Criticism Arises Over Maharashtra's Deteriorating Public Health System and Staffing Deficiencies in CAG Report

Nagpur, Dec 21 (NationPress) The Comptroller and Auditor General of India (CAG) has delivered a harsh assessment of Maharashtra’s public health infrastructure, pointing out that it is overwhelmed because of a deficiency in health care facilities, leading to populations being served that exceed the Indian Public Health Standards.

The report also brought attention to the shortage of manpower at the foundational level.

The CAG's analysis regarding public health infrastructure and health service management in Maharashtra was submitted in the state Assembly by Deputy Chief Minister Ajit Pawar on the concluding day of the Winter Session on Saturday.

“A significant disparity was noted in the populations served by Sub-Centres, Primary Health Centres, and Rural Hospitals, which points to significant flaws in the planning and establishment of health care facilities. Approximately 70 percent of the construction of new health care facilities and 90 percent of the upgrades outlined in the master plan (January 2013 and June 2014) had not been completed by September 2022. Additionally, the Super Specialty Hospital (Phase II) in Amravati, built at a cost of Rs 31.91 crore in June 2015, remained unused for over three years.

“Moreover, 433 projects listed in the master plan could not commence due to land acquisition issues. The Government should formulate a comprehensive strategy to identify infrastructure gaps in accordance with projected population growth and implement it timely to ensure sufficient health care facilities in line with the Indian Public Health Standards. It is also crucial for the Government to secure land for the completion of medical infrastructure,” states the report.

On the topic of insufficient manpower, the CAG reported a 22 percent shortage of doctors, 35 percent for nurses, and 29 percent for paramedical staff within primary and secondary health care under the Public Health Department.

For women's hospitals under the same department, the shortages were 23 percent for doctors, 19 percent for nurses, and 16 percent for paramedical staff.

Additionally, a staggering 42 percent shortfall was noted among specialist doctors within the Public Health Department.

The Medical Education and Drugs Department faced shortages of 37 percent for doctors, 35 percent for nurses, and 44 percent for paramedics.

Overall, the state experienced a 27 percent shortfall in doctors, 35 percent in nurses, and 31 percent in paramedics across both the Public Health Department and the Medical Education and Drugs Department.

The audit further identified regional disparities in manpower shortages.

Furthermore, the Trauma Care Centres under the Public Health Department and Medical Education and Drugs Department reported vacancies of 23 percent and 44 percent respectively.

There were also vacancies of 21 percent for doctors, 57 percent for nurses, and 55 percent for paramedical staff in AYUSH colleges and hospitals under the Medical Education and Drugs Department.

The sanctioned number of doctors was 17 percent below the requirement as per the Indian Public Health Standards, 2012 within the Public Health Department.

“The Government should expedite the filling of vacancies in the health sector to ensure effective and high-quality health care delivery to the public.

“Additionally, it is recommended that the Government increase the sanctioned number of doctors in the Public Health Department in line with the Indian Public Health Standards,” advises the CAG.

The CAG also noted that the Out-Patient Department services in hospitals were lacking, with 93 percent of Rural Hospitals having only one registration counter instead of the two required by the Indian Public Health Standards in the seven selected districts.

The audit also observed long waiting times for registration, with 26 percent of doctors attending to more than double the acceptable patient load as per Indian Public Health Standards.

Many specialist Out-Patient Department services, including general medicine, general surgery, and dental services, were absent in numerous district hospitals, women’s hospitals, and hospitals affiliated with medical colleges.

“The government must ensure that specialist services such as general medicine, general surgery, and dental services are available in all health care institutions as per the Indian Public Health Standards. The audit also revealed a lack of radiology and imaging services. The Government should guarantee the availability of essential radiology services such as X-ray, Ultrasonography, and Mammography according to the Indian Public Health Standards,” the report recommends.

Patient-oriented diets were not provided in 33 of the Sub-District and Rural Hospitals assessed. Diet committees were absent in seven (nine percent) of the 78 health care institutions that offered dietary services.

“The food supplied by contractors was not tested by the Public Health Laboratory in 16 of the health care institutions evaluated under the Public Health Department.

“The government should ensure that the nutritional needs of patients are met through the provision of patient-centered diets,” the report states.

In light of recent hospital fire incidents, the CAG has urged the government to ensure that health care institutions adhere to fire, electrical, and structural audit standards promptly.

“The failure to obtain a No Objection Certificate from the Fire Department by 36 health care institutions assessed, the non-compliance with fire and electrical safety recommendations in all the health care institutions evaluated across eight selected districts, and inaction on structural audit recommendations by eight health care institutions put patients, staff, and property at risk of fire,” the report states.

The CAG also highlighted that the non-implementation of the Clinical Establishment Act, 2010 in private nursing homes and health care facilities heightened the risk of clinical establishments operating without proper registration and lacking adequate health care delivery.

“The Government should consider the adoption of the Clinical Establishment Act, 2010 to ensure that all clinical establishments in the state are registered and appropriately monitored to provide minimum standards of facilities and services to the public. The government should also maintain an updated database of medical facilities,” the report suggests.

(Sanjay Jog can be contacted at sanjay.j@ians.in)