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Expired medicines, no doctors & equipment: What audit of India’s govt health scheme found

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CAG report shows in 17 states, including Gujarat and West Bengal, equipment for ultrasound, X-ray and ECG lie idle due to lack of doctors.

New Delhi: Medicines distributed under the National Rural Health Mission (NRHM) — India’s largest health scheme so far — in 14 states between 2011 and 2016 were past their expiry dates, says the latest report by the Comptroller and Auditor General (CAG).

The audit report says patients in these states, which included Bihar, Haryana, Jharkhand, Karnataka, Kerala, Maharashtra and Uttar Pradesh, were exposed to health risks as they were issued medicines without ensuring the prescribed quality checks and without observing their expiry period.

Launched in 2005 by the UPA government, NRHM is treated as a flagship programme by the present NDA government as well. Once Ayushman Bharat — also called ‘Modicare’ — rolls out next month, NRHM will become the ‘second-largest’ health scheme of the country.

Also read: Made in India, but Modicare owes a lot to China, South Korea and Thailand

The audit also noticed the unavailability of essential medicines, including paracetamol and vitaminB complex tablets, in 24 states and union territories.

The audit has found significant shortfalls in the availability of doctors, healthcare support staff, technicians, essential medicines and equipment in districts hospitals, sub-divisional hospitals, community and primary health centres across India.

“Thus the aim of the mission to ensure uninterrupted and quality healthcare in all health facilities remains unfulfilled compromising the quality of healthcare being administered,” (sic) says the report.

The ministry of health and family welfare records show that state health societies have spent Rs 1,06,179 crore out of Rs 1,10,930 crore during the period of 2011-16.

The audit also recommends that the ministry should follow up with states to ensure that sanctioned posts of healthcare professionals are filled up to meet the requirements. “Release of further grants under the mission may be linked with progress on this count,” the report says.

Poor infrastructure 

The audit report highlights that despite having funds, the hospitals failed to provide services. In Gujarat, for instance, out of three selected general hospitals where operation theatres were functional, pre-operative and post-operative rooms were not available, increasing chances of infections.

It also says that in general hospital in Godhra, only 210 beds were available against the requirement of 440 beds, forcing the remaining patients to be accommodated on the floor.

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In 17 states, including Andhra Pradesh, Chhattisgarh, Gujarat, Tamil Nadu, Uttarakhand and West Bengal, 428 types of equipment worth Rs 30 crore, including basic ones for ultrasound, X-ray and ECG, were lying idle due to a lack of adequate number of doctors and other trained staff, the report says.

The audit also detects absence of basic requirements such as labour table, delivery kit, emergency obstetric care equipment at Reproductive Child Health (RCH) Centres,  the places meant for reducing infant and maternal mortality rate.

In eight states, out of Rs 175 crore allotted for procurement of ambulances, Rs 155 crore remained unused and several existing ambulances were not attending the calls properly.

Missing doctors and paramedics

In the selected community health centres across 27 states, the average shortfall of five types of specialists — general surgeon, general physician, gynaecologist, pediatrician, anesthetist — ranged from 77 per cent to 87 per cent, the audit reveals.

At other selected health facilities across 29 states, specialists are missing despite having required infrastructure. The percentage of the shortage of staff nurses was more than 50 in eight states, including Jharkhand, Karnataka, Maharashtra, Odisha, Sikkim, Tamil Nadu, Uttar Pradesh and Uttarakhand.

As per the guidelines, at primary health centres (PHC), a medical officer has to be supported by 13 paramedics and other staff. The audit at 305 PHCs in 13 states found that 67 PHCs are operating without a doctor.

Around 87 per cent of community health centres (CHCs) — 30-bed hospitals providing specialist care in medicine, obstetrics, gynecology, surgery and paediatrics — were functioning without specialist doctors.

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