Comptroller and Auditor General of India (CAG)’s performance audit report of select district hospitals in Nagaland for the year ended March 31, 2019, which was tabled on the floor of the house on November 25, 2021, has noted that the secondary healthcare facilities in the State suffered inadequate physical infrastructure, shortage of drugs, equipment, specialist services, and other diagnostic services due to inadequate spending under the state budget.
The report pointed out that the budget allotment and expenditure of the health and family welfare department against the overall state budget during the five-year period 2014-19 ranged from Rs.521.09 crore (4 per cent) in 2014-15 to Rs.797.48 crore (3.90 per cent) in 2018-19 even as the National Health Policy, 2017 envisaged allocation of at least eight per cent of the total budget of the state for health sector.
CAG report found that expenditure on health ranged from Rs.418.09 crore (4.13 per cent) to Rs.631.42 crore (4.17 per cent) of the total state budget during the period. It stated that the department did not utilise the allocated funds in five years period 2014-19 with savings ranging from Rs.103 crore (19.77 per cent) in 2014-15 to Rs.166.07 crore (20.82 per cent) in 2018-19.
Out of the total expenditure of Rs.2649.93 crore incurred on health during 2014-19, CAG report stated that revenue expenditure was Rs.2493.73 crore (94.10 per cent) and the capital expenditure was Rs.156.20 crore (5.90 per cent). It said the department spent a mere 0.58 per cent of the total revenue expenditure on drugs/ medicines.
Due to decline in revenue expenditure on drugs and medicines, CAG report said there was shortage of drugs in health units across the state. It said availability of drugs in the sub-centres varied from 5 per cent to 73 per cent with an average of 33 per cent.
In the case of PHCs, availability of drugs was 36 per cent and in the case of CHCs, availability of drugs was very poor, it said, adding that only 39 per cent drugs were available across the State as against 225 recommended drugs.
CAG has, therefore, recommend that the department could further shore up its overall spending on healthcare and particularly increase its spending on drugs and medicines and make them available across all health facilities.
Unspent NHM funds: Against available funds of Rs.564 crore (GoI/ GoN/OB/interest) during the period 2014-19, the report said NHM state society utilised Rs.473.26 crore of the funds, with unspent balances ranging from 43 to 68 per cent of the available funds during the period.
In three important NHM programmes (National Oral Health Programme, National Programme for Health Care of Elderly and Non-Communicable Diseases), CAG report said the unspent balances ranged from 50 to 99 per cent, which indicated that the intended beneficiaries were deprived of the benefits of these programmes.
Shortage of doctors, nurses and paramedical staff: Audit scrutiny revealed that there was persistent shortage of doctors in three test checked districts hospitals of Phek, Wokha and Tuensang in important cadres of services of medical officers, staff nurse and paramedical staff. Shortage of doctors in DH Phek was 50 per cent against norms, whereas in DH Wokha, the shortage of doctors was 54 per cent during 2014-19. Number of doctors in DH Tuensang slightly improved from 12 (2014-15) to 14 (2018-19). In the case of DH Kohima, position of number of doctors had improved from 44 to 62 (40.91 per cent) during 2014-19.
Blood bank & blood storage units: Out of four test checked DHs, Blood Bank was available only in DH Kohima. Blood Storage Unit at DHs Wokha, Phek and Tuensang were non-functional.
Procurement of drugs with less shelf life: All the supplied drugs should have a minimum life of 18 months, but in drug procurements, it was observed that in 13 out of 20 supply orders placed by the Department in 2017-19, 123 drugs supplied were with less than stipulated shelf life of 18 months.
Cancer care: Audit observed that Mammography machine and Colposcope were not available in the test checked three DHs. Test checked hospitals did not maintain the records of suspected cancer cases referred from CHCs/ PHCs and forwarded to DH Kohima.
The Tertiary Care Cancer Centre (TCCC) at DH Kohima approved (December2016) by the Centre for Rs.43.50 crore, and for which funds received were Rs.13.23 crore, could not be made functional due to delay in completion of civil works. Equipment procured for Rs.7.04 crore for TCCC before completion of civil works were lying idle in DH Kohima. Despite availability of funds, the citizens were deprived of specialised cancer care facility in the State (October 2019), it stated.
HIV & AIDS care in the state: The report said that significant deficiencies were observed in implementation of programmes by Nagaland State AIDS Control Society (NSACS). It said specific surveillance plan was not formulated by the NSACS and hence identification of the pockets of infection of HIV&AIDS was limited to data received from District Aids Prevention and Control Unit (DAPCU).
Counselling offered in ICTC centres for pregnant women was inadequate as out of 376 pregnant women screened as positive for HIV&AIDS in test checked DHs, only 41.41 per cent were referred or attended in ARTs. Since all the positive cases were not given ART services, the report said possibility of transmission of HIV&AIDS to the new-borns cannot be ruled out.