297 results
Search Results
Now showing 1 - 10 of 297
Item Performance Audit of Four Major Public Hospitals in Delhi (2001-2006)(CAG of India, 2007) CAG of IndiaA performance audit of the functioning of four major public hospitals in Delhi was conducted to assess their performance in terms of providing proper medical care by efficient use of available resources and infrastructure. The hospitals reviewed were Lok Nayak Hospital (LNH) and Deen Dayal Upadhyay Hospital (DDUH) under the Government of Delhi, Hindu Rao Hospital (HRH) under the Municipal Corporation of Delhi and Charak Palika Hospital (CPH) under the New Delhi Municipal Council.Item Performance Audit of National Rural Health Mission (NRHM) in Jammu and Kashmir(CAG of India, 2009) CAG of IndiaGovernment of India launched (April 2005) the National Rural Health Mission (NRHM) to carry out necessary architectural correction in the basic health-care delivery system. The Plan of Action includes increasing public expenditure on health, reducing regional imbalance in health infrastructure, decentralization and district management of health programmes, community participation and operationalising community health centres into functional hospitals. The performance audit review of implementation of NRHM in Jammu and Kashmir showed that the status of health profile of the State has been quite encouraging vis-à-vis the performance indicators available for the country. These can be further improved if there is proper fund management/utilisation and various sectors involved are covered in conformity with the guidelines issued for implementation of the Programme. There are large gaps in planning as well as implementation of the Mission activities in the State even after four years of launching the programme. This is evidenced by the findings that no new health centre was put in place, essential services and amenities were not available in many centres and there was critical shortage of technical manpower. Maternal and child health programmes have not made much headway. Planning, implementation and monitoring of the programme through participation of NGOs and community-based organisations was nonexistent.Item Performance Audit of National AIDS Control Programme in Bihar (1998-2003)(CAG of India, 2004) CAG of IndiaNational AIDS Control Programme aimed at reducing the spread of HIV infection and strengthening the country's capacity to respond to HIV/AIDS on a long term basis. Implementation of the programme in the State suffered mainly due to absence of proper monitoring mechanism. Physical progress in the components of targeted intervention for high risk groups and prevention of HIV/AIDS among low risk groups was either nil or marginal except in the case of condom promotion. Blood banks lacked basic infrastructure facilities. No community centre was set-up for low cost AIDS care. Institutional strengthening was weak. Inter-sectoral collaboration was absent. Thus, the intended objective of reducing spread of HIV infection and strengthening country’s capacity to respond to HIV / AIDS on a long term basis was not achieved to a large extent. Main audit findings are summarised below: 1. During 1998-2002 due to poor spending only 46 per cent (Rs 11.14 crore) of funds allocated (Rs 24.27 crore) by GOI were released. Excess expenditure of Rs 0.49 crore during 1999-2003 on awareness campaign was incurred by diverting funds from different components. Against an allocation of Rs 15.00 lakh relating to civil works, AIDS Control Society advanced Rs 1.17 crore to District Magistrates in March 2003 for construction of rooms for blood banks without approval of NACO. 2. Physical progress in the components of targeted intervention for high risk groups and prevention of HIV/AIDS among low risk groups was dismal during 1998-2003. Lack of mandatory equipments like air conditioners and elisa readers in blood banks rendered the blood banks ineffective. 107 equipments supplied by NACO to 15 blood banks for their modernisation were non functional as the blood banks had no operational license from appropriate authority. Even in seven licensed blood banks 168 equipment supplied by NACO were lying idle. 3. Low cost AIDS care was not initiated in the State as no community care centre was set-up. 4. Intersectoral collaboration was non-existent. Level of awareness development was low and no society was formed at district level for effective implementation of the programme. 5. The number of AIDS cases which was 10 in 1998-99 increased to 63 in 2001-02. 6. There was absence of effective monitoring mechanism of the programme. The reports on the impact analysis of the programme done by ORG Centre (May 2000) and World Bank Mission (May 2002) were not available with the state Government.Item Performance Audit on Drugs and Cosmetics Act in Gujarat (1997-2003)(CAG of India, 2004) CAG of IndiaThe Drugs and Cosmetics Act 1940 (Act) is a Central Act to be implemented by all the States. The Act along with the other associated Acts and the rules made thereunder regulate the import, manufacture, distribution, sale and clinical research of drugs and cosmetics. In Gujarat, huge shortage of Drug Inspectors adversely affected the functioning of the Drugs and Cosmetics Act and the menace of spurious drugs continued to prevail. No follow-up action was taken to withdraw the drugs declared as not of standard quality from the market. The licensing system was ineffective and the DCA did not maintain proper record. Monitoring at State level was poor. Thus the objective of prevention of the menace of spurious drugs to eliminate the danger to human life had not been achieved. Following are the main audit findings: 1. Inadequate strength of technical staff weakened the enforcement of the Administration and diluted regulatory functions. 2. There was sharp increase in pendency in the cases of prosecution. 3. Sales of drugs without complying with the conditions of licences were noticed. 105 sales licences were issued to pharmacies without registered pharmacists to supervise sales in contravention of the provisions of the Act. Shortfall in inspections ranging from 54 to 69 per cent (manufacturing units) and from 63 to 77 per cent (selling units) was noticed. Two Blood banks with serious deficiencies collected 5948 units of blood. Real magnitude of spurious/Not of Standard Quality drugs sold in the market could not be assessed due to inadequate sampling. Under-utilisation of capacity of the laboratory resulted in delay in testing and follow up action. Inordinate delay in despatch of the drug samples to the testing laboratory resulted in delayed declaration of NSQ drugs. Delayed declaration of NSQ drugs resulted in selling of NSQ drugs before they could be withdrawn. 4. Sub-standard drugs worth Rs.68 lakh purchased by CMSO and ESIS were not replaced.Item Integrated Audit of Health and Family Welfare Department in Mizoram(CAG of India, 2009) CAG of IndiaIntegrated audit of the Health and Family Welfare Department in Mizoram revealed poor budget, accounting and procurement procedures and non-implementation of various Centrally Sponsored Schemes. Some of these are highlighted below: 1. The Directorate of Hospital and Medical Education parked funds amounting to Rs. 2 crore in Civil Deposit for periods ranging from 4 to 30 months. 2. An amount of Rs. 30 lakh was drawn for electrification of buildings and fencing works, out of which, only 2.17 lakh was utilised for water connection, while the balance amount remained unaccounted for. 3. Unauthorised disbursement of Rs. 42.44 lakh led to probable misappropriation of funds by the Deputy Director (Nursing). 4. The Directorate of Hospital and Medical Education disbursed Rs. 16.59 lakh to a New Delhi based firm before issue of formal supply order and without ensuring delivery of stores.Item Performance Audit of Drugs and Cosmetics Act in Karnataka(CAG of India, 2004) CAG of IndiaPerformance Audit of Implementation of Drugs and Cosmetics Act in Karnataka covering the period 1997-98 to 2002-03 revealed huge deficiencies in inspection, drawal and analysis of sample drugs and laxity in monitoring compliance with the results of analysis. This indicated that Department of Drugs Control had not discharged enforcement functions effectively. Improper decisions favouring licensees, reporting results of analysis after expiry of validity date of drugs and abnormal delay in a few other cases facilitated marketing of drugs found ‘not of standard’ quality. Drugs Controller had no information regarding number of seizures of sub-standard/ fake drugs. In test-checked Circle Offices, such drugs were seized only in 48 cases (seven per cent) out of 671 ‘not of standard’ drugs. Abnormally low percentage of seizures indicated lack of determination to prevent marketing of drugs found ‘not of standard’ quality. Drug testing laboratory was found deficient in equipment, manpower and methods of analysis, as a result of which 2,032 samples could not be analysed and were given ‘no opinion’ report. Performance of intelligence wing was unsatisfactory considering that action in respect of 826 cases (86 per cent) out of 961 complaints was pending for periods ranging from one to seven years.Item Performance Audit of Supplementary Nutrition Program under ICDS in Assam (2002-2007)(CAG of India, 2008) CAG of IndiaThe problem of malnutrition amongst children in Assam is being addressed through Supplementary Nutrition Programme (SNP), a constituent component of a package of services under ICDS. A performance review of the “Nutrition Programme under ICDS” revealed the following shortcomings: 1. The State Government did not provide funds for Supplementary Nutrition Programme from 2002-03 to 2004-05. The Additional Central Assistance of Rs. 135.86 crore for nutrition meant exclusively for children below 3 years was diverted for providing nutrition for all groups of beneficiaries. 2. Performance of the SNP in terms of nutritional supplementation vis-à-vis prescribed feeding days was grossly inadequate. Poor delivery of nutrition supplementation at only 21-29 percent (calories) and 24 to 33 percent (protein) negated the programme objectives. 3. The programme implementation remained disappointing, often being handicapped by long spells of non-feeding days, inequality in allotment of nutritious food, diversion of allotment of foodstuffs without compensatory replacement and expenditure in excess of norms. 4. RTE weighing 2,32,708 kgs valued at Rs.86.10 lakh were diverted without corresponding compensatory replacements thereby depriving 1,99,020 beneficiaries of 46 projects of supplementary nutrition indicating lack of control in programme management. 5. Despite subsidized PDS (APL) rice being abundantly available, the Department procured SNP rice at higher rates resulting in avoidable expenditure of Rs. 11.69 crore. 6. Overlooking a cheaper rate for RTE offered by a manufacturer the Department procured the item at higher rate consecutively for three years by repeated extension of time of the contact resulting in an avoidable expenditure of Rs. 2.85 crore.Item Performance Audit of Prevention and Control of Diseases Programme in Arunachal Pradesh (1996-2001)(CAG of India, 2002) CAG of IndiaThe review highlights failure of the State Government to utilise Central assistance of Rs.1.44 crore (National TB Control Programme – Rs. 0.20 crore, National Programme for Control of Blindness – Rs. 0.40 crore and National Aids Control Programme – Rs.0.84 crore), non-implementation of Revised strategy for National Tuberculosis Control Programme (RNTCP), non-establishment of eye bank, unnecessary blockade of fund, shortfall in achievement of targets fixed for different components of these programme and lack of proper monitoring of implementation of these programmes. Main audit findings are summarised below: 1. Against total releases of Rs. 5.03 crore (Rs. 0.27 crore RNTCP, Rs. 0.58 crore NPCB and Rs. 4.18 crore NACP) by the Government of India, Rs. 3.59 crore were utilised during 1996-2001 leaving Rs.1.44 crore (29 percent) unspent. 2. Under RNTCP, none of the 4 DTCs could start functioning due to delay in formation of societies. 3. Under NTCP, in 7 out of 13 districts in the State, no DTCs were established. Even the 6 functional DTCs were not provided with all the essential equipment. 4. Unproductive expenditure of Rs.8.71 lakh due to non-functioning of the State TB Training Demonstration Centre at Naharlagun. 5. Nine districts with a population of 5.45 lakh were deprived of the benefit of district mobile eye units (DMUs) due to non-appointment of eye specialist etc. for 4 districts and non-sanctioning of the DMUs for 5 districts. 6. Shortfall in achievement in cataract surgery during 1996-2001 varied from 35 to 73 per cent. 7. No eye bank was established either in the Government sector nor by NGOs. 8. Unnecessary locking up of fund of Rs.13.00 lakh for purchase of 6500 wall clocks for distribution/display to different hostels/schools prior to selection of NGO. 9. Doubtful expenditure of Rs.7.19 lakh for procurement of consumables, reagents etc.Item Performance Audit of Store Management in Health and Family Welfare Department in Jharkhand(CAG of India, 2003) CAG of IndiaFunctional efficiency of health services is largely dependent upon the medical infrastructure available be it in the form of equipments, Hospitals, medicare or doctors. Stores management inclusive of equipments and medicines plays a vital role in providing modern facilities required for diagnosis as well as appropriate treatment. This performance audit of Store Management in Health and Family Welfare Department in Jharkhand revealed that: 1. Nearly 40 per cent medicines procured were purchased without assessment of actual requirement. 2. Medicines worth Rs 7.01 crore were purchased from private firms/ unauthorised agencies without inviting tenders/approval of purchase committee. 3. 18 out of 63 samples of medicines collected by Drug Inspectors were found to be substandard. 4. Equipments worth Rs 44.07 lakh were purchased without adhering norms. C.T. Scan machine was purchased by payment of extra cost of Rs 21.95 lakh. Equipments worth Rs 64.69 lakh were lying idle for want of repairs.Item Performance Audit of National Rural Health Mission (NRHM) in Assam(CAG of India, 2008) CAG of IndiaThe National Rural Health Mission (NRHM) was launched in April 2005 throughout the country to provide accessible, affordable and reliable healthcare to the rural population, especially the vulnerable sections of the society. The programme envisaged convergence of various existing standalone health programmes, decentralization of the planning process with special emphasis on bottom-up approach in decision making and creating better linkages and cooperation among various social sector departments. A mid-term review of the implementation of the programme in the third year of the Mission period (2005-2012) in Assam is aimed at reviewing the initiatives taken by the State Government to bridge the gaps in healthcare facilities provided in the earlier programmes and highlight the areas and issues of concern, which need to be addressed for successful achievement of the objectives of the Mission by the target date. The performance review brought out several positives relating to maternal and child care services like increase in institutional deliveries as envisaged in the programme guidelines. Diseases like polio were contained and there were no cases of kala azar during 2005-07. There was a significant improvement in the cure rate of tuberculosis and the overall achievement of primary immunization of children in the targeted age group was quite high. There were, however, many areas of concern which require the attention of the State Government on priority basis. Foremost among these is the planning process. Community owned, decentralized planning as envisaged by the Mission, was not achieved as yet in the State. Household survey was not completed at all the levels – village, block and district and time bound action plans were not drawn up to achieve the objectives of the programme. Community based monitoring committees were also not formed at various levels. The State Government increased its outlay on healthcare during the review period in keeping with the programme guidelines. However, it failed to utilize the available funds optimally to strengthen the healthcare infrastructure and delivery at the grass root level. Fund management was quite poor and the State had not released its share of funds for implementation of the programme. Funds were released to the health centres in excess of the prescribed norms and in certain cases, funds were shown to have been released to non-existent dispensaries and subsidiary health centres. Basic accounting records were not maintained at both the State and the district level, leaving scope for fraud and misappropriation. Infrastructure, both physical and human, is an area where the State fared badly in achieving the targets set by the Mission. The number of health centres, especially in the tribal areas, was woefully inadequate resulting in non-achievement of the primary objective of the programme to provide accessible health facilities to the rural population. There was a delay in completing the construction of health centres and the basic facilities and diagnostic services were not available in a number of health centres that were sampled during audit, affecting the quality and reliability of health services in rural areas. There was a shortage of medical and support staff at the health centres, impeding the goal of providing quality healthcare. Procurement of medicines and medical equipments in the State was ad-hoc and the quality of drugs procured remained questionable. Considering that drug management is a critical input, delays, shortages or poor quality of drugs are likely to jeopardize the implementation of the programme. Information, Education and Communication (IEC) activities are meant to promote behavioural changes, increase the awareness of the public about their rights and available health facilities. The State could not achieve this objective of spreading awareness and dissemination of information regarding availability of and access to healthcare facilities for the rural population owing to lack of planning and implementation strategy in this regard. As regards maternal health, while there was a considerable improvement in the registration of pregnant women, they were not administered the prescribed dosage of medicines, due, apparently, to their non availability in sufficient numbers. The overall achievement in terms of maternal health was far from satisfactory and registration of pregnant women for systematic ante-natal check up and tracking was not in place. Scrutiny revealed that essential obstetrics care facilities were lacking in almost all the health centres. Reproductive healthcare was not accorded adequate attention and the complete details in this regard were not available with the district health authorities. There was a wide variation among the districts with regard to achievement of targets for immunization and the overall achievement, especially with regard to secondary immunization, was quite poor.