Shortage of manpower at every level of health care institutions in Maharashtra: CAG report

Nagpur: The shortage of manpower at every level of healthcare institutions under the Maharashtra Health Department and overburdening of infrastructure are the main concerns flagged by the CAG in its audit report.

The Comptroller and Auditor General noted that providing adequate and quality healthcare services to a large population requires a robust healthcare infrastructure and services.

This performance audit report for 2023-2024 was tabled in the legislative assembly on Saturday.

The shortage of doctors, nurses and paramedical staff was 22 per cent, 35 per cent and 29 per cent, respectively in primary and secondary healthcare under the state Health Department.

The shortage of doctors, nurses and paramedical staff was 23 per cent, 19 per cent and 16 per cent respectively in primary and secondary healthcare for women hospitals. The shortage is 42 per cent in the cadre of the specialist doctors.

The CAG stated that the overall shortage of doctors, nurses, and paramedics in the Health Department and Medical Education and Drugs Department was 27 per cent, 35 per cent, and 31 per cent respectively.

The audit also noticed the regional disparity in the availability of manpower.

Similarly, vacancies in the trauma care centres under the Health Department and Medical Education and Drugs Department were 23 per cent and 44 per cent, respectively.

The CAG stated vacancies of doctors, nurses, and paramedical staff in AYUSH colleges and hospitals are 21 per cent, 57 per cent and 55 per cent respectively.

The sanctioned strength of doctors was less than the requirement as per Indian Public Health Standards (IPHS), 2012, by 17 per cent under the Health Department.

The CAG report asked the government to fill up vacancies in the health sector in a time-bound manner to ensure optimal and qualitative delivery of healthcare services to people. It said the government may also increase the sanctioned strength of doctors under the Department as recommended in IPHS.

The public health infrastructure is overburdened due to shortages of healthcare institutions, which are catering to the population in excess of the norms laid down in IPHS, the CAG stated.

The audit noticed that 70 per cent of the work for constructing new healthcare institutions and 90 per cent of the work for upgrading healthcare institutions as per the master plan (January 2013 and June 2014) was not completed as of September 2022.

It said a Super Speciality Hospital (Phase II), Amravati, constructed at the cost of Rs 31.91 crore in June 2015 remained unutilised for more than three years. Further, 433 works included in the master plan could not be started due to non-availability of land.

Out-Patient Department (OPD) services in hospitals were inadequate with 93 per cent of rural hospitals having only one registration counter as against two required as per IPHS in seven selected districts, the CAG said.

It said 26 per cent of doctors are attending to more than double the minimum number of patients.

Additionally, several specialist OPD services were unavailable in many district hospitals, women's hospitals, and hospitals attached to medical colleges. The audit also noticed the non-availability of radiology and imaging services.

Patient-centric diet was not provided in 33 test-checked sub-district and rural hospitals, the CAG stated.

It said the testing of food supplied by contractors was not done from the public health laboratory by 16 test-checked healthcare institutions under the Health Department.

The CAG stated that 36 test-checked healthcare institutions failed to obtain the Fire Department's NOCs and pointed out non-compliance to fire electric safety recommendations by all the test-checked healthcare institutions in eight selected districts.

It said the failure to take action on structural audit recommendations exposed the lives of patients and staff and property to risk.

The CAG said the government may increase the sanctioned strength of doctors as recommended in IPHS. It said the government may prepare a comprehensive plan to identify the gaps in infrastructure considering the projected population and implement it.

The federal auditor noted that OPD services in hospitals were inadequate with 93 per cent of rural hospitals having only one registration counter as against the required two in seven selected districts.

The CAG said the Haffkine Bio-Pharmaceutical Corporation's failure to place supply orders caused non-utilisation of funds to the tune of Rs 2,052.28 crore parked with Haffkine Bio-Pharmaceutical Corporation (HBPC).

The audit states that 71 per cent of the items demanded by the test-checked healthcare institutions were not supplied by HBPC.

It also noticed non-supply of equipment, equipment lying idle/non-commissioned and improper storage of drugs and medicines in the health care institutions.

The CAG said the government may fix responsibility on officials responsible for the improper storage of medicines and consumables and ensure that medicines and consumables are stored as per IPHS.

It said the Medical Education and Drugs Department was relying only on the analysis report of drugs and medicines provided by the supplier without ensuring independent quality control testing.

The CAG stated that the test analysis of e-Aushadhi data of the seven selected districts relating to Central purchase (2016-17 to 2021-22) indicated errors in the drug details entered into the system.

The government may consider capturing drug details automatically from the bar codes present on the supplied items, the CAG said.