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Health sector in Telangana is in bad shape, says CAG report

Hyderabad, March 27 : The Comptroller and Auditor General of India, in its Audit Report on ‘General & Social Sector’ pertaining to Government of Telangana for the year ended March 2016, has exposed several deficiencies in the health sector.

Following are the excerpts of CAG report which was presented in the Telangana State Legislative Assembly on Monday:

The CAG, in its report, said that the budgeted funds were not released in full and there were short releases ranging from 4% to 35% during 2014-16 for procurement and distribution of medicines and equipment. Further, the amounts released were not fully utilised by the Corporation. In the case of procurement of drugs, medicines and equipment in 2014-15, the non-utilisation was almost 40%.

The Telangana State Medical Services and Infrastructure Development Corporation (TSMSIDC) has been procuring drugs, medicines and surgical items without considering the need-based requirement of health facilities. As a consequence, there were instances of non-supply/inadequate supply of essential drugs and surgical items to hospitals, compelling them to procure such drugs and surgical items locally at higher prices and that too tapping the meagre budget allocated to them for emergency local purchases of drugs.

Against 635 items of essential drugs identified in the State, no arrangements were made for procurement of 237 items. Further, 197 purchase orders (cost Rs. 12.17 crore) placed during 2014-16 were not executed by the supplier firms. As a consequence, a number of essential drugs were not supplied/belatedly supplied to health facilities, thereby depriving the patients of the timely availability of essential medicines. The Central Medicine Stores (CMSs), Adilabad, Hyderabad and Warangal had accepted drugs and medicines (cost: Rs. 1.27 crore), having less than 80% of shelf-life and drugs and medicines (Adilabad and Hyderabad/cost: Rs. 1.28 crore) having active ingredients below the stipulated optimal level, disregarding the Procurement Policy as well as the conditions of bids with regard to ensuring potency of drugs.

In the five test-checked hospitals, although a significant volume of drugs and surgical items costing Rs. 8.30 crore had been procured through decentralized procurement system, the hospital authorities had neither obtained proper confirmation/acknowledgement of non-availability of items of drugs/surgical items from the Central Medicine Stores, nor did they adopt the rate contract for transparency in procurement.

Against 635 listed items of essential medicines, only 303 (48% for 2014-15) and 335 (53% for 2015-16) items of drugs and medicines were available with Central Medicine Stores in the Stale and this had defeated the prime objective of making available the essential drugs to all the health facilities when needed. As for the essential surgical items, against 360 listed items, 289 (80% for 2014-15) and 272 (76% for 2015-16) surgical items only were available with CMSs.

Several items of drugs went out of stock repeatedly and there were delays in replenishing exhausted stock. Cases of stock remaining un-replenished in Central Medicine Stores. Adilabad, Hyderabad and Warangal were observed resulting in critical medicines getting out of stock at hospitals, thereby compelling hospitals/ patients to source them from the market on their own.

Provision of space and storage arrangements for large quantities of various drugs/ medicines and surgical items were inadequate at all the three sampled Central Medicine Stores. There was also no assurance that FEFO (First Expiry First Out) system as stipulated in the Procurement Policy had been followed.

Although certain medicines were required to be stored in controlled environment, there were no proper arrangements in Central Medicine Stores, Adilabad, Warangal and many of the test-checked hospitals, exposing medicines to the risk of degradation.

Due to inadequate pre-despatch quality testing of drugs (even in case of vital medicines) and surgical items through empanelled laboratories, there was no assurance that all the batches of all drugs and surgical items procured were undergoing Quality Control (QC) testing before they were distributed to health facilities and that standard/quality medicines were being issued to patients as stipulated in the Procurement Policy.

There were delays in acquiring Quality Control Test reports from the empanelled laboratories. During the year 2015-16, only 29% (Tablets, Capsules, etc.). 47% (I.V. fluids & injections) and 56% (surgical items) of samples could get QC test reports within the stipulated period, leaving QC test reports for the remaining samples either being received after extended periods of delays or remaining to be analysed by the laboratories.

Due to the absence of Procurement Policy for purchase of medical equipment, there were deficiencies relating to need-assessment, indent mechanism, technology options, specification of equipment, delays in installation and maintenance of equipment, etc.,

Audit observed deficiencies such as delays in supply of equipment (ranging from 74 to 153 days) and delays (ranging from 30 to 224 days) in installation of 383 items of equipment worth Rs. 10.67 crore and equipment lying idle due to non-availability of consumables/facilities to install or utilise the equipment.

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