CAG of India2024-06-292024-06-2927-12-2018https://resourcerepository.azimpremjiuniversity.edu.in/handle/apurr/514Human resources management As per information provided by the PCPNDT Cell of National Health Mission, 250 (36 per cent) out of 702 genetic/ ultrasonography (USG) centres in 19 out of 24 districts of the State as on March 2017, engaged 227 unqualified doctors (38 per cent) out of total 599 doctors employed in total USG centres in the State without any qualified doctors on their panel. Of these, 87 USG centres engaged 81 MBBS doctors without any experience or training, 163 USG centres appointed 146 MBBS doctors, who, though having one year experience/ six months training, had not cleared the mandatory Competency Based Evaluation (CBE). In the test-checked districts, 126 unqualified doctors working in 136 USG centres conducted 59,959 sonography during 2014-17 of which, 604 were done by 56 inexperienced and untrained MBBS doctors in 61 USG centres. In five out of 24 districts, 18 radiologists were registered with 71 USG centres during 2014-17, each radiologist working in between three to six USG centres, violating Government of India stipulations of a maximum of two USG centres per radiologist. Recommendation The Department should initiate appropriate action against (i) unqualified doctors performing sonographies, (ii) USG centres who permit such unqualified doctors to perform sonographies, and (iii) DAAs who registered such USG centres despite their not having qualified doctors. (Paragraphs 2.2.2.2 and 2.2.2.3) Monitoring and inspection for implementation of the Act The State government had not constituted Sub-district Appropriate Authorities in any of the sub-divisions even after more than two decades of enactment of the Act. Further, there was delay of two years in reconstitution of State Supervisory Board and State Advisory Committee for reviewing, monitoring and supervision of the implementation of the Act at the State level. These shortcomings prevented implementation of the recommendations of State and Central level committees such as restricting qualified doctors to work in a maximum of two ultrasound clinics in a district, setting up online grievance/complaint portal for receiving complaints, inspecting ultrasound clinics by State Level Monitoring committee, tracking online form F, geographic information system (GIS) mapping of USG centres etc. This also resulted in failure to monitor and inspect implementation of the Act as evident from non-maintenance of essential records for conducting sonography of pregnant women in 2,257 cases, sonography conducted without referral slips of registered medical practitioners in 979 cases, engagement of radiologists other than the registered radiologists in 14 USG centres. Recommendation The Department should establish Sub-district Appropriate Authorities at the earliest to strengthen the institutional arrangements to fulfil the mandate of the Act and ensure strengthening of supervisory and advisory committees. (Paragraphs 2.2.4.2 and 2.2.4.3) The State Inspection and Monitoring Committee (SIMC) neither carried out any field visit nor inspected any USG centre during 2014-17. The District Appropriate Authorities (DAA) conducted only three per cent (244 out of 8,608 inspections) of targeted inspections in the State during 2014-17. In test checked districts, inspections by DAAs were only to the extent of two per cent during 2014-17 (96 against required 5,060 inspections). Audit verification of records of nine USG centres (whose inspections by the concerned DAAs had revealed no irregularities) revealed deficiencies such as non-maintenance of basic records by the centres, USGs conducted by unqualified doctors, unavailability of backup of images, absence of name, registration number and qualification of radiologist on the display board etc. Recommendation The Department should ensure required numbers of inspections by SIMC and DAAs and shall take appropriate action against those DAAs whose inspections of the nine USG centres did not reveal the irregularities noticed by Audit. (Paragraph 2.2.4.7 (i) & (ii)) Joint physical inspection of 72 USG centres by Audit and Departmental officials revealed several violations, including 21 USG centres functioning illegally due to their delayed renewal and approval, non-maintenance of vital records in 61 per cent of 3,717 cases for conducting sonography of pregnant women, absence of referral slips of registered medical practitioners in 26 percent of 3,717 cases for doing sonography, non-submission of monthly reports by USG centres in 65 per cent cases etc. Recommendation The Department should ensure regular inspection of USG centres to prevent violations of the Act, and take appropriate corrective action. (Paragraph 2.2.4.7 (iii)) The Department has not completed till date (May 2018) development of online grievance/ complaint portal and comprehensive website for information on implementation of the PCPNDT Act even after more than three years of instructions (May 2015) by Government of India. Resultantly, not a single complaint was recorded in the Department against violation of the Act, as noticed by Audit. Recommendation The Department should develop and make operational the website and ensure that online grievance redressal system is functional at the earliest. The website should carry information about the status of the redressal along with the authority with whom it is pending. (Paragraph 2.2.4.9 (i))EnglishAudit Report