Delhi's creaking health infra: CAG flags staff, equipment shortage, unspent funds, project delay

Delhi's health infrastructure grappled with staff crunch, lack of adequate medicines and equipment, and unspent funds, revealed a CAG report tabled in the assembly on Friday that also painted a poor picture of the previous AAP dispensation's flagship Mohalla Clinic project. It said that a review of 74 Mohalla Clinics found none had the full stock of all 165 essential medicines. The CAG report also highlighted the lack of essential equipment such as pulse oximeters, glucometers, X-ray viewers, thermometers and blood pressure monitors at these facilities.

This is the second CAG report which has been tabled in the House. A report on the Delhi liquor policy was tabled in the assembly last Tuesday. Twelve reports on the previous Aam Aadmi Party government's performance are to be tabled by the Rekha Gupta-led BJP dispensation.

The CAG report on the state of the city's health infrastructure said that around 70 per cent of the patients visiting Mohalla Clinics between October 2022 and March 2023 spent less than a minute with the doctor.

It found that 41 of the 218 Mohalla Clinics in four selected districts of Delhi remained closed for periods ranging from 15 days to nearly two years due to doctors resigning, leaving or being on extended leave.

Moreover, against the aim of opening 1,000 Mohalla Clinics by March 31, 2017, only 523 were operational by March 31, 2023, stated the report covering the period from 2016-17 to 2020-21.

Emergency services at hospitals struggled due to a lack of permanent specialist doctors alongwith serious deficiencies in public health services that impact both patients and medical professionals, it noted.

In the test-checked hospitals, the report noted instances where operation theatres were not being utilised due to a shortage of manpower. Moreover, the average waiting time for surgeries in these hospitals ranged from one to 10 months.

The intensive care unit (ICU) services were similarly found lacking in the performance audit report. In the ICU of Lok Nayak Hospital's (LNH's) medicine department, five out of 12 ECG machines were non-functional as of March 2020.

One machine went missing in July 2020 and a case was filed in February 2021, but no further details were provided by the hospital, the audit report said.

It flagged a 21 per cent paucity of nursing staff in the health and family welfare department with "critical" shortages of doctors, nurses and paramedical staff across major hospitals.

"Overall, there is a 21 per cent shortage in nursing staff -- with shortages ranging from 1 per cent to 34 per cent on a hospital-by-hospital basis. Significant vacancies have been observed at GB Pant Hospital (34 per cent), GTB Hospital (28 per cent), LNH (20 per cent), and Bhagwan Mahavir Hospital (33 per cent)," the report stated.

Additionally, over 30 per cent of vacancies were reported in 19 different paramedical categories, such as occupational therapist and physiotherapist. The audit also collected data on the sanctioned strength and availability of specialists in 27 district-level hospitals.

A severe shortfall of both teaching and non-teaching specialists has led to long waiting times for surgeries, with some procedures delayed by up to six months, the CAG report observed. It said the hospitals are also struggling with a lack of essential medicines and equipment.

"The Central Procurement Agency failed to supply up to 47 per cent of essential drugs, forcing hospitals to purchase medicines from private vendors, while delays in quality testing have led to the inadvertent use of substandard drugs," it said.

Infrastructure development too has fallen well short of promises by the government with only 1,357 beds added between 2016 and 2021 against a planned 10,000, the report pointed out.

It said that several hospital projects have been delayed by up to six years, and 15 allocated plots for new healthcare facilities remain unused.

The report also said "financial mismanagement" further compounded the crisis, with Rs 510.71 crore under the National Health Mission left unutilised with the city's health expenditure was just 0.79 per cent of Gross State Domestic Product (GSDP) -- far below the 2.5 per cent target set under the National Health Policy-2017.

Additionally, over 57 per cent of the funds meant for maternal and child health programmes remained unutilised, it said.

The audit also highlights deficiencies in basic amenities.

According to Indian Public Health Standards, hospitals should provide proper patient amenities such as potable drinking water, functional and clean toilets with running water and clear signage.

A joint inspection of LNH revealed that its new OPD block lacked toilets for patients and attendants, forcing visitors to use facilities in the Emergency and Casualty building.

Similarly, an inspection of Chacha Nehru Bal Chikitsalaya revealed that only one water cooler was available on the ground floor despite the OPD also operating on the first floor with complaints going unattended.