A recent audit by the Comptroller and Auditor General (CAG) of India on the public health infrastructure and management of health services in Maharashtra has revealed severe shortcomings in the state’s public healthcare system, exposing systemic neglect, chronic resource shortages and financial inefficiencies. Covering the years from 2016 to 2022, the report presents a grim picture of the health sector struggling to meet demands of its population, particularly in rural areas.
The report was tabled on the last day of the winter session of the Maharashtra Assembly on Saturday.
The audit uncovered widespread staff shortage, with a 27 per cent deficit of doctors and a staggering 42 per cent vacant posts for specialised doctors in district hospitals. In the primary and secondary healthcare sector under the Public Health Department (PHD), the shortage of doctors, nurses and paramedical staff was 22 per cent, 35 per cent and 29 per cent respectively.
Tertiary care hospitals are faring even worse, with 57 per cent nursing positions and 44 per cent paramedical roles vacant. The report highlights how acute personnel shortage leaves healthcare workers overburdened, and exacerbate inequities in access to care, particularly in rural regions.
With respect to women hospitals, the shortage of doctors, nurses and paramedical staff was 23 per cent, 19 per cent and 16 per cent respectively. “The shortage of doctors/specialists, nurses and paramedical staff under the jurisdiction of Medical Education and Drugs Department (MEDD) was 37 per cent, 35 per cent and 44 per cent respectively. The overall shortage of doctors, nurses and paramedics in the State under PHD and MEDD was 27 per cent, 35 per cent and 31 per cent respectively,” it said.
The report further said that the shortage of doctors, nurses and paramedics and others in AYUSH colleges and hospitals was 21 per cent, 57 per cent and 55 per cent respectively.
The trauma care centres under the jurisdiction of PHD and MEDD had 23 per cent and 44 per cent shortage of staff respectively. Shortages in imparting trainings to doctors, nurses and paramedics under PHD were also flagged in the report.
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“Government may fill up the vacancies in the health sector in a time-bound manner to ensure optimal and qualitative delivery of healthcare services to public,” recommended the CAG even as it advised to increase the sanctioned strength of doctors under the public health department.
The report also pointed out that the state government did not conduct gap analysis for assessing the requirement of manpower in healthcare institutions as per Indian Public Health Standards. Only 7 per cent of district hospitals meet these benchmarks for maternal and child health services.
Emergency and diagnostic facilities remain grossly inadequate, with hospitals lacking essential imaging equipment. Moreover, 70 per cent of health infrastructure projects planned under 2013-2014 development scheme remain incomplete. A hospital worth Rs 31.91-crore in Amravati, completed in 2015, has not been operational due to administrative delays, exemplifying inefficiencies of the system.
The audit also noticed non-supply of equipment, equipment lying idle/non-commissioned and improper storage of drugs and medicines in the healthcare institutions. Between 2016 and 2022, the state’s primary supplier, Haffkine Bio-Pharmaceutical Corporation, failed to deliver 71 per cent of requested medicines and equipment. Existing medical supplies were often improperly stored or maintained, rendering them ineffective.
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The audit pointed out that the Medical Education and Drugs Department was relying only on the analysis report of drugs and medicines provided by the supplier without ensuring independent quality control testing. Biomedical waste management, a critical aspect of public health, remains neglected, with many healthcare facilities failing to comply with disposal norms.
Funds meant for key health programmes are also underutilised. Between 2016 and 2022, 76 per cent of the budget allocated to urban health missions and 50 per cent of funds for rural health programmes remained unspent. Disease eradication initiatives, such as the National Tuberculosis Elimination Programme and the National Leprosy Eradication Programme, failed to meet their targets due to inadequate funding and ineffective implementation.
Emergency preparedness is another weak area. Hospitals lack basic fire safety equipment, and no systems are in place to monitor or improve the efficiency of facilities during crises. The report criticized the failure to follow fire safety norms across healthcare institutions, leaving patients and healthcare staff vulnerable during emergencies. Even basic patient needs, such as tailored diets, are often ignored, with irregular inspections of food quality in public hospitals.
To address these challenges, the CAG recommended filling staff vacancies through expedited recruitment processes and increasing the health budget to meet national benchmarks. Infrastructure projects need to be completed without further delays, while regulatory bodies must enforce strict compliance with licencing requirements and biomedical waste management rules. The report also urged the adoption of Clinical Establishments Act, 2010, to ensure uniform standards for private healthcare facilities.
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Dr Rajesh Sharma, a public health expert, described the findings as “a wake-up call for Maharashtra’s healthcare system.”
“The persistent gaps in staffing, infrastructure, and fund utilisation have left the system ill-equipped to handle the growing health demands of the population. Addressing these issues requires an urgent, multi-pronged approach from both policymakers and administrators,” said Dr Sharma.
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