On 27th February, a performance audit report by the CAG (Comptroller and Auditor General of India) on the health infrastructure was presented in the Jharkhand Assembly. It expressed the possibility of irregularities in the departments due to non-submission of utilization certificates. According to the remarks on the financial accounts, 5209 utilization certificates were not submitted by the bodies and authorities of the state government against the amount of ₹19,125.88 crore provided by the departments as grants-in-aid, during the year 2023-24.
An objection has been raised in the CAG report that no information was given regarding the purpose for which this amount was utilized. Furthermore, 42158 utility certificates were issued for a total of ₹114035.62 crore, however, the certificates were pending till 31st March 2024. According to the report, a high number of outstanding utility certificates raises the likelihood of fund irregularities and misuse.
The CAG disclosed that during the financial year 2023-24, eight departments of the state withdrew ₹26.22 crore from government accounts against 30 short contingency bills. Nine short contingency bills worth ₹13.32 crore were taken out in March 2024 alone. Twenty-five contingency invoices containing ₹21.54 crore of the amount withdrawn were not submitted by the end of the fiscal year. The report demonstrated that 18,011 short contingency bills were not deposited through which a total amount of ₹4,891.72 crore was withdrawn.
According to the report, the Jharkhand government recorded expenditures of ₹4,536.39 crore in the capital component of the budget rather than the revenue section during the same fiscal year. It was established with the intention of spending money. It was stated that revenue and capital expenditures were either less than or greater than ₹4,536.39 crore. Of this sum, ₹4,433.60 crore was allocated for capital asset creation grants, ₹36.27 crore for scholarships, cash reliefs, ₹50 crore for assistance aid, ₹16.52 crore for maintenance and repair.
Severe staffing shortages across healthcare facilities
As of March 2022, CAG discovered that 2,210 medical officer and specialist positions remained unfilled in the state out of 3,634 authorized spots or around 61% of the total. Additionally, there were 864 vacant seats against the approved positions of 1,080 paramedics and 3,033 seats against 5,872 sanctioned slots of staff nurses. Six of the 24 districts, Dhanbad, Dumka, Gumla, Garhwa, Seraikela-Kharsawan and Simdega were selected for detailed investigation as the main sampling units.
Performance audits were conducted on two of the six medical colleges, two Ayush (Ayurveda, Yoga, and Naturopathy, Unani, Siddha and Homoeopathy) educational institutions, five of the twenty-three district hospitals, fourteen of the 188 community health centers, thirteen of the 330 primary health facilities, twenty-five of the 1,755 health and wellness centers, eleven private hospitals and six district joint Ayush dispensaries. The audit found that district hospitals, community health centers and basic healthcare institutions were lacking in medical officers, specialists, staff nurses, and paramedics. There was a 21 to 80% shortfall of medical specialists, a 14 to 76% lack of staff nurses and a 50 to 100% shortage of paramedics, respectively.
It was discovered that there were no better OPD (Out Patient Department) facilities in any of the districts whose hospitals were picked as samples. District, community, and primary health centers did not offer inpatient treatments, particularly for ENT (ear, nose and throat), psychiatry, orthopedics, pediatrics, general surgery and general medicine IPD (Inpatient Department) services in Community health centers (CHCs). Medical colleges also have a severe lack of teaching and non-teaching staff, according to the CAG assessment.
As of July 2022, 286 (45%) of the 641 teaching and non-teaching staff positions that had been approved for six medical schools and hospitals were unfilled. According to the report, the state government should address the lack of medical officers, specialists, staff nurses and paramedics in all healthcare establishments as well as implement all the recommendations of the MCI (Medical Council of India) working groups to address the shortage of teaching staff.
Gaps in healthcare services and drug availability
Gaps in the provision of diagnostic, obstetric, mobile medical and other associated services along with out-and-in-patient services, were also uncovered by the inquiry. It showed that the sampled community health centers, district hospitals, and medical colleges and hospitals had a 65-95% deficit of necessary medications, during 2020–21 and 2021–22. CAG mentioned that out of the 22 mobile medical units available till March 2022, only 11 were active.
Female doctors and radiographers were not available in the MMUs to provide ANC (Antenatal care) and infant vaccination. 19 to 33 per cent of the essential materials were also missing there. CAG revealed that the JMHIDPCL (Jharkhand Medical And Health Infrastructure Development Procurement Corporation Limited) used just ₹279.39 crore or 20% of the available amount on purchasing medications and equipment between 2016 to 2022, in contrast to the available sum of ₹1395.67 crore. The remainder was stored in the ledger accounts or returned.
The government agency did not purchase 77 to 88 per cent of the medicines due to which a 66-94% shortage of medicines transpired in the testing centers chosen as samples. Moreover, the equipment shortfall was as high as 48 to 67 per cent even in OTs (Operating theaters).
