Nagpur, December 2024: A recent performance audit by the Comptroller and Auditor General (CAG) of India has revealed significant challenges in Maharashtra’s public healthcare infrastructure, including critical shortages of medical staff and delays in healthcare projects. The report, which covers the period 2023-2024, was tabled in the legislative assembly and outlines various issues hindering effective healthcare delivery in the state.
Shortages of Healthcare Personnel
The audit found alarming manpower shortages across the state’s healthcare institutions, particularly in primary and secondary healthcare. The report highlighted the following shortages:
- Doctors: 22% in primary and secondary healthcare, 42% in specialist doctor cadres.
- Nurses: 35% in primary and secondary healthcare.
- Paramedical Staff: 29% in primary and secondary healthcare.
Furthermore, the shortage was more pronounced in specific areas like women’s hospitals, trauma care centers, and AYUSH colleges and hospitals. The CAG urged the government to expedite the recruitment process to address these deficiencies and meet the staffing requirements as outlined by the Indian Public Health Standards (IPHS).
Overburdened Healthcare Infrastructure
The CAG also noted that Maharashtra’s healthcare infrastructure is overstretched, with existing institutions catering to a population far exceeding the recommended norms. The report pointed out that:
- 70% of the work for constructing new healthcare institutions and 90% of the work for upgrading existing facilities, as per the master plan (2013-2014), was still incomplete as of September 2022.
- The Amravati Super Speciality Hospital (Phase II), built at a cost of Rs 31.91 crore in June 2015, has remained unused for over three years.
- 433 planned projects were delayed due to land unavailability.
Inadequate Patient Services and Poor Facilities
The CAG audit revealed several deficiencies in the quality of patient services and hospital facilities:
- OPD Services: 93% of rural hospitals had only one registration counter instead of the two required under IPHS.
- Specialist Services: Several district hospitals and women’s hospitals lacked specialist OPD services.
- Diet and Nutrition: 33 sub-district and rural hospitals failed to provide patient-centric diets.
- Fire Safety and Structural Issues: Many healthcare institutions did not comply with fire safety regulations, and failure to act on structural audit recommendations posed risks to staff and patients.
Procurement and Management Failures
The CAG identified several procurement and management issues, particularly with the Haffkine Bio-Pharmaceutical Corporation (HBPC):
- Supply Failures: 71% of the items demanded by healthcare institutions were not supplied by HBPC.
- Unused Funds: Rs 2,052.28 crore in unutilized funds was parked with HBPC due to its failure to place supply orders.
- Improper Storage: Drugs and consumables were found to be improperly stored, raising concerns about their safety and efficacy.
Additionally, the CAG pointed out errors in drug details in the e-Aushadhi system and recommended using barcode technology to automatically capture drug information for better tracking and accuracy.
Recommendations for Improvement
The CAG called for urgent action to:
- Fill vacancies in the health sector on a time-bound basis.
- Increase the sanctioned strength of doctors and healthcare staff as per IPHS standards.
- Complete pending infrastructure projects and improve hospital facilities.
- Fix responsibility for poor procurement and storage practices.
- Improve quality control by ensuring independent testing of medicines and drugs.
The report concluded that these actions are necessary to improve the quality and availability of healthcare services in the state and ensure that public health infrastructure can meet the needs of Maharashtra’s growing population.
