For 6 yrs, more than half of the sanctioned posts in health dept remained vacant: CAG

The report states that against WHO’s recommendation of one doctor for 1,000 persons, Punjab districts had one doctor for more than 7,000 persons. For instance, the CAG report stated that Moga had the worst case scenario with one doctor sanctioned for 7,376 people. Ropar was the best with one doctor for 2,377 persons.

The CAG reports, tabled in the House, are on the management of public health infrastructure and health services from 2016-17 to 2021-22 and the annual technical inspection of Panchayati Raj Institutions (PRIs) and urban local bodies from April 2019 to March 2022, as per an official statement. The incumbent Aam Aadmi Party (AAP) government had taken over the reins of the state in March 2022.

The report also noted non availability/shortage of specialist doctors, medical officers, nurses, paramedical staff and other staff against the sanctioned strength in all district hospitals (DHs), community health centres (CHCs) and primary health centres (PHCs) and added that there was also skewed distribution of manpower across health care institutions.

Skewed staff availability

Availability of staff nurses against the sanctioned strength varied widely. It was excess by 17.60 per cent in Moga while there was a shortage of 56.76 per cent in Mansa. Shortage of Maternity Assistants (ANM) against the sanctioned strength varied from 19.23 per cent in Moga to 97.19 per cent in Amritsar district. However, in Fazilka district, 40 per cent ANM were posted in excess.

It said spending on health services was found to be below the target. “Out of the allotted budget by the state government, funds ranging from 6.5 per cent to 20.74 per cent were not utilised,” it added.

The Congress government could spend only 3.11 per cent of its total expenditure and 0.68 per cent of gross state domestic product on health services during 2021-22, which was way below 8 per cent of the budget and 2.50 per cent of GSDP targeted under the National Health Policy (NHP) 2017, according to the report.

Medicine shortage during pandemic

Adequate drugs were not found available in the state during the COVID-19 pandemic and excess expenditure was also incurred by RH Patiala on purchase of oxygen cylinders due to non-renewal of Liquid Medical Oxygen (LMO) storage license timely, according to CAG. It added that there was shortage of essential drugs and equipment in all test-checked health institutions and there was wide variation in availability across same type of institutions. Reasons for the shortage were non-supply, short-supply, and delay in supply of drugs to the warehouses and health institutions and non/short procurement of medicines. There were many issues in procurement by Punjab Health Systems Corporation (PHSC) including short-supply of drugs, loss due to expiry of drugs, accepting drugs having less shelf life, purchase of drugs and vaccines after expiry of rate contract, etc. In the quality assurance aspect, issues such as issuance and consumption of substandard medicines, absence of sample testing for local purchase, were noticed. Thus, quality control was compromised at every step, and for short delivery or non-delivery, no action was taken against the defaulting suppliers. Quality assurance was also compromised by non-testing/failed testing, supply of expired drugs and again no action was taken for violation.

Sharp growth in C-Sec deliveries

In maternity services, institutional births in public health facilities remained at 50 per cent during the period 2016-2022 and deliveries in private health facilities were increasing year by year. Labour room facility was not found available in eight PHCs. C-Section deliveries were also seen higher than the norms prescribed by WHO. National guidelines for Prevention of Parent-to- Child Transmission of HIV were not adhered to in 18 per cent cases. Further, there was shortfall in conducting review of maternal deaths and neonatal deaths during 2016-17 to 2021-22.

The Audit observed that 8.23 lakh C-Section deliveries were performed in the state from 2016-22 (37.60 per cent). In public healthcare facilities in the state, out of 10.93 lakh total institutional deliveries, 3.06 lakh deliveries (28%) were performed through C-section. Moreover, in private healthcare facilities, out of 10.95 lakh institutional deliveries, 5.17 lakh were performed through C-Section. The deliveries performed through C-Section in public and private healthcare institutions was on an increasing trend ranging from 26 per cent to 30 per cent and 32 per cent to 54 per cent respectively.

Huge amount of Government money was lying unutilised outside Government account with Punjab Nirogi Society (Rs 4.92 crore) and under Mukh Mantri Punjab Cancer Rahat Kosh Scheme (Rs 76.81 crore) as of March 2022. Besides, user charges amounting to Rs 1.94 crore collected by Rajindra Hospital, Patiala up to 2021-22 and part of concession fee amounting to Rs 85.70 crore transferred to PHSC were also lying with them outside Government account, in contravention of codal provisions.

Panchayati Raj institutions

The annual technical inspection report on PRIs and urban local bodies found that only 13 out of 29 functions envisioned by the 73rd Amendment Act have been devolved to PRIs.

“Delays in transferring Central Finance Commission grants resulted in avoidable interest payments by the state government. Moreover, there was significant underutilisation of funds received under various schemes, ranging from 5 per cent to 94 per cent. Staff shortages in PRIs increased from 29 per cent in 2019-20 to 41 per cent in 2021-22,” the report said.

It also highlighted issues in urban local bodies, including a staff shortage ranging from 34 per cent to 44 per cent.

“Delays in transferring grants resulted in avoidable interest payments and user charges worth Rs 510.56 crore remained pending for recovery. Additionally, 137 urban local bodies failed to contribute Rs 10.77 crore towards the Punjab State Cancer and Drug Addiction Treatment Infrastructure Fund,” it said.