The Comptroller and Auditor General of India’s performance audit on the State’s health sector from 2016-2022 has observed a serious shortage of staff — doctors, nurses, pharmacists and lab technicians — in all levels of hospitals under the modern system of medicine.
The deficiency of manpower in public hospitals not just affects the accessibility of public to quality healthcare but also exerts pressure on the available resources, thereby compromising on effective delivery of healthcare services, the CAG has noted. The report was tabled in the Assembly on Tuesday.
Family Health Centres were not providing services as intended under Aardram Mission due to lack of infrastructure, required manpower, etc. and thus the aim to provide augmented patient care services at reasonable cost, time and optimum levels had not been met.
The number of doctors in the outpatient departments of the hospitals was not commensurate with the number of patients seeking medical care, creating overload for doctors as well as inconvenience for patients.
The CAG also pointed to the issues of shortage of drugs and lack of equipment in hospitals and squarely placed the blame for it on Kerala Medical Services Corporation Limited (KMSCL).
The main objective of the formation of KMSCL was to avoid scarcity of drugs in hospitals at all times, which can be realised only if indents are realistic and the indented quantity was procured. The CAG audit observed that the above objective was not met resulting in stock-out of drugs in hospitals during the period of audit.
The shortage of drugs in hospitals was attributable to inadequate indenting due to the financial cap set, lack of response from pharma companies to bids, delay/non-supply of drugs by vendors etc.
The CAG also noted that the suppliers of around 82% of the drugs delayed their consignment and that in many instances, they were not penalised by the KMSCL for the delay.
Quality check of drugs
It pointed out that the policy of subjecting only 10% of drugs to quality check (QC) did not yield desired results as all the batches of 46 drugs and all supplies from 14 suppliers escaped QC during the audit period. It was noticed that against the requirement of 603 essential drugs and consumables in district-level hospitals, the availability ranged from 44% to 58% only.
Analysis of data for the period from 2016-17 to 2021-22 relating to 67 healthcare institutions checked during audit revealed that many essential drugs were out of stock on various dates in these hospitals. There were 62,826 instances of stock-out of drugs and the stock-out period ranged up to 1,745 days.
Many vital medical equipment were not available in hospitals due to delay in purchase and non-maintenance of equipment. A mechanism for regular maintenance of equipment did not exist in the tertiary hospitals resulting in denial of services to patients, the CAG pointed out.
The CAG has noted the delay in payment of insurance claims to beneficiaries was noticed under Pradhan Mantri Jan Arogya Yojana (PMJAY). A district implementation unit to support the implementation of PMJAY and a combined unit for anti-fraud, medical audit, and vigilance at State-level with district level officers were not formed.
Blood banks
Some blood banks in the State were found to be functioning without licences. The existing bio-medical waste treatment and disposal facilities in the State were under stress and there was an immediate requirement for establishing more such facilities. Radiographic equipment was being utilised in some hospitals without Atomic Energy Regulatory Board licence.
The percentage of health expenditure with reference to allocated funds declined from 97.64% in 2016-17 to 93.28% in 2020-21. However, the expenditure increased to 98.92% of the outlay on health in the year 2021-22. The CAG noted that the State sector health spending did not meet the target of more than 8%of the budget as envisaged in the National Health Policy, 2017. Against the expenditure of ₹48,735.92 crore on health during the audit period, the capital expenditure was only 4.24%. The allotment of fund to KMSCL for the purchase of drugs was not based on requirement, the report says.
Recommendations
The CAG has recommended that the government take immediate steps to reduce the wide disparity in doctor to population ratio in the State by increasing the strength of doctors in the districts with the most adverse ratio.
A clear assessment of the requirement of doctors and paramedical staff at different levels and regions should be made so that human resources availability is ensured in hospitals as per the standards stipulated in the Indian Public Health Standards or the Aardram Mission.
Published – January 21, 2025 07:09 pm IST
