22 per cent shortfall of specialist doctors in AP: CAG Report

Vijayawada: A total of 3,316 positions were sanctioned across the state, of which 2,573 were filled, leaving 743 vacancies, resulting in an overall shortfall of 22 per cent in Andhra Pradesh, according to the Comptroller and Auditor General (CAG) of India report.  

The report on ‘Public Health Infrastructure and Management of Health Services in Andhra Pradesh’ covering the period from 2018 to 2022 was presented before the state Assembly on November 22. The report was taken up to assess the adequacy of funding, health infrastructure, human resources, availability of drugs and equipment, and management of healthcare and emergency services.

Raising serious concerns regarding the public health infrastructure and management of health services in Andhra Pradesh, the report stated that out of the 3,316 sanctioned positions across the state, 2,573 have been filled, leaving 743 positions vacant.

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According to the report, the government had failed to achieve the targets set for the health sector. Compared to a target of the health sector expenditure of more than 8% of the total State budget to be achieved by 2020, the State could achieve only 3.11% (March 2022).

In Primary Healthcare, shortages in ANM posts and Mid-Level Health Providers in Sub-Health Centres were observed. Further, vacancy in the staff nurse cadre was 2.21 per cent (August 2023). Due to a shortage of Public Health Nurse (Non-Technical) posts, the service area of 472 PHCs was deprived of sensitisation on primary health concerns. 

In Secondary Healthcare, the vacancy in the doctors cadre including specialists was 16 per cent (August 2023). In Tertiary Healthcare, 149 posts out of 608 posts of Professor cadre and 156 posts out of 744 posts of Associate Professor cadre were vacant (September 2022) in 11 GMCs. 

"The shortfall in the posts of Professor and Associate Professor would increase the workload on existing Professors and Associate Professors and thus would affect quality teaching in the teaching hospitals. Shortage of human resources in Medical College & Hospitals may hamper medical education and research work and compromise the quality of tertiary healthcare services," said the report. 

Healthcare Services

Out of eight test-checked PHCs, primary management of the fracture is not available in four PHCs and the services of tubectomy and vasectomy are not available in five PHCs. Out of 175 CHCs in the state, 83 CHCs are functioning without having OPD services for General Medicine, 47 CHCS without General Surgery, 15 CHCs without Gynaecology and 34 CHCS without Paediatrics. 

According to the report, ICUs are not available in five out of twelve DHS. Obstetric High Dependency Units (HDUs) are functioning without dedicated manpower in two test-checked DHs. Equipment for HDU was received in two test-checked DHs. Due to the non-completion of civil works, HDUs are not functional. Laboratory services are deficient in test-checked HCFs. Dietary services, fire safety, mortuary services, dedicated ambulance services and provision of linen are also deficient in test-checked HCFS.

Drugs, medicines, equipment

Andhra Pradesh Medical Services and Infrastructure Development Corporation (APMSIDC) procured 70 to 88 per cent of types of required drugs and medicines during the period 2018-22 and 65 to 88 per cent of types of required surgical items during the period 2017-22. 

Since the Director of Public Health and Family Welfare (DPH&FW) and Andhra Pradesh Vidya Vidhana Parishad (APVVP) did not seek earmarked funds for local purchases, they were not given provision for the purchase of emergency drugs during the period 2017-18 to 2021-22. 

"Thus, the HCFs under their control were neither provided with all the drugs nor given the provision for the local purchase. Medical Equipment worth ₹4.77 crore was lying idle at nine selected HCFs due to non-availability of manpower, incomplete civil works and non-availability of accessories," added the report. 

Health Infrastructure

As per IPHS 2012, based on population, the shortfall of Primary Health Centres in the State is 15.47 per cent and that of Community Health centres is 57.52 per cent. 

Separate examination rooms for pregnant women were not available in eight test-checked SCs, two SCs did not have toilet facilities, and six SCs did not have examination tables. Further, in seven out of eight test-checked PHCs, separate wards for male and female patients were not available, six test-checked PHCs did not have separate septic labour areas out of eight test-checked PHCs. 

Two Government Medical colleges upgraded from an intake capacity of 100 seats to 150 seats in the year 2019 and were not provided with the infrastructure required for a 150 intake capacity. 

As per the report, the upgradation of medical colleges without providing the required amenities, equipment and teaching faculty may result in incompetent physicians as their training would be constrained by these deficiencies.

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