CAG reveals pathetic condition in working of Rural Health Mission

Source: The Hitavada      Date: 11 Jan 2019 11:19:07


Staff Reporter,


The Audit Report on General, Social and Economic Sectors under Government of Chhattisgarh, for the year ended March 31, 2017, which was tabled in Chhattisgarh Assembly on Thursday, revealed that Chhattisgarh suffers from shortages of human resources in critical positions affecting  adequate improvement in health care facilities.

The CAG report revealed that the state suffers shortages of specialist doctors to the extent of 89 percent, medical officers by 36 percent, staff nurses by 34 percent and paramedics by 12 percent against their sanctioned strengths. These shortages adversely affected the delivery of health care services by the District Hospitals (DH), Community Health Centres (CHC) and Primary Health Centres (PHC). Due to these shortages, the infant and maternal mortality rates (IMR: 39/1000; MMR: 173/100000) were far short of the National Rural Health Mission goals (IMR: 25/1000; MMR: 100/100000). The state stands at 15th place in IMR and 12th place in MMR in the country.

It is worth mentioning here that National Rural Health Mission (NRHM) was launched in April 2005 by Government of India to provide accessible, affordable, accountable, effective and reliable health care facilities in rural areas to strengthen public health systems.

The CAG revealed that in the sampled DH/CHC/PHCs, even where doctors were available (75% to 100%), the patients were still deprived of necessary treatments for various illnesses and diagnostic services due to shortages of medical equipments (25% to 69%), drugs and consumables (40% to 76%), laboratory  services (36% to 71%), and were referred to other hospitals such as Dr Bhimrao Ambedkar Hospital, Raipur or Chhattisgarh Institute of Medical Sciences, Bilaspur, as observed from the indoor patient department registers.

The state faced shortage of CHCs to the extent of 24% (54 out of 223) and PHCs by 11 percent (99 out of 884). The main reasons of shortages were on account of non-completion of 186 construction works despite lapse of 20 to 56 months from the dates of their sanctions on grounds of non-participation of bidders in the tender for works located in sensitive areas, receipt of high tender premiums, delay in identification and finalization of availability of land. On these incomplete works, expenditure of Rs 14.06 crore was incurred.

Also 20 CHCs, 88PHCs and 768 Sub Health Centres (SHC) didn’t have designated government buildings and were operational from private buildings or other government buildings as on March 2017, which lacked space, infrastructure, delivery service, OPD facilities, labour rooms, beds, water connectivity, toilets, etc. These deficiencies impaired the healthcare services through these health centers. The department upgraded 28 (61%) CHCs as first referral unit (FRU) against the target of upgrading 46 CHCs into FRU though the state had 169 CHCs on grounds of shortage of doctors and specialists. Reluctantly, the C-section deliveries were limited to 14 percent CHCs in the State. Similarly, 273 (55 percent) out of targeted 492 PHCs could only by made 24x7 service provider due to shortages of doctors and nurses.

There were significant shortages of essential equipments to the extent of 38 percent at DHs and 53 percent at CHCs, while deficit of drugs and consumables were by 40 to 75 percent in DHs, 33 to 75 percent in CHCs and 45 to 75 percent in PHCs on account of failure of the Chhattisgarh Medical Services Corporation Ltd to supply the drugs and equipment despite receiving indents from the department on grounds of non-availability of rate contract for medicines, non-receipt of tenders, late receipt of annual demands from Directorate of Health Services.

The department lagged behind in extending benefits of NRHM to all the pregnant women. Out of 33.09 lakh pregnant women registered for ante natal check-ups (ANC), 20.73 lakh (62.65 percent) were registered in the first trimester, of these, 72.48 to 95.03 percent pregnant women all the three ANCs in the state during 2012-17.

Against the objective of promoting 48 hours stay in hospital after child birth, 5.05 lakh (35.27 percent) women in the state and 1.72 lakh (35.02 percent) women in the sampled districts were discharged within 48 hours of delivery during 2012-17 on account of left against medical advice (LAMA), non-availability of diet facility in some of the PHCs, absence of 24x7 facilities in 512 (out of 785) PHCs and 141 (out of 169) CHCs were not FRUs to undertake PNC by retaining pregnant women after delivery.

The target set for child immunization against seven vaccine preventable diseases could not be achieved in 17 to 23 percent cases during 2012-17 due to lack of awareness, inaccessible area and migration of families along with children to other states.