By Our Reporter
SHILLONG, Feb 28: The Comptroller and Auditor General (CAG) of India has recommended that the Meghalaya government address gaps in human resources in the health sector.
Meghalaya had a population of 29.66 lakh as per Census 2011. To cater to the healthcare services of its citizens at different levels, the state government established 10 Civil/District Hospitals, two Maternal and Child Health Facilities, two specialised hospitals, 30 Community Health Centres (CHC), 119 Primary Health Centres (PHC) and 467 Sub-Centres. As of June 2023, no functional Medical Colleges or tertiary care hospitals were available under the state government.
The subject specific compliance audit by the CAG covered health facilities at village and block levels which provide primary health care services and a holistic view of improvement of necessary infrastructure created for meeting emergency-related issues and service delivery by the sampled health institutions for the period 2016-17 to 2021-22.
Joint physical verification of private health facilities/nursing homes in four selected districts by Audit revealed that 19 facilities (out of 22) were running without a valid licence, and 17 doctors employed in government hospitals were found practising in private health facilities, in violation of Meghalaya Nursing Home Rules, 2015.
There was an overall shortage of 60 and 50 per cent of doctors, 7 and 4 per cent of nursing staff, and 58 and 4 per cent of paramedical staff in the eight selected CHCs and PHCs respectively, when compared with state norms.
Joint physical verification (August/September 2022) showed shortage of equipment in the selected CHCs ranging from 16 per cent to 100 per cent, while the shortage of equipment in the selected PHCs ranged from 20 per cent to 58 per cent in respect of six categories of equipment.
Similarly, there was shortage of 63 to 76 per cent of essential drugs in the selected CHCs, while all five categories of drugs were in shortage in the PHCs.
Shortage of 90 per cent of essential drugs was observed in the selected CHCs and PHCs with respect to 1,329 numbers of drugs on the State Essential Drugs List.
Non availability of essential diagnostic services in the selected CHCs ranged from 33 per cent (Serology) to 100 per cent (Ophthalmology).
During the period from 2017-18 to 2021-22, altogether 13,893 out of the total registered 11,32,394 patients had been referred out from the CHCs/PHCs. Common reasons for referral were mainly shortage of manpower, equipment, drugs, diagnostic services and absence of required treatment facilities, etc.
As per SDG India Index 2020-21, Meghalaya ranked 19th out of 37 states and Union Territories in SDG-3 Index score.
The 100-bed prefab centres at Shillong and Tura, constructed at a total cost of Rs 5.18 crore, remained unutilised due to non-availability of water supply in case of Shillong centre and absence of electricity connection and water supply connection in respect of Turn centre.
Installation/construction of 18 oxygen generation plants was completed at a cost of Rs 3.53 crore. However, 10 plants constructed at a total cost of Rs 2.46 crore were not utilised from the date of their completion mainly due to non-availability of transformer or pipeline connection issues or low transformer load.
Eight AYUSH facilities, constructed at a cost of Rs 1.77 crore, were handed over during May 2019 to December 2020. However, they remained non-functional till September 2022.
A total of 755 non-medical items were lying idle at the stores of five Corona Care centres as of July 2022. However, as item-wise expenditure for the items lying idle was not made available, the quantum of expenditure involved in the procurement of these items could not be ascertained in Audit.
The report recommended that keeping in view that Health is a state subject, it is imperative that the state government address gaps in human resources.
“To be able to administer quality health care services, medical equipment must always be available and function effectively,” the report said, adding that a comprehensive arrangement should be in place according to the need of hospitals to ensure all-time availability of essential drugs in each health facility.
According to the report, it should be ensured that each health facility prepares a formulary of drugs based on disease patterns and patient inflow, the State Essential Drug List is updated accordingly, and that stock-outs of required drugs are prevented.
“Necessary action may be taken to make all idle medical infrastructure functional for better health services,” the report stated.
Concerns over labour welfare schemes execution
The Comptroller and Auditor General of India (CAG) has raised serious concerns over the execution of labour welfare schemes in Meghalaya, pointing to irregular fund transfers, denial of approved benefits and weak administrative oversight.
The findings are part of the Report on Social and Economic Sectors and Urban Local Bodies for the year ended March 31, 2023. The report was tabled in the Assembly on Friday by Chief Minister Conrad K Sangma.
According to the audit, instances of multiple transfers were detected in the database of beneficiaries. The report recorded four transfers made in 15 cases, three transfers in 60 cases and two transfers in 381 cases to individuals bearing identical names. The audit flagged these transactions as indicative of deficiencies in verification and monitoring mechanisms.
The CAG also highlighted lapses in the disbursement of maternity benefits. Although 156 beneficiaries were approved under the scheme, they were collectively deprived of Rs 4.68 lakh.
The report noted that maternity benefits amounting to Rs 4.41 lakh were credited to only 147 beneficiaries in their respective bank accounts. No reasons were furnished by the Labour department for the failure to transfer the remaining sanctioned amounts.
Further scrutiny revealed that 64 beneficiaries did not receive death benefits totalling Rs 1.28 crore, despite the Welfare Board having sanctioned the payments. The Board informed the audit authority that the beneficiaries lacked proper documentation and that the claims would be reconsidered upon submission of the required papers.
The audit report also drew attention to the ineffective implementation of the cash award scheme meant for meritorious children of registered labourers. None of the 12 applicants received assistance. The CAG observed that the Welfare Board had not framed clear eligibility guidelines and failed to conduct information, education and communication activities to create awareness among registered workers.
The Labour department did not offer clarifications in response to the audit queries, the report stated, raising broader concerns over transparency and the delivery of welfare benefits to intended recipients.
