The Comptroller and Auditor General (CAG) report on the health sector has found several lacuna in the AYUSH department and the lack of initiatives on part of the health and family welfare department to streamline operations of AYUSH.
Issues included a complete absence of research, underutilisation of allocated funds, non-completion of projects approved in 2015, shortage of qualified professionals and teaching staff, substandard quality of curriculum, poor quality AYUSH drugs and the food and drug control administration’s failure in conducting proper quality checks as well as lacuna in following appropriate treatment protocol.
The audit also flagged serious gaps in mental healthcare initiatives as well as non-compliance with provisions laid down under the Mental Healthcare Act, 2017, with hospital test-checks revealing absence of psychiatric wards as well as absence of stock of medicines.
The audit noted that in eight test-checked districts, no appointment was made of AYUSH doctors in 125 (39 percent) of 324 PHCs and no AYUSH drugs were supplied to these PHCs. “This defeated the very purpose of mainstreaming of AYUSH” and also observed that “adequate efforts were not made by the health and family welfare department for mainstreaming AYUSH”.
In AYUSH hospitals, it was also observed that for out-patient as well as in-patients, case papers of treatment were being retained by the hospitals and no documents were provided to the patients. “As a result, the patients did not have the option of getting continued treatment from other hospitals or for a second opinion,” the audit noted.
One of the core activities of AYUSH services – school health programme (SHP) – aimed at addressing health needs of school going children was also not implemented in the state. The Union government had released a grant of Rs 2 crore to State AYUSH Society (SAS) for SHP, of which only Rs 0.43 crore was utilised until February 2019 for preparation of school health booklets. “Thus despite availability of funds, the programme was not implemented in the state,” the report stated.
The government in June 2020, however, attributed the reasons for non-implementation of the programme to a lack of coordination with the education department. It was further stated that an action plan has been finalised with the education department and the desired result would be achieved.
The audit further observed that the Gujarat government had not prepared a “perspective/long-term plan” and had only prepared annual action plan of AYUSH during 2014-19, the scrutiny of which, that is the annual action plans for the years 2014-15 to 2018-19 prepared by the AYUSH directorate, revealed that “no plans were made for allocation of AYUSH facilities at PHCs, CHCs and district hospitals”, though funds were earmarked for it under National AYUSH Mission (NAM).
For AYUSH medical colleges, “full coverage of syllabus was found doubtful as actual teaching hours imparted for both theory and practical sessions were much less than the teaching hours prescribed under CCIM regulations, 2016.”
A shortage of teaching staff was observed in four out of six test-checked government Ayurved Colleges (GACs) and audit observed a shortage of 44 per cent PG teaching staff as of March 2019. This inadvertently led to an adverse effect where 45 percent students failed the exam for Bachelor of Ayurvedic Medicine and Surgery (BAMS).
Drugs manufactured in the two test-checked govt Ayurved Pharmacies were supplied without conducting quality tests and cooperative pharmacy at Odhav, Ahmedabad were found to be manufacturing and supplying drugs without valid licence.
None of the test-checked pharmacies were mentioning the expiry dates of medicines. However, the government had submitted in June 2020 that due to lack of supervisory staff, outsourced workers did not stamp the expiry date till November 2019. However, it has been rectified since December 2019.
When it came to research-related activity for AYUSH, “even after lapse of more than six years, the Centre of Excellence (CoE) could not complete the five activities of research assigned to it.”
In fact, the Gujarat government as of May 2017 had decided to start an advanced Ayurvedic Research Centre at Model Government Ayurvedic Collge attached hospital, Kolavada. However, audit observed that as of June 2020, the said research centre was not started in the college.
Gaps in mental healthcare
When it came to mental healthcare, despite Gujarat’s suicide incidence rate per lakh population (11.70) being higher than national level (10.60), there was a lack in initiatives. Only 0.50% of the state health budget was allocated for mental health services and “audit observed gaps in policies, plan and executive response…”
Acute shortage of mental health professionals were noticed in all four hospitals for mental health and District Mental Health Programme (DMHP) units. Shortage of mental health professionals against prescribed strength ranged between 60 and 90 per cent and shortage against sanctioned strength ranged between 33 and 66 per cent.
Audit observed that, ‘…delivery of mental healthcare suffered in hospitals for mental health (HMHs) and DMHP units due to shortage of mental health professionals. The government in June 2020 however stated that GPSC results are awaited to fill 28 posts of psychiatrist and 23 posts of psychologists. Further it was found that professional courses for building up manpower for mental healthcare were not commenced owing to shortage of faculties. Audit also found that health personnel of PHCs and CHCs were not provided training for early detection of mental illnesses and management of common mental disorders.
The audit observed that the state mental health authority (SMHA) constitution was incomplete as state government had not nominated any non-official members as required under the Act and framing of rules and regulations for implementation of the Act was also not done as of May 2020. The government stated in June 2020 that these could not be done “due to Covid-19 and lockdown, and would be done by October 2020.”
In terms of infrastructure, the audit observed that in Sabarkantha district hospital, despite a separate psychiatric ward, psychiatric patients were kept with patients of skin ward, increasing the risk of acquiring infections for the former. Of the 11 hospitals test-checked, five district hospitals did not have a separate ward for psychiatric patients, who were being admitted to general ward.
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