in Health and Family Welfare Department of Government of Assam revealed that procurement of medicines was not need based. During the last five years (2002-03 to 2006-07), supply of medicines to health care units was inadequate. Thus, the intended health care services were not made available to a large section of the people of the State. The objective of providing comprehensive health care to the people was not fulfilled due to uneconomical procurement policy, inadequate planning and funding, lack of transparency and effectiveness in bids evaluation and short supply of medicines to health care units. Medicines were procured in some cases at higher rates indicating lack of financial discipline and weak internal control mechanism. Non receipt and delayed receipt of laboratory test reports defeated the purpose of maintaining quality control of drugs. Dispensing of allopathic medicines by ayurvedic doctors due to non-procurement of ayurvedic medicines also defeated the objective of providing health care under Indian System of Medicines.Item Compliance Audit on Procurement of Machines Equipments and Accessories for Dental Institute RIMS Ranchi(CAG of India, 04-08-2022) CAG of IndiaThe Rajendra Institute of Medical Sciences (RIMS), Ranchi is an autonomous medical institute of the Government of Jharkhand (GoJ) under the administrative control of the Health, Medical Education & Family Welfare Department (the Department). A Dental Institute, with a capacity of 50 annual intakes in Bachelor of Dental Surgery (BDS) course, was started from the Academic year 2017-18 in RIMS for which 176 types of dental equipment worth ₹ 37.17 crore was procured. On the request of the Secretary of the Department, audit of procurement of equipment for Dental Institute, RIMS was conducted between July 2019 and May 2020 for the period 2014-15 to 2018-19 to assess whether the tendering process was regular and equipment were procured economically. Main audit findings are summarised below: 1. Against an original proposal of ₹ 5.80 crore for procurement of dental equipment as approved by the Governing Council, the Director, RIMS submitted detailed budget of ₹ 9.29 crore to the State Government. However, RIMS procured dental equipment valued at ₹ 37.17 crore during 2014-19 which was 400 per cent of the budget. 2. In a tender invited in January 2016, technical and financial evaluation was not done on combined scoring pattern as per terms of the NIT giving weightage to the technical qualification and financial offers without recording any reasons. The purchase and technical committees approved the lowest rates from the rates quoted by technically qualified bidders without giving scores at any stage. Against this tender, 20 items valued at ₹ 18.52 crore were procured. 3. Though instructed by the Health Minister, the Director, RIMS neither crossverified the compliance submitted by the accused supplier nor surveyed the market price or procurement price of similar equipment in other medical institutions prior to payment of outstanding bill of ₹ 5.40 crore and further procured equipment valued ₹ 11.40 crore from the same supplier without obtaining the approval of the Health Minister. 4. The Finance and Accounts Committee did not decide the tenders though required under the Regulations of RIMS. Instead two different committees (Purchase Committee and Technical Committee) having no defined role in the Regulations were entrusted with the decision of tender by RIMS. 5. There was absence of uniformity and transparency in technical evaluation of bids besides arbitrariness in deciding technical qualification in favour of a bidder with respect to procurement of basic and advance dental chairs, mobile dental van and 15 other items valued at ₹ 25.70 crore. 6. RIMS incurred avoidable expenditure of ₹ 14.25 crore on procurement of dental equipment (Chairs, Mobile dental van and RVG) compared to the rates given in the budget estimates. 7. Attachments and accessories with basic dental chairs, advanced dental chairs and Mobile Dental Van were either missing or of lower specifications. Two out of ten supplied Radiovisiography systems were of different model. RIMS also failed to impose penalty of ₹ 2.37 crore for delayed supply. 8. Dental equipment worth ₹ 12.02 crore supplied to the Dental Institute was not found entered in inventory and was thus fraught with the risk of misuse. 9. Equipment worth ₹ 1.94 crore purchased (August 2016) for laboratory and the operation theatre (OT) was found lying idle in the store as laboratories and OT had not been set up as of May 2020. Disinfectants worth ₹ 17.85 lakh purchased in August 2016 for use in the OT had expired.Item Procurement and Maintenance of Equipment in PGIMER Chandigarh(CAG of India, 04-04-2018) CAG of IndiaThe Institute lacked an established procedure in the form of a Procurement Manual that could ensure effective procurement management and timely acquisitions of equipment based on a holistic and systematic assessment of requirements. This resulted in procurements being made on an ad hoc basis, rush of expenditure towards the end of the financial year and delays in progressing of procurement cases. The Institute also failed to effectively invoke contractual remedies available to it where the supplier did not fulfil their contractual obligations with delay in levy of penalty amounting to ₹ 72.77 lakh for delay in supply or installation of equipment and incorrect calculation of downtime and non-recovery of penalty of about ₹ 1.46 crore for excess downtime with reference to the contractual terms. This undermined both the deterrent effect of the penal provisions as well as the Institute’s ability to enforce due performance of the contract by the suppliers.Item Procurement of Food Baskets at Exorbitantly Higher Rates in Chhattisgarh(CAG of India, 28-08-2020) CAG of IndiaProcurement of food baskets under Chief Minister TB Nutrition Scheme at exorbitantly higher rates from lone ineligible bidder resulted in avoidable extra expenditure of INR 5.04 crore.Item Performance Audit of Procurement of Medicines and Medical Equipment & Its Impact on Healthcare Services in Delhi (2003-2008)(CAG of India, 2009) CAG of IndiaA Performance audit covering drug policy of Delhi Government, procurement policies, procedures and practices followed in the Department and its subordinate offices i.e. DHS, CPA, Central Store and EPC for procurement of drugs, surgical items, equipments and their testing for the period 2003-2008 was carried out during June to December 2008. Performance audit of procurement of drugs and medical equipment and its impact on delivery of health services in Delhi revealed that due to lack of documented procurement procedures and instructions, ad-hoc systems and practices were adopted by the department. Failure of indenting units to assess the actual requirements resulted in stock outs of essential life saving drugs in spite of having sufficient budget for their procurements. In spite of having a centralized system of procurement of equipments, there was no efforts made to standardize equipments and monitor performance of firms after finalisation of A/Ts. No system has been put in place for monitoring quality of drugs being supplied to hospitals/ institutes and dispensaries. Testing of CPA drugs and surgical items were carried out in a routine manner and there was no tracking of supplies at CPA and the Central Store level to ensure that testing of all batches was carried out. Further, distribution of drugs before conducting quality testing of drugs and further delay in circulating reports about failed tests to the end users put lives of patients at risk. The department further failed to initiate action against erring suppliers and placed orders with same suppliers/ manufacturers. No Management Information System, either manually or in computerized environment was devised at department, DHS, CPA and Central Store level for planning and managing procurements and supplies. It infers that despite creating all the infrastructure by the department to assist in providing health care services to nearly 1.70 crore population of Delhi, the object based on equality and health care for the under-privileged sought to be attained through Delhi Health Policy was defeated.Item Improper Procurement Planning Resulting in Idle Equipment(CAG of India, 04-04-2018) CAG of IndiaImproper planning in procurement of equipment by National Institute of Nutrition as well as failure to enforce performance on terms of supply order by supplier resulted in equipment worth ₹ 1.52 crore lying idle and equipment worth ₹ 2.13 crore not being put to optimal use for more than five years.Item Unfruitful Expenditure on Oxygen Generation Plant at JNIMS Manipur(CAG of India, 25-03-2022) CAG of IndiaJawaharlal Nehru Institute of Medical Sciences, Porompat, Manipur failed to put Oxygen Generation Plant (OGP) into use leading to unfruitful expenditure of INR 1.11 crore. There was a failure to get the damaged air compressor of the plant repaired and the plant was non-functional since 25th October 2015. Further, the Institute was still heavily dependent on the oxygen supplied by private firm (Ms Den Gas Agency, Uripok Machin, Imphal, Manipur) for which expenditure of INR 10 lakh per month on an average was being incurred.Item Compliance Audit of Procurement of Medicines with Special Emphasis on Quality Aspect in Assam (2013-2016)(CAG of India, 31-03-2017) CAG of IndiaTimely supply of drugs is necessary for the purpose of ensuring quality medical services to citizens. This involves an efficient procurement and distribution system as well as sound logistics management. The Director of Health Services (DHS), Government of Assam (GoA) procures medicines for distribution among 26 District Hospitals, 13 Sub-Divisional Hospitals, 108 Community Health Centers, 852 Primary Health Centers, 358 Ayurvedic Dispensaries, 75 Homeopathic Dispensaries and six Medical College Hospitals. Medicines are procured from Small Scale Industry (SSI) units through the Assam Small Industries Development Corporation (ASIDC) Ltd., and firms approved by the State Medical Stores Purchase Committee (SMSPC) through a process of open tenders at rates fixed by the Technical Committee and approved by the SMSPC. In emergency situations (epidemics, floods, earthquakes etc.), medicines are purchased at the Directorate level at institutional (market) rates. The Drugs Controller of the Department is responsible for overseeing the quality control aspect of procured drugs through the Drugs and Cosmetics Act, 1940 in the State. The Drugs Controller is assisted by a Joint Drugs Controller, a Deputy Drugs Controller, eight Senior Inspectors and nine Inspectors. The Compliance Audit of ‘Procurement of medicines with special emphasis on quality aspects’, covering the period from 2013-14 to 2015-16 was taken up to analyse the efficiency of the system of procurement and distribution of medicines in Assam. This compliance audit showed that absence of adequate funding and an established procurement policy, in conjunction with a weak internal control mechanism, resulted in lack of financial discipline and short supply of medicines, as also supply of sub-standard medicines. Not-observing of storage norms, non-eceipt/ delayed receipt of laboratory test reports, also defeated the purpose of maintaining the quality of drugs being supplied to health care units.