CAG report flags severe shortage of drugs, staff at Tamil Nadu hospitals

CHENNAI: A newly tabled report of the Comptroller and Auditor General (CAG) of India on the performance audit of Public Health Infrastructure and Management of Health Services during 2016-22, revealed that more than 75 per cent of shortage was found in certain posts like Block Extension Educator, Family Welfare Assistant and Educator, Lady Health Visitor, Maternity Child Health Officer etc., in the State Health department.

The sanctioned strength of medical and paramedical staff in secondary care institutions was inadequate concerning the norm-based requirement. Vacancies of doctors and nurses at primary care institutions were high in comparison with the vacancies in secondary and tertiary care institutions, evidently due to the willingness for postings in urban centres. As of March 2022, the vacancy percentage of doctors, nurses and paramedical staff in all government medical college hospitals was 22, 6 and 44 per cent respectively.

The report stated that the recruitment of medical manpower lagged despite constituting a separate Board for the recruitment of medical manpower. Further, a large number of vacancies in the healthcare facilities under the Directorate of Indian Medicine and Homoeopathy would not augur well for popularizing alternative medicines, which is a policy of the government.

The report also flagged non-supply or short supply of drugs to the hospitals. The shortfalls in procuring short-expiry drugs, non-blacklisting of suppliers for deficiencies in supply and quality control issues were also identified. There were instances of non-supply and short supply of drugs to the hospitals, it stated.

Lapses on the part of Tamil Nadu Medical Services Corporation (TNMSC) resulted in the lifting of non-standard quality drugs for issue to the patients by healthcare facilities.

The audit also found that there was a serious disconnect between the healthcare facilities and the TNMSC in assessing the requirement and procuring only the required equipment resulting in the procurement of unnecessary equipment.

Basic healthcare services took a hit in TN, says CAG

According to the CAG report, the lack of basic healthcare services such as patient waiting space, registration counters, drinking water, toilets, and compound walls, while deficiencies in laundry, kitchen, mortuary, etc., impacted the quality of services in government healthcare facilities. Shortages in the availability of Intensive Care Units and Operation Theatres in District headquarters hospitals ranged from 20 per cent to 65 per cent with respect to ICUs and 20 per cent to 83 per cent concerning OTs.

The delay in the commissioning of a building constructed for the National Centre for Ageing for more than two years was noted due to the non-provision of required manpower and equipment.

An important finding in CAG was that the government spent only around five per cent of its budget on health against the National Health Policy's recommendation of earmarking eight per cent of the budget for health. The State expenditure ranged from 3.99 per cent to 5.99 per cent of the total expenditure during 2016-22. It was also found that unutilised funds, sanctioned for procurement of drugs and equipment, were held by TNMSC and Tamil Nadu Medicinal Plant Farms and Herbal Medicine Corporation Ltd (TAMPCOL).

In the case of maternal care, the audit revealed that at least 36 per cent of total deliveries were performed through Lower Segment Caesarean Section during 2019-21 in government healthcare facilities against the all-India average of only 14 per cent. Only 46 per cent of mothers who gave birth in government healthcare facilities in the State were provided transport to their residences by Government or outsourced vehicle under Janani Shishu Suraksha Karyakram. The funds under the Janani Suraksha Yojana were not paid to 26 per cent out of all institutional deliveries in the sampled healthcare facilities.

Despite the availability of funds, the state government incurred only six per cent of the funds released for 'Anaemia Mukt Bharat' and only 14 per cent of the funds allotted under the 'Labour Room and Quality Improvement Initiative' Scheme.

There was an inordinate delay of 21 years in framing Rules under the Tamil Nadu Clinical Establishments (Regulation) Act, 1997, leading to slackness in monitoring the working of private medical institutions. Moreover, government healthcare facilities were not proactive in getting certified under the National Accreditation Board for Hospitals and Healthcare Providers and National Quality Assurance Standards, leading to the non-institution of systems for ensuring the quality of service during 2016-2022. The report found that the government did not monitor all the targets under Sustainable Development Goals-3.