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Item Avoidable Expenditure on Water Supply Contract for District Hospitals in Mizoram(CAG of India, 16-02-2023) CAG of IndiaDirectorate of Hospital and Medical Education (DHME), Health and Family Welfare Department, Government of Mizoram (GoM), Aizawl entered (May and December 2012) into Memorandum of Understandings (MoU) with a firm M/s Intergen Energy Limited (IGEL), New Delhi for installation of renewable energy and water treatment plant to supply water at nine Hospitals which include Referral Hospital, Falkawn and all eight District Hospitals of Mizoram. This was based on the suo-moto proposal submitted (February 2012) by the firm to GoM, for installation of Water Treatment Plant with solar power water pumping system to supply water on the basis of BOOT at the nine Hospitals. Audit observed that all Hospitals were getting water supplies on priority from Public Health Engineering (PHE) Department and there were no insufficiency in supply of water to the Hospitals reported, before or during the period of MoU with IGEL. Hence, engagement of IGEL was arbitrary and proposal of the firm was agreed to by the Department without ascertaining the actual need for water supply in the Hospital. Thus, expenditure of ₹ 0.50 crore for installation of Water Treatment Plants in five Hospitals and ₹ 4.80 crore on buy-back MoU in June 2019 totalling ₹ 5.30 crore was avoidable as there was no scarcity of water in the Hospitals prior to signing of agreement with the firm. Hospitals also did not report any issue in water supply during the stoppage of operation of the firm. Hence, there was a total avoidable expenditure of ₹ 5.30 crore in addition to committed liability of ₹ 4.20 crore against the balance payable on MoU on buy-back of equipment and water supplied. Further, Department, was supposed to terminate the MoUs on failure of IGEL to supply the required volume of water but entered into an unnecessary buy-back agreement.Item Unfruitful Expenditure Due to Non Functional Trauma Hospital at Khellani Jammu and Kashmir(CAG of India, 23-09-2020) CAG of IndiaFailure of Health and Medical Education Department to make the Trauma Hospital Khellani functional through posting of necessary staff and provision of laboratory/ diagnostic facilities, operation theatre, blood bank and ambulance etc., has rendered the investment of INR 394.59 lakh unfruitful.Item Performance Audit of District Hospitals in Manipur(CAG of India, 2021) CAG of IndiaThis Stand Alone Report of the Comptroller and Auditor General of India contains the results of Performance Audit of Select Public Health facilities of tertiary care (Medical College & Hospitals), secondary care (District-level Hospitals), and primary care (one CHC and one PHC in selected districts) in the State of Manipur covering the period 2014-15 to 2018-19. In this Performance Audit we have focused on patient care given by secondary and tertiary care levels in the State. We assessed the availability of basic infrastructure facilities in the State, adequacy of manpower in the selected DHs and various Services provided therein like Out-Patient and In-patient Services, Emergency Services, Drug Management, Infection Control, Bio Medical Waste Management, Diagnostic Services, Fire control measures etc. and select services of maternity and child care, Cancer and HIV/ AIDS, based on pre-determined performance indicators/criteria in the sampled hospitals. We have adopted the Indian Public Health Standards (IPHS) guidelines as prescribed by Government of India, which are a set of uniform standards envisaged to improve the quality of health care delivery in the country as well as State norms as applicable for benchmarking various audit findings.Item Procurement of Disposables at Higher Cost in Karnataka(CAG of India, 09-12-2020) CAG of IndiaFailure of the Karnataka Institute of Medical Sciences, Hubballi to finalise its tender for procurement of disposables within the scheduled time resulted in re-tendering and additional expenditure of INR 1.18 crore.Item Excess Payment to Contractors on IFMS at Eight Super Speciality Hospitals in West Bengal(CAG of India, 25-03-2022) CAG of IndiaWest Bengal Medical Services Corporation Limited made an excess payment of INR 4.93 crore to three contractors for Integrated Facility Management Services in eight Super Specialty Hospitals during March 2018 to August 2020, as it allowed payment in excess of carpet area in deviation from bid documents.Item Performance Audit on Public Health Infrastructure and Management of Health Services in Himachal Pradesh(CAG of India, 21-12-2024) CAG of IndiaAs per National Family Health Survey reports, Health indicator1 of the State of Himachal Pradesh was better than national indicators for infant mortality rate, but poorer for sex ratio at birth for children in the last five years and average out-of-pocket expenditure per delivery in a public health facility. Considering the goals laid down in the National Health Policy (NHP), 2017 and experience in COVID-19 pandemic, a Performance Audit on “Public Health Infrastructure and Management of Health Services” in the State of Himachal Pradesh was conducted to assess the adequacy of financial resources allocated, availability of healthcare infrastructure, human resources, drugs, medicines, equipment and other consumables in the health institutions as well as efficacy in the management of health services in the State. The Performance Audit also covered the adequacy and effectiveness of the regulatory mechanism being enforced by the Government to regulate public/private health sector, schemes being implemented by Government of India through the State Government and overall linkage with the Sustainable Development Goal (SDG – 3). The audit was conducted for the period 2016-21 but wherever feasible, the data has been updated upto 2021-22 and in case of human resources, upto March 2023.Item Compliance Audit on Cancer Institute in Lucknow(CAG of India, 22-09-2022) CAG of IndiaThere were significant deficiencies and delays in implementation of the project. The inflated estimates combined with not preparing of the justification statement resulted in excess expenditure of INR 64.60 crore on the project. Construction of Cancer Institute was incomplete (November 2021) even after lapse of more than four years from the scheduled date of completion due to delay on the part of Uttar PRadesh Rajkiya Nirman Nigam and construction agency resulted in denial of full benefits to the intended beneficiaries of the project, viz. cancer patients and research students.Item Maintenance of Bio-Medical Equipment in Telangana(CAG of India, 26-03-2021) CAG of IndiaMaintenance of critical equipment was not ensured on time and to the envisaged service levels by the third party service providing Agency, impacting critical medical services in the hospitals. The objective of the program to ensure uninterrupted services from bio-medical equipment, was not achieved due to poor service delivery from the Agency. Despite the Agency’s poor service levels, Government gave the Agency a long rope and terminated the contract only in December 2019.Item Unfruitful Expenditure and Blocking of Funds on Non Functional SNCUs and SPVs(CAG of India, 23-09-2020) CAG of IndiaFailure of Health and Medical Education Department to procure the medical equipment for SNCU Sarwal over a period of more than two years, post staff for SNCUs Bhaderwah and Gandoh and make two solar power generators functional resulted in unfruitful expenditure of INR 122.18 lakh and blocking of INR 44.82 lakh. The envisaged services for care of newborns could not be ensured despite availability of funds and engagement of additional staff.Item Compliance Audit on Procurement of Machines Equipments and Accessories for Dental Institute RIMS Ranchi(CAG of India, 04-08-2022) CAG of IndiaThe Rajendra Institute of Medical Sciences (RIMS), Ranchi is an autonomous medical institute of the Government of Jharkhand (GoJ) under the administrative control of the Health, Medical Education & Family Welfare Department (the Department). A Dental Institute, with a capacity of 50 annual intakes in Bachelor of Dental Surgery (BDS) course, was started from the Academic year 2017-18 in RIMS for which 176 types of dental equipment worth ₹ 37.17 crore was procured. On the request of the Secretary of the Department, audit of procurement of equipment for Dental Institute, RIMS was conducted between July 2019 and May 2020 for the period 2014-15 to 2018-19 to assess whether the tendering process was regular and equipment were procured economically. Main audit findings are summarised below: 1. Against an original proposal of ₹ 5.80 crore for procurement of dental equipment as approved by the Governing Council, the Director, RIMS submitted detailed budget of ₹ 9.29 crore to the State Government. However, RIMS procured dental equipment valued at ₹ 37.17 crore during 2014-19 which was 400 per cent of the budget. 2. In a tender invited in January 2016, technical and financial evaluation was not done on combined scoring pattern as per terms of the NIT giving weightage to the technical qualification and financial offers without recording any reasons. The purchase and technical committees approved the lowest rates from the rates quoted by technically qualified bidders without giving scores at any stage. Against this tender, 20 items valued at ₹ 18.52 crore were procured. 3. Though instructed by the Health Minister, the Director, RIMS neither crossverified the compliance submitted by the accused supplier nor surveyed the market price or procurement price of similar equipment in other medical institutions prior to payment of outstanding bill of ₹ 5.40 crore and further procured equipment valued ₹ 11.40 crore from the same supplier without obtaining the approval of the Health Minister. 4. The Finance and Accounts Committee did not decide the tenders though required under the Regulations of RIMS. Instead two different committees (Purchase Committee and Technical Committee) having no defined role in the Regulations were entrusted with the decision of tender by RIMS. 5. There was absence of uniformity and transparency in technical evaluation of bids besides arbitrariness in deciding technical qualification in favour of a bidder with respect to procurement of basic and advance dental chairs, mobile dental van and 15 other items valued at ₹ 25.70 crore. 6. RIMS incurred avoidable expenditure of ₹ 14.25 crore on procurement of dental equipment (Chairs, Mobile dental van and RVG) compared to the rates given in the budget estimates. 7. Attachments and accessories with basic dental chairs, advanced dental chairs and Mobile Dental Van were either missing or of lower specifications. Two out of ten supplied Radiovisiography systems were of different model. RIMS also failed to impose penalty of ₹ 2.37 crore for delayed supply. 8. Dental equipment worth ₹ 12.02 crore supplied to the Dental Institute was not found entered in inventory and was thus fraught with the risk of misuse. 9. Equipment worth ₹ 1.94 crore purchased (August 2016) for laboratory and the operation theatre (OT) was found lying idle in the store as laboratories and OT had not been set up as of May 2020. Disinfectants worth ₹ 17.85 lakh purchased in August 2016 for use in the OT had expired.