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Item Performance Audit of Indian System of Medicines and Homeopathy in Odisha (2000-2005)(CAG of India, 2005) CAG of IndiaThis performance audit of Indian System of Medicines and Homeopathy (ISM&H) in Odisha covering the period 2000-2005 revealed that the poor infrastructure in hospitals and dispensaries, non revision of norms of medicine and diet, shortage of staff in dispensaries, inadequate supply of medicines and equipment to dispensaries stood in the way of providing quality health care services through ISMH. Vacancy in the teaching staff of the medical colleges affected the standard of education imparted under the systems. In the absence of Drugs Testing Laboratory in the State for testing of homoeopathy and ayurvedic medicines, the quality and standard of ISMH drugs in circulation in the State could not be ensured. Maintenance of herbal gardens was not effective and thus uneconomical.Item Performance Audit of Indian System of Medicines and Homeopathy in Tamil Nadu (1999-2004)(CAG of India, 2005) CAG of IndiaThe Government of Tamil Nadu took initiatives to encourage Indian Systems of Medicine with the objective of popularising them and to bring out their benefits. However, the Indian Medicine and Homoeopathy Department did not maintain any statistics to prove their effectiveness in treatment of diseases. The vacancies in the posts of Assistant Medical Officers resulted in shortfall in providing services. Against 9604 in-patients admitted in Arignar Anna Government Hospital of Indian Medicines, Chennai, during 1999-2004, 4465 (46 per cent) patients either abandoned the treatment or got discharged against medical advice. Four Research Units established in the above hospital for cancer and AIDS, diabetes, infertility and fracture did not carry out any research activities due to lack of modern machineries/ equipments and staff. Grants from Government of India for procurement of equipments for Drug Testing Laboratory was utilised only partially. Main audit findings are summarised below: 1. Out of Rs 60 lakh released by Government of India as grant for procurement of equipments for Drug Testing Laboratory Rs 27.88 lakh were not utilised. 2. The statistical data available with the Department only indicated the number of visits by patients and no data was available to prove the effectiveness of the Indian Systems of Medicines in treating diseases. 3. Out of 9604 patients admitted in the in-patient ward in Arignar Anna Government Hospital of Indian Medicines, Chennai, during 1999-2004, 4465 patients either abandoned the treatment or got discharged against medical advice. 4. The attendance of Assistant Medical Officers was less than 15 days in a month in 56 per cent and 68 per cent of the months in Thiruvannamalai and Nagapattinam Districts respectively during the five years from 1999 to 2003. 5. The four Research Units established in Arignar Anna Government Hospital of Indian Medicines, Chennai, did not carry out any research activity due to lack of modern equipments and staff. 6. A Regional Pharmacy (at Thirumayam, Pudukottai District) was defunct from April 2002 but Rs 11.59 lakh was spent towards staff of the defunct pharmacy.Item Performance Audit on Efforts to Popularise and Strengthen Ayurveda in Rajasthan (2012-2017)(CAG of India, 05-09-2018) CAG of IndiaIndian Systems of Medicine comprise Ayurveda, Unani, Siddha, Yoga and Naturopathy, of which Ayurveda is widely practiced in Rajasthan. The Ayurveda Department (Department) has an extensive network of 118 hospitals and 3,577 dispensaries in the State and during 2012-17, Government of Rajasthan (GoR) incurred INR 2,655.89 crore for Ayurveda Healthcare Services and Ayurveda Education. Though the Department prepared State Public Health Standards for standardization of facilities in Ayurveda dispensaries and hospitals in May 2014, they were still pending approval of GoR as of October 2017. The Department’s decision in September 1994 to establish a dispensary for minimum population of 2,000 persons was not followed and there was imbalanced distribution of dispensaries in rural areas. Further, in absence of an effective awareness programme, the utilisation of the vast network of Ayurveda healthcare facilities could not be ensured in the State. Even the specialty clinics for key diseases had not been established. Basic infrastructural facilities were inadequate as electricity was not available in 46.88 per cent and drinking water in 74.17 per cent of the Ayurveda healthcare centers. Further, in seven test checked districts, toilets were not available in 75.38 per cent healthcare centers and most healthcare centers did not have all essential equipment. There was shortage of manpower at all levels and disproportionate deployment of Medical Officers and Nurse/Compounders was also noticed. Further, efforts for filling up the vacant posts on contractual basis were also not initiated. There was no significant growth in number of Ayurveda patients during last decade in spite of the fact that Department had inflated the number of beneficiary patients. The number of hospitals having nil bed occupancy increased from 60 in 2012-13 to 79 in 2016-17 and no patient was admitted consecutively for five years in 40 hospitals, four years in 48 hospitals and three years in 49 hospitals. In spite of this trend, no review to reduce/relocate the staff was conducted. The performance of the departmental pharmacies was dismal as the achievement in drug production vis-à-vis targets during 2012-17 was only 39.12 per cent. Further, the cost of drugs manufactured by the departmental pharmacies was 1.23 to 3.92 times higher the price of Indian Medicines Pharmaceutical Corporation Limited. Distribution of drugs was done without ascertaining demand and there were instances of delay in distribution of drugs, distribution of expired drugs to the patients and failure to distribute drugs in small hygienic packaging. The quality of drugs produced was also not tested adequately to maintain standards. No new Post Graduate courses could be started in Government Ayurveda College, Udaipur after 1986 due to non-availability of qualified teachers. Further, practical training in Surgery and Gynecology was not being provided to the students as the Ayurveda colleges did not have facilities for delivery and surgery cases. The financial management was also weak as the Department failed to monitor the delays in submission of UCs resulting in the deprival of central assistance of ` 52.96 crore. As 91.78 per cent of total available funds during 2012-17 were spent on pay and allowances, a very small percentage of funds was available for strengthening and upgradation of healthcare facilities, which adversely impacted the quality of healthcare services provided in the State. The Department thus was not able to provide effective and quality Ayurveda healthcare services to the public despite having the largest number of Ayurveda dispensaries/hospitals in the country. Considering the existence of large number of professionals, dispensaries and hospitals in the State, there is an urgent need for GoR to review and improve the prevalent deficiencies in the Ayurveda healthcare services by adopting a suitable policy and standards.Item Performance Audit of Indian System of Medicines and Homeopathy in Tripura (1999-2004)(CAG of India, 2005) CAG of IndiaThis performance audit report on functioning of Indian System of Medicines and Homeopathy in Tripura covering the period 1999-2004 revealed that lack of planning, poor infrastructure, shortage of staff, poor manpower management, absence of adequate support system and opening of dispensaries without any feasibility study making many of the dispensaries dysfunctional – all in combination had a deleterious effect on working of the systems of Ayurveda and Homoeopathy to cater to the needs of public health care in the State. Main audit findings are summarised below: 1. Dispensaries were opened without feasibility study. This resulted in non-functioning of 17 Homoeopathic dispensaries for want of patients and wasteful expenditure of Rs. 22.10 lakh. 2. Neither Medical Officers nor Pharmacists were provided in five Homoeopathic dispensaries. This made these five Homoeopathic dispensaries dysfunctional. 3. Bed capacity of the Homoeopathic Hospital at Agartala remained heavily under-utilised due to non-supply of meals to the patients, poor pathology and radiography services and even non-availability of ambulance. 4. An amount of Rupees eight lakh spent on a project for development and cultivation of medicinal plants at Kamalpur proved wasteful as the infrastructure created by July 1999 remained abandoned since then.Item Unfruitful Expenditure on ISM Centre and Dispendary Due to Non Availability of Land in J&K(CAG of India, 23-09-2020) CAG of IndiaDepartmental failure to ensure the availability of land before taking up the construction of hospital buildings and execute works as per cost estimates and ensure their completion over a period of eight years, resulted in unfruitful expenditure of INR 1.16 crore and interest liability of INR 44.21 lakh on the borrowed funds.Item Performance Audit of Indian System of Medicines and Homeopathy in Chhattisgarh (2000-2004)(CAG of India, 2005) CAG of IndiaIn Chhattisgarh, the Directorate of Indian System of Medicine and Homeopathy (ISM&H) has the responsibility of providing medical treatment through the systems of Ayurveda, Unani, Homeopathy, Yoga and Naturopathy. Poor infrastructure, high establishment cost and negligible expenditure on medical facilities were observed in this performance audit covering the period 2000-2004. Financial and operational management of the Department were deficient. Thirteen to 58 per cent of funds allocated for purchase of medicines were not utilised. Pharmacy was not modernised and quality control of medicines was not ensured. Due to lack of infrastructural facilities, adequate health care facility was not being made available. Main audit findings are summarised below: 1. Thirty bedded hospital at Ambikapur was not functional even after 25 years of sanction. 2. Sixty one of the 63 buildings sanctioned in 2002 were incomplete till date. 3. One hundred and forty eight dispensaries in six districts were running without doctors, and an unfruitful expenditure of Rs. 4.73 crore was incurred on pay and allowances of para medical staff. 4. The cost of medicines, produced during the period 2000-04 ranged from a meagre 17 per cent to 54 per cent of the overall running cost of the pharmacy. 5. Pharmacy machinery worth Rs.80.21 lakh was either not received or not installed hampering strengthening and modernisation of the pharmacy. 6. Quality of teaching was adversely affected in Government Ayurvedic Medical College due to non-posting of eight professors, nine readers and 12 lecturers as required under the Central Council of Indian Medicine (CCIM) norms.Item Performance Audit of AYUSH Department in Uttarakhand (2011-2016)(CAG of India, 02-05-2017) CAG of IndiaA performance audit on Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy (AYUSH) covering the period 2006-07 to 2010-11 was included in the Audit Report (Civil) for the year ended 31 March 2011. The Report was placed before the State Legislative Assembly in December 2012. This follow up audit was conducted with the objective of assessing the implementation of recommendations made in the earlier Audit Report and other important audit findings. The follow-up audit was conducted from April to May 2016 through test-check of records of the offices of the Director, Ayurvedic and Unani Services, the Director, Homoeopathy, the Principal cum Superintendent, Rishikul Post Graduate Medical College and Hospital, Haridwar, the Superintendent, Government State Pharmacy, Haridwar and two out of four district level offices (Haridwar and Pauri) of Ayurveda and Homoeopathy audited earlier. The period covered in audit was from 2011-12 to 2015-16. The audit was conducted with reference to the four recommendations accepted by the Government in the exit conference (March 2012) against 27 observations included in the Audit Report 2011.Item Performance Audit of Indian System of Medicines and Homeopathy in Tamil Nadu (2013-2018)(CAG of India, 24-06-2021) CAG of IndiaThe policy of the Government is to provide holistic health care by bringing Indian Systems of Medicine (ISM) into the mainstream. Government seeks to achieve its objectives by expanding the existing network of ISM institutions, improving the quality of medical education, etc. The present Performance Audit revealed near absence of a system for management of project funds provided by the Central and the State Governments, chronic shortage of physical and human infrastructure in medical institutions and lack of efforts to further research and development in ISM. Main audit findings are summarised below: 1. Delays in procurement of equipment resulted in huge sums lying in the bank accounts of Tamil Nadu Medicinal Plant Farms and Herbal Medicine Corporation Ltd., (TAMPCOL) and State AYUSH Society. The Department parked unutilised funds with TAMPCOL. 2. The shortage of manpower across various posts ranged from 10 to 38 per cent in regular ISM wings, 48 per cent in ISM wings created under National Rural Health Mission and up to 100 per cent in ISM wings created under AYUSH. 3. Out of 297 ISM wings in the sampled districts, 31 stopped functioning and 25 functioned for four days or less per week due to shortage of medical personnel. 4. TAMPCOL, the PSU which manufactures and supplies medicines to ISM wings supplied only 47 and 50 per cent of the total quantity of medicines indented by the hospitals/wings during 2016-17 and 2017-18 respectively due to inadequate provision of funds and short production. No medicines were supplied to Unani wings during 2016-17. 5. During 2013-18, 82 drugs found to be ‘Not of Standard Quality’ could not be frozen or recalled immediately from distribution due to delay in drug testing on account of shortage of staff in drug testing laboratory. 6. Ayurveda, Unani and Homoeopathy colleges of the Government did not offer Post Graduate courses, hampering expansion of the reach of ISM. 7. The Research and Development wing sanctioned by the Government in 2013 at a cost of Rs 12 crore did not start functioning even as of August 2018 and the assets created were lying idle due to lack of coordinated action in procuring equipment and recruiting staff.Item Performance Audit of Indian System of Medicines and Homeopathy in Bihar (1999-2004)(CAG of India, 2005) CAG of IndiaThe Government established the department of Indian System of Medicine and Homoeopathy (ISM&H) for making available doctors practising these systems of medicine and providing medical and health care services to the masses at an affordable price. The Department failed to provide adequate educational and research facilities in Indian System of Medicine and Homoeopathy (ISM&H). Medical and health care services were also poor in the State. Following are the main audit findings: 1. Ayurvedic, Unani and Homoeopathic Medical Colleges and hospitals did not fulfill the required standard prescribed by the Central Council of Indian Medicine and the Central Council of Homeopathy New Delhi in respect of deployment of teaching, non-teaching, medical and para medical staff. 2. In the Government Homoeopathic Medical College and Hospital, Muzaffarpur considerable number of students dropped out every year. 3. Functioning of the Ayurvedic College-cum-Hospital, Begusarai and the Government Tibbi College, Patna suffered due to lack of basic infrastructure facilities. 4. No patient was admitted in paediatric emergency and research department of Government Ayurvedic College hospital, Patna during 1999-2003. 5. Out of Rs 1.25 crore released by the GOI for strengthening of infrastructure in Ayurvedic & Unani Colleges / Pharmacies, expenditure of Rs 73.22 lakh incurred on the facilities was rendered unfruitful. 6. The ISM&H department had not established any monitoring mechanism for evaluating the functioning of Ayurvedic, Homoeopathic and Unani colleges, hospitals and dispensaries.Item Performance Audit of Indian System of Medicines and Homeopathy in Punjab (1999-2004)(CAG of India, 2005) CAG of IndiaThis performance audit shows that in Punjab, the Indian Systems of Medicine and Homoeopathy (ISM&H) could not be made effective. The major percentage of expenditure was on salaries and negligible expenditure was incurred on medicines. Although sufficient infrastructure had been created in Government Ayurvedic Pharmacy, Patiala for manufacture of Ayurvedic drugs, only negligible expenditure was incurred on purchase of raw herbs to be used for preparation of Ayurvedic drugs. As a result, no medicine could be provided to the hospitals/dispensaries and there were no indoor patients in 10-bedded Ayurvedic Hospital, Ludhiana and seven Ayurvedic Swasth Kendras. This led to unfruitful expenditure on pay and allowances of idle staff. Main audit findings are summarised below: 1. More than 98 per cent expenditure was incurred on salaries and negligible expenditure was incurred on medicines etc. Per patient expenditure on medicines decreased from 76 paise in 1999-2000 to 22 paise in 2003-04 (ISM) and ranged between 3 paise and Rs 1.20 (Homoeopathy) during 1999-2004. 2. Rupees 1.91 crore for Ayurveda released by Government of India were either not released by State Government or released only at the end of the year. 3. Rupees 0.19 crore for Homoeopathy released by Government of India could not be utilised due to late sanctioning of scheme by the State Government. 4. The department not only failed to fully utilise the funds received from Government of India for Government Ayurvedic Pharmacy Patiala but also incurred ungainful expenditure of Rs 36.98 lakh on purchase of machinery. 5. As no indoor patients were admitted in hospitals/Swasth Kendras, unfruitful expenditure of Rs 1.19 crore was incurred on account of pay and allowances of idle staff. 6. Response to the proposal to surrender 32 posts which could have saved Rs 40 lakh per year sent to Director, Research and Medical Education in November 1999 has not been received so far.