CAG flags acute staff shortages, drug shortages in Bengal’s public health system

Patients requiring more serious healthcare attention are referred to the second tier of the healthcare system, by the primary healthcare units, which comprises District Hospitals (DHs), Sub-divisional Hospitals (SDHs) and State General Hospitals (SGHs). At present 18 DHs, 36 SDHs and 24 SGHs, are functioning.

Shortage of Doctors, Nurses and Staffs

Among its most serious findings, the audit reported a 54.27% shortage of medical officers (general duty) and a 91.14% shortage of specialist medical officers in Community Health Centres (CHCs). At the state level, shortages stood at 36% for specialist MOs and 49% for general duty MOs, while the sampled districts recorded an overall shortage of about 41%. In the District Hospitals, the shortage of General Duty Attendants was 63.20%.

The report also pointed to severe shortages of other healthcare personnel. Nearly 89% sub-centres (SCs) had no male healthcare worker, 46% of staff nurse posts at Primary Health Centres (PHCs) were vacant, and 75% of laboratory technician posts remained unfilled. More than 92% of PHCs were functioning without either a male or female health assistant, while 251 of the state’s 348 CHCs had no radiographer; and no staff nurses were posted in 51 CHCs. Twenty-nine CHCs had no Pharmacists, 30 CHCs had no laboratory technicians and 341 (almost 98%) CHCs had no O.T. attendants posted.

Infrastructural deficiencies

The audit also highlighted major infrastructure gaps. Though 55,000 deliveries had been conducted at homes across the state, in the last three years, none of the SCs had been upgraded with facilities for conducting deliveries.The CAG mentioned that the MOs had not visited 45% of the SCs, even once a month.

It found that 71% of PHCs lacked emergency or casualty services, while 90% were not equipped to provide emergency obstetric care, including Caesarean sections. Around 70% of PHCs had no functional beds, and labour rooms were unavailable in more than half of them. Only 11 new sub-centers and three new Primary Health Centres had been set up in the State in the last six years.

At the CHC level, 285 of the state’s 348 centres did not have a blood storage unit, while emergency newborn care was unavailable in several facilities. The report also noted that super-speciality services, barring oncology, were absent in 89 to 100 per cent of district hospitals.

The CAG also questioned the availability of medicines. It found that 63% of notified essential drugs had never been procured by district hospitals, while several others remained out of stock for prolonged periods.

The report flagged deficiencies in maternal healthcare, noting that 35% of registered pregnant women did not receive even one check-up by a medical officer during their four scheduled antenatal visits. It also found that 99.56% of home deliveries were not assisted by skilled birth attendants.

Traditional birth attendants and ASHA had not even been trained in 1,294 SCs. Against 454 cases of home deliveries, in areas covered by the sampled SCs, only 49 home deliveries had been assisted by ANMs.

Reviewing the implementation of centrally sponsored health programmes, the CAG said progress under the National Programme for Control of Blindness and Visual Impairment had not been adequately assessed, while screening under the National Leprosy Eradication Programme remained inadequate. It noted that leprosy prevalence exceeded prescribed norms in six districts.

The audit also criticised food services at Kolkata’s SSKM Hospital, designated by the state government as a “Centre of Excellence”. It found there had been no dietician at the hospital since 2018, no system for regular quality checks of food, and poor hygiene in the kitchen and storage areas.

Implementation of centrally sponsored scheme

CAG report stated, “Progress under the National Programme for Control of Blindness & Visual Impairment (NPCB&VI) had not been assessed. Adequate Vision Centres had not been set up. Vacancies of 44.26 per cent existed in the cadre of Medical Technologist (Optometry). Insufficient number of cataract surgeries and inadequate Corneal transplantation, were observed.”

Poor food quality in SSKM

It further added, “Adequate screening of the population was not done, as prescribed under the National Leprosy Eradication Programme. A considerable number of persons, prima facie suspected for leprosy during the screening, were not medically examined for confirmation. The prevalence rate of leprosy was more than the norms prescribed, in six districts of the State.”

During a joint inspection conducted in 2022, auditors found damaged flooring with stagnant dirty water, food grains stored directly on the floor, poor ventilation in the storeroom and rodent-damaged sacks of rice and wheat.