HYDERABAD: A Comptroller and Auditor General (CAG) report on Public Health Infrastructure and Management of Health Services in Telangana mentions various irregularities and shortcomings in the state’s healthcare system.
The audit, covering the period from 2016-17 to 2021-22, studied seven departments and programmes, including human resources, healthcare services, and financial management.
Human resources shortage
In its report, the CAG highlights a shortage of healthcare staff, with a 45% vacancy rate across the department. The position of the director of medical education (DME) had the highest vacancy rate at 56%. The posts of associate and assistant professor in nine medical colleges were found vacant, affecting the quality of education. The health department lacked a policy for appointing specialist doctors and did not maintain a centralised database of staff deployment.
Outpatient services deficit
The report says Fixed Day Health Services (FDHS) were not extended to rural areas. Out of 3,206 sub-centres converted into Health Wellness Centres, 122 lacked medical officers. Imaging equipment in healthcare institutions did not have the required licences from the Atomic Energy Regulatory Board, and fire safety norms were not met in several district hospitals.
Drug & equipment availability
The state failed to review and update the Essential Medicines List (EML) and Additional Medicines List (AML) every two years, as required. Medicines from 20 therapeutic groups were unavailable in most district hospitals. Additionally, expired drugs worth Rs 390.26 crore were not replaced in time, resulting in huge financial losses.
Infrastructure shortfalls
The report found a shortage of Community Health Centres, Primary Health Centres, and Sub-centres, with deficits of 69%, 25%, and 29%, respectively. There was also a bed shortage, with 27,996 beds available against a requirement of 35,004. Construction projects for healthcare facilities were often delayed or incomplete, leading to unproductive expenditure.
Financial management issues
The state’s expenditure on health was below the target set by the National Health Policy (NHP) 2017, with spending ranging from 2.53% to 3.47% of the total state Budget. The report also found irregularities in fund releases under the National Health Mission, and Central funds for Covid-19 management not being reimbursed.
Immunisation, maternal health
The state showed improvements in TB case management and Measles Rubella immunisation but performed poorly in oral polio vaccine coverage. C-section deliveries were higher than the national average, with a notable increase in private health facilities.
Sustainable developmrnt goals
Telangana achieved targets for Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR) in urban areas but fell short in rural areas. The state’s per capita out-of-pocket health expenditure was higher than the national average.