Shortfall of 71 Sub Centers, 20 Primary Health Centers, 6 Community Health Centers in Goa: CAG Report

Panaji: The Comptroller and Auditor General (CAG) of India recently placed reports on Public Health Infrastructure and Management of Health Services in the government of Goa in the State Legislative Assembly. 

The State Finances Audit Report for the year ended 31 March 2023 on the Government of Goa placed by the CAG in the Assembly on Wednesday provides an analytical review of the Annual Accounts of the state government. 

The Performance Audit on Public Health Infrastructure and Management of Health Services in Goa for the year ended 31 March 2022, states that the state did not frame a human resource policy for the health sector to ensure the adequacy of human resources in the health sector and their effective and efficient management. 

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There were vacancies among doctors, nurses and paramedics to the extent of 17.5 per cent in North Goa district and 17.9 per cent in South Goa district under primary health care and to the extent of 20.24 per cent in North Goa district and 18.75 per cent in South Goa district under secondary health care in the state. 

Additionally, Doctors, nurses and paramedics were hired on a contract basis in excess of the sanctioned strength by the Directorate of Health Services (DHS) in primary and secondary healthcare.

In both North Goa and South Goa District Hospitals, test-checked Public Health Institutions (PHIs) under DHS and in Goa Medical College and Hospital (GMCH), the Audit noticed a lack of adequate specialists, leading to non-delivery of related services to patients. Despite being the only tertiary hospital in the State, GMCH had a shortfall of 51 per cent of doctors/medical officers in 2022. The vacancy of doctors ranged from 18.18 to 81.25 per cent in the super-speciality departments of GMCH.

Healthcare services

The report also says that North Goa District Hospital and all Community Health Centres (CHCs) in the state could not achieve the required Bed Occupancy Rate (BOR) as per Indian Public Health Standards (IPHS) norms. There were gaps in the availability of essential IPD services as per IPHS norms in both the District Hospitals, in all CHCs in the State and the test-checked Sub-District Hospital. Intensive Care Unit (ICU) services were not available in both the District Hospitals of the State.

There were also gaps in the availability of diagnostics, maternity and dietary services in PHIs as per IPHS norms. There were gaps in the availability of auxiliary services such as firefighting and hospital infection control.

Availability of Drugs, Medicines, Equipment and Other Consumables

In this regard, the Audit found that the state neither framed a procurement policy nor set up a Centralised Procurement Body for the procurement and distribution of drugs, consumables and equipment. Procurement of drugs and equipment by PHIs in the state was fraught with inadequate quality controls and delays.

Non-availability of drugs in the range of 10 to 83 per cent was observed in the test-checked PHIs under DHS and in GMCH from May to July 2022. 43 to 76 per cent of the drugs required as per IPHS norms were not available in the test-checked PHIs under DHS during 2020-21.

"The lack of policy or mechanism for testing each batch of drugs received from suppliers by DHS and GMCH led to drugs being distributed without testing, exposing patients to health risks. Gaps in the availability of infrastructure as per norms for storage of drugs at GMCH, at Medical Store Depot and at test-checked hospitals under DHS were noticed," added the report. 

Healthcare Infrastructure

Further, the report says that there was a shortfall of 71 Sub-Centres (24 per cent), 20 Primary Health Centres (42 per cent) and six Community Health Centres (50 per cent) in the State vis-à-vis Indian Public Health Standards norms.

"There were excessive delays in setting up the Tertiary Care Cancer Centre and up-gradation of the Trauma Care Facility in GMCH. There were gaps in the availability of infrastructure in GMCH against National Medical Commission (NMC) norms and in test-checked PHIs under DHS vis-à-vis IPHS norms, including instances of dilapidated buildings, which impacted health care services," added the report. 

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