CAG flags gaps in healthcare sector in Gujarat, citing staff shortage, lack of beds.

The Comptroller and Auditor General of India (CAG) has pointed out several deficiencies in Gujarat’s healthcare sector, including the shortage of doctors, nurses, beds and the lack of a comprehensive health policy. The ‘Report of the CAG of India on Public Health Infrastructure of Health Services’, which was tabled on the assembly floor on Friday, said a shortage of more than, 25% doctors in 22 districts alongwith shortage of paramedics was noticed in 19 districts, respectively, said the report. The state has 33 districts.

CAG have also reiterated that Gujarat may increase the budgetary allocation for the health sector up to 8% of the state budget as recommended by the National Health Policy (NHP) in 2017. The central auditor said the state’s Health and Family Welfare Department had not framed a policy for human resource management for the public health institutions.

“Despite recruitment of 9,983 healthcare personnel between 2016 and 2022, there was a shortage of doctors (23%), nurses (06%) and paramedics (23%) respectively. The overall vacancy in doctors, nurses, and paramedics cadres stood at 13% in public health facilities as of March 2022. Vacancies of specialist doctors stood at 51%, and 49% in sub-district hospitals (SDHs) and community health centres (CHCs), respectively, it said.

“Under the National Health Mission Scheme, 31% of specialist doctors and 32% of paramedics posts were vacant till the end of March 2022. Overall, 76% shortage of teaching staff was noticed in Nursing Colleges / Schools against the norms of Indian Nursing Council,” said the central auditor.

As per the report, the vacancy of specialist doctors was 28% in civil hospitals, 36% in district hospitals (DHs) and 51% in SDHs against the sanctioned strength.

“Further, against the sanctioned strength in DHs, vacancy of 18% in doctor’s cadre, 07% in nurse’s cadre, and 46% in paramedics cadre existed. Out of 8,208 posts sanctioned under the National Health Mission scheme, 1,510 posts which constitutes 18% remained vacant till March 2022”, according to the report.

The CAG suggested that the state government may take “necessary steps to fill up vacant posts of doctors, teachers and paramedics”. The national auditor also pointed to shortcomings in services like emergency, intensive care units (ICUs), operation theatres (OTs) and blood banks in healthcare facilities. “Emergency Services were partially available in 13 DHs out of 19 DHs. Separate Operation Theatres for Pediatrics (as per Indian Public Health Standards-IPHS) were not available in three civil hospitals out of five test-checked facilities”, said the CAG.

There was a shortfall of two (02) Operation Theatre’s in one district hospital out of five test-checked DHs. Blood bank service was not available in three such hospitals out of 19 DHs, it said.

“Pathology services were partially available in all 19 DHs. Ambulance services were partially available in 15 DHs out of 19 DHs. Mortuary service was not available in four DHs out of 19 DHs. Dietary service was not available in one DH out of 19 DHs”, the report stated.

The CAG said the state may take steps to improve these services with the required manpower and equipment. In 16 of 19 district hospitals in Gujarat, the number of beds was less than prescribed as per the IPHS norms, it said. The report also pointed out a shortage of beds and building infrastructure.

It further added that the state government has not framed a “comprehensive health policy” to guide the development of the health sector in Gujarat.

The percentage of capital expenditure to total expenditure on health was 14.17 during 2016 – 2022. The percentage of the health budget to the total state budget for 2021-22 was 5.42, which was less than the target of more than 08% as laid down under the National Health Policy 2017.

“Government may take necessary steps to increase the budgetary allocation for the health sector up to 08% of the state budget and make efforts to augment the capital expenditure in the healthcare sector”, it concluded.

Team Maverick