Published On : Wed, Feb 5th, 2025
By Nagpur Today Nagpur News

Audit shock-II: Maharashtra’s healthcare in crisis, shortage of doctors, nurses, projects in limbo: CAG

Highlights

· Maharashtra’s health budget remains significantly lower than the National Health Policy’s target of 8% of the total state budget, standing at just 4.91% as of March 2022

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· 93% of rural hospitals operated with only one patient registration counter instead of the required two, leading to long wait times.

· 26% of doctors attended more than double the recommended number of patients.

· Specialist services like general medicine, surgery, and dental care were absent in many district hospitals and medical colleges.

· Essential radiology services such as X-ray, ultrasonography, and mammography were not available in several hospitals.

· Nutrition for patients was another neglected aspect, with 33 sub-district and rural hospitals failing to provide patient-centric diets.

· Fire safety violations were rampant, with 36 hospitals lacking fire safety clearances and all test-checked hospitals failing to comply with fire and electrical safety regulations.

· Maharashtra’s health budget remains significantly lower than the National Health Policy’s target of 8% of the total state budget, standing at just 4.91% as of March 2022

· Haffkine Bio-Pharmaceutical Corporation Limited, responsible for supplying medicines and equipment, failed to place orders, leading to ₹2,052.28 crore lying unutilized.

Nagpur: Maharashtra, the country’s second most populous state, faces a massive challenge in delivering quality healthcare services due to severe manpower shortages and infrastructure deficiencies, a performance audit by The Comptroller and Auditor General (CAG) has revealed. Despite significant government spending, gaps in medical staffing, inadequate health facilities, and delayed infrastructure projects continue to burden the system. This performance audit report for 2023-2024 was tabled in the Legislative Assembly recently.


Critical manpower shortages

The audit found alarming shortages across healthcare institutions, with 22% of doctor posts, 35% of nursing positions, and 29% of paramedical staff posts vacant in primary and secondary healthcare facilities. Women’s hospitals were also understaffed, with a 23% shortage of doctors, 19% of nurses, and 16% of paramedics. Specialized medical services were particularly affected, with a 42% shortfall in specialist doctors.

The Medical Education and Drugs Department fared no better, reporting a 37% shortage of doctors, 35% of nurses, and a staggering 44% shortage of paramedics. Trauma Care Centres and AYUSH hospitals also suffered from serious staff shortages, raising concerns about the quality of care provided to patients.

Overburdened and incomplete infrastructure

The State’s public health infrastructure is struggling to keep up with demand. Many healthcare institutions are catering to populations far exceeding the limits prescribed under Indian Public Health Standards (IPHS). Nearly 70% of new health center construction projects and 90% of planned upgrades remained incomplete as of September 2022.

One glaring example of mismanagement is the ₹31.91 crore Super Speciality Hospital (Phase II) in Amravati, which has remained non-operational for over three years. Additionally, 433 planned healthcare projects were stalled due to land unavailability.

Deficiencies in patient care and services

The audit also highlighted severe lapses in patient care services:

• 93% of rural hospitals operated with only one patient registration counter instead of the required two, leading to long wait times.

• 26% of doctors attended more than double the recommended number of patients.

• Specialist services like general medicine, surgery, and dental care were absent in many district hospitals and medical colleges.

• Essential radiology services such as X-ray, ultrasonography, and mammography were not available in several hospitals.

Nutrition for patients was another neglected aspect, with 33 sub-district and rural hospitals failing to provide patient-centric diets. Fire safety violations were rampant, with 36 hospitals lacking fire safety clearances and all test-checked hospitals failing to comply with fire and electrical safety regulations.

Also read : Audit shock: CAG slams Maha Govt: Healthcare in shambles, Rs 688 crore go unspent

Procurement failures and wasted funds

The audit exposed inefficiencies in procurement and distribution of medical supplies. Haffkine Bio-Pharmaceutical Corporation Limited, responsible for supplying medicines and equipment, failed to place orders, leading to ₹2,052.28 crore lying unutilized. Shockingly, 71% of the requested medical items were not supplied to healthcare institutions between 2017-18 and 2021-22.

Budgetary mismanagement and policy gaps

Maharashtra’s health budget remains significantly lower than the National Health Policy’s target of 8% of the total state budget, standing at just 4.91% as of March 2022. Unspent funds and last-minute expenditure spikes were common, undermining effective planning.

The State has also failed to formulate its own health policy, despite health being a state subject. Regulatory lapses persist, with Maharashtra yet to adopt the Clinical Establishments Act, 2010, leaving private healthcare facilities under weak oversight.

It said the testing of food supplied by contractors was not done from the public health laboratory by 16 test-checked healthcare institutions under the Health Department.

The CAG stated that 36 test-checked healthcare institutions failed to obtain the Fire Department’s NOCs and pointed out non-compliance to fire electric safety recommendations by all the test-checked healthcare institutions in eight selected districts.

It said the failure to take action on structural audit recommendations exposed the lives of patients and staff and property to risk.

The CAG said the government may increase the sanctioned strength of doctors as recommended in IPHS. It said the government may prepare a comprehensive plan to identify the gaps in infrastructure considering the projected population and implement it.

The federal auditor noted that OPD services in hospitals were inadequate with 93 per cent of rural hospitals having only one registration counter as against the required two in seven selected districts.

The CAG said the Haffkine Bio-Pharmaceutical Corporation’s failure to place supply orders caused non-utilisation of funds to the tune of Rs 2,052.28 crore parked with Haffkine Bio-Pharmaceutical Corporation (HBPC).

The audit states that 71 per cent of the items demanded by the test-checked healthcare institutions were not supplied by Haffkine Bio-Pharmaceutical Corporation (HBPC). It also noticed non-supply of equipment, equipment lying idle/non-commissioned and improper storage of drugs and medicines in the health care institutions.

Needs improvement

The CAG report has also recommended the implementation of the Clinical Establishment Act in Maharashtra for the proper registration and adequate monitoring of clinical establishments in order to ensure a minimum standard of services to the public. “Nursing homes and healthcare facilities in the state are regulated under the Maharashtra Nursing Homes Registration Act which has limited scope,” the report says. “It does not cover dispensaries, clinics, sanatoriums and diagnostic centres even as the local supervising authorities do not conduct periodic inspections of nursing homes.”

Apart from directing the government to fill the vacant posts in the Food and Drug Administration for effective monitoring of chemists and medical facilities, the CAG report also recommends strict regulation of bio-medical waste management in healthcare institutions.

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