AHMEDABAD: Gujarat's public health system is facing a severe crisis, as the 2024 Comptroller and Auditor General (CAG) report on Public Health Infrastructure reveals significant deficiencies in health services.
The report flagged doctor vacancies, missing specialists, vacant nursing faculty posts, hospitals lacking resources, services being patchu and most projects remained incomplete.
The CAG Report noted, "The State lacks a human resource policy for public health institutions, fueling an alarming shortage of doctors, nurses, and paramedics. Despite hiring 9,983 healthcare workers between 2016-22, vacancies stood at 23%, 6%, and 23% respectively as of March 2022. In 22 districts, over a quarter of doctor posts remained unfilled, while 19 districts faced a similar crisis for paramedics."
According to the CAG Report, Gujarat's public health system is grappling with severe shortages of specialist doctors. Vacancy rates are alarmingly high, reaching 28% in Maternal and Child Health Centers (MCHs), 36% in District Hospitals (DHs), and a staggering 51% in Sub-District Hospitals (SDHs). In DHs alone, 18% of doctor positions, 7% of nursing posts, and 46% of paramedic slots remain vacant. The National Health Mission scheme also faces significant challenges, with 18% of its 8,208 sanctioned posts lying vacant.
Nursing Colleges and Schools are suffering from a 76% shortage of teaching staff, far below the norms set by the Indian Nursing Council. This lack of personnel is taking a toll on crucial patient services.
Four out of five test-checked MCHs lacked five to twelve registration counters, and four of 19 DHs operated with just a single registration desk. Only 10 of 19 DHs provided all essential OPD services, while inpatient care and emergency services were only partially available in 13 out of 19 DHs.
Operation theatres were missing for pediatric cases in three MCHs, and one DH had two fewer OTs than required. Blood Banks were absent in three DHs, while pathology and ambulance services were only partially available in all 19 DHs.
Mortuary services were non-existent in four DHs, and dietary services were unavailable in one. Lab testing delays compounded the crisis. The Food and Drugs Laboratory (FDL) in Vadodara lagged in quality checks, with pending reports ranging from 5% (Bhuj Warehouse) to 55% (Surat Warehouse) between 2019-22.
Healthcare centers also remain unevenly distributed. Fourteen districts lacked between one and three Community Health Centers (CHCs), while nine districts were short of two to nine Primary Health Centers (PHCs), all falling short of Indian Public Health Standards (IPHS) norms. Infrastructure projects have seen dismal execution; of the 5,332 sanctioned works from 2016-22, only 24% were completed, while 70% were either abandoned or never started. Sixteen DHs operated with fewer beds than IPHS norms, further straining the public health institutions.
This crisis is exacerbated by deeper financial neglect. The State’s health budget for 2021-22 stood at just 5.42% of total expenditure—well below the National Health Policy 2017’s 8% target. Capital spending on health was a mere 14.17% over six years. Bio-medical waste management also added to the failures. The implementation of the Bio-Medical Waste Management Rules 2016 was ineffective, raising serious concerns over environmental and patient safety.
Without a comprehensive health policy, the State’s public health system remains overburdened, underfunded, and critically short of personnel and infrastructure.