CAG reports highlights glaring deficiencies in Bihar health infrastructure

Out of budget provisions of ₹69,790.83 crore made during FYs 2016-17 to 2021-22, Bihar spent only ₹48,047.79 crore (69 %), leading to non-utilizations of ₹21,743.04 crore (31%)

Audit Report on Public Health Infrastructure and Management of Health Services, 2016-2022 was presented to Bihar legislative assembly and Bihar Legislative Council on Thursday (November 28, 2024) during the ongoing winter session which highlighted the poor performance of Bihar government.

Deputy Chief Minister Samrat Choudhary who also holds the finance portfolio tabled the audit report of the Comptroller and Auditor General (CAG) in the both house of Bihar legislature.

Also Read: The fault line of poor health infrastructure

Under the Human Resources, there was an overall 49% vacancy across the Directorate of Health Services, State Drug Controller, Food Safety wing, AYUSH and Medical Colleges and Hospitals (MCHs) of the Health Department. However, In Bihar, 1,24,919 allopathic doctors (1:1,000) were required to fulfil the recommendation of the World Health Organisation (WHO) against which, only 58,144 (1:2,148) allopathic doctors were available.

“Shortage of staff nurses ranged from 18% (Patna) to 72% (Purnea) and shortage of paramedics ranged from 45% (Jamui) to 90% (East Champaran). Recruitment for 35 types of 13,340 posts, out of 82 types of 24,496 posts related to healthcare services, was pending (January 2022), with the Human Resource agency hired by the Department,”the report said.

Operation Theatre (OT) was not available in all the test-checked four Sub-District Hospitals (SDHs), although it was to be made available in each SDH as per Indian Public Health Standards (IPHS).

The audit report of the health department shows that 1% to 67%of the registered pregnant women were not supplemented with a full course of IFA tablets in 11 test checked healthcare facilities during 2016-22.

“Even maternal death review had been conducted in only one case (PHC, Goraul – Vaishali district), out of 24 cases of maternal deaths reported in 16 test-checked healthcare facilities, during FYs 2016-22. From 19% to 100% of required diagnostic test facilities were not available in test checked 68 healthcare facilities. In test-checked 19 healthcare facilities (PHC to SDH), shortages of Lab Technicians (LTs) ranging up to 100% (on average) were found,” the report added.

The report also stated that joint physical verification of 25 ambulances showed that none of the ambulances had required equipment/medicine/consumables as per the agreement. None of the test-checked 10 SDHs, RHs (Rural Health Statistics) and CHCs (Community Health Centres) had functional Blood Storage Units (BSUs).

In eight healthcare facilities, BSUs were non-functional due to the non-availability of manpower and authorisation certificates issued by the State Licensing Authority.

The audit report has also found shortage of the drugs/medicines, equipment and other consumables.

Shocking finding has been shown in the audit report, that during 2016-22, nodal agency-Bihar Medical Services & Infrastructure Corporation Limited (BMSICL), executed rate contracts with suppliers for only 14 to 63% of essential 387 drugs, resulting in non-availability of such medicines. Non-availability of essential drugs for Outpatient Department (OPD) ranged between 21% to 65% and for Impatient Department (IPD), the non-availability was 34% - 83%, during 2016-22.

“Darbhanga Medical College and Hospital (DMCH) and Government Medical College and Hospital (GMCH), Bettiah, 45 to 68% drugs were not available during FYs 2019-21, due to short/non-supply of drugs by the BMSICL. Bihar, could not purchase essential drugs prescribed by Government of India, though grants of ₹35.36 crore were provided during FYs 2014-20,” it said.

Out of 132 ventilators available in test-checked healthcare facilities, only 71 (54%) were found functional. 57 (43%) ventilators were lying idle, due to non-availability of technicians and non-functional ICUs.

The Government of Bihar had not prepared any comprehensive health policy/plan, aligned with the National Health Policy, 2017, to address the gaps in infrastructure/equipment in every healthcare facility.

“Out of budget provisions of ₹69,790.83 crore made during FYs 2016-17 to 2021-22, Bihar spent only ₹48,047.79 crore (69%), leading to non-utilizations of ₹21,743.04 crore (31%). Percentage of expenditure on healthcare against the Gross State Domestic Product (GSDP) ranged between 1.33 and 1.73%, whereas against the Budget of the State, it ranged between 3.31 and 4.41%.

As per Sustainable Development Goals (SDG) India Index Report (2020-21) of NITI Aayog, Bihar scored 66, out of 100 under SDG index score for SDG-3 (related to Health Sector).

“Achievement of Bihar in respect of key health indicators like Maternal Mortality Rate, Neonatal Mortality Rate, Total Fertility Rate etc. was far below the SDG target, as well as average national achievement during 2020-21,” the report said.

Published - November 29, 2024 08:40 am IST