Expired medicines, no doctors & equipment ; reveals CAG report
The latest health audit by the Comptroller and Auditor General states that the medicines distributed under the National Health Mission (NHM) — India’s largest health scheme so far — in 14 states between 2011 and 2016 were past their expiry dates. The report, which is the concluding part of a series on the CAG’s assessment of the National Rural Health Mission (NRHM) also points out that, all these states, which includes Bihar, Haryana, Jharkhand, Karnataka, Kerala, Maharashtra and Uttar Pradesh, were exposed to health risks since they issued medicines without ensuring the prescribed quality checks and without checking their expiry period. The National Health Mission was launched in 2005. NHM is considered the largest health programme which aims at providing universal access to healthcare. It passes funds to the state health societies to strengthen local health systems and their capabilities. According to the latest reports, the states are not utilizing these funds optimally. Also, the audit noticed the unavailability of medicines, including needed medicines like paracetamol and vitamin–B complex tablets, in 24 states and union territories.
Lack of staff
The report points out the significant shortfall in the availability of doctors and technicians in districts hospitals, sub-divisional hospitals, community and primary health centers across India. While NHM aims at ensuring uninterrupted and quality health care by increasing the availability of health staff, state governments are supposed to fill up the existing vacancies with new contractual appointments. Central governments provide funds for that. But in the audit report, the CAG has found more than 50% shortfall in the availability of health staff in five states: Bihar, Jharkhand, Sikkim, Uttarakhand and West Bengal. Also, around 77 -87 percent of community health centers were functioning without specialist doctors such as obstetricians, and pediatricians. 67 out of the 305 primary health centers surveyed in 13 states: Andhra Pradesh, Arunachal Pradesh, Assam, Chhattisgarh, Haryana, Himachal Pradesh, Karnataka, Madhya Pradesh, Odisha, Punjab, Rajasthan, Uttar Pradesh and Uttarakhand were functioning without any doctor. Also, in the selected 236 community health centers in 24 states/union territories, only 1,303 nurses were posted against the required strength of 2,360.
Poor Infrastructure
The audit report points out the poor infrastructure of the health centers. In 17 states, 428 equipment for ultrasound, X-ray, ECG, cardiac monitoring, incineration, operation theatres and blood storage units costing Rs 30 crore were lying unutilized due to non-availability of doctors and lack of trained manpower to use them. In eight states, of the Rs 175 crore allotted to buy ambulances, Rs 156 crore (89 percent) remained unutilized. Some of the irregularities observed by the audit were administrative delays, tendering process for procurement process not being initiated, diversion of funds for other purposes etc. Also, in Gujarat, out of three selected three hospitals were the operation theatres are functional, pre-operative and post-operative rooms were not available which increases the chance of Infections. The audit also highlights the absence of basic requirements such as labor table, delivery kit, emergency obstetric care equipment at Reproductive Child Health (RCH) Centres. In 20 states, 1,285 projects, though completed, were not commissioned or made functional.
The audit report also pointed out that the unspent funds ranged from 40 percent to 76 percent, in which Meghalaya spent least. Also, In 2011-12, the unspent balance available with 27 state health societies without interest was Rs 5253 crore ($ 1.02 billion) which came down to Rs 3686 crore ($ 555 million) in 2015-16. However, over the same period, the unspent balance, including interest, with 27 states increased from Rs 7375 crore ($1.44 billion) to Rs 9509 crore($1.43 billion). States that do not spend the money given to them must be penalized, according to the procedure laid out by the Union Cabinet and applicable from 2014-15. State governments had to release the money to state health societies within 15 days of receiving it, and if they failed to do so, state governments were liable to pay interest – 5.75% to 7.25%, depending on the going bank deposit rate. The audit observed that Rs 49 crore released during 2014-15 and Rs 450 crore released during 2015-16 under Mission Flexipool and RCH Flexipool to state treasuries were not transferred to state health societies as of May 2016.
As a response, the ministry of health and family welfare has said that it has already put in place a slew of measures to deal with these problems: regulation of fresh funds, the use of the Public Financial Management System which provides a digital platform for fund management in real time, audit of state funds, training and review of state finance staff and the immediate transfer of funds between state health societies and state treasuries.
But the question in all the public minds, when will all this be implemented still remains unanswered!