Huge gaps in Bihar's medical facilities, says CAG report

The condition of the health sector in Bihar is far from optimum with a major shortfall of facilities and staff, as per a Comptroller and Auditor General of India (CAG) report tabled in the state legislature on Wednesday.

As per the performance and compliance audit report, the government auditor conducted performance audits in the five districts - Patna, Biharsharif, Hajipur, Jehanabad, and Madhepura districts for the period 2014-15 to 2019-20, and found 52 to 92 per cent shortfall of beds as per the Indian Public Health Standards (IPHS) in the district hospitals.

Apart from two, three district hospitals have only 24 to 32 per cent beds available for patients, with the CAG report saying that the state Health Department had failed to increase the bed strength since 2009.

It also pointed out that there was a persistent shortage of MBBS doctors, nurses, paramedical staff, lab technicians from 2014 to 2020.

The district hospitals did not provide medical test facilities in 12 to 15 departments like cardiology, gastro, enterology, nephrology, ENT etc due to the shortage of specialist doctors, and basic infrastructures such as buildings, medical equipment, furniture, and fixtures.

There are 121 diagnostic facilities mentioned in a district hospital as per the IPHS in the country, but only a maximum of 33 per cent diagnostic facilities are available in Hajipur district hospital.

Facility of diagnosis and management of cases of cardio-vascular disease, cancer, myocardial infraction and stroke facilities were not available in any of the test-checked district hospitals.

Four of these district hospitals do not have test facilities of Japanese encephalitis and chikungunya.

Also, accident/trauma and psychiatry wards and positive/negative isolation wards for infectious patients were not available in any of the test-checked district hospitals.

The operation theatres for emergency surgeries are not available in any of the district hospitals, while shortage of essential drugs in OTs ranged between 64 to 91 per cent, forcing patients to generally purchase drugs from outside.

The Intensive Care Unit (ICU) is available only in Jehanabad district hospital but is also having shortage of paramedical staff, nurses, drugs, and medical equipment.

The Cardiac Care Units (CCU) is not available in any of the five sample district hospitals. The Bihar government had approved a CCU in the Hajipur district hospital in 2012 but it lacks specific equipment like CCU ventilator, defibrillator, cardiac monitor, ECG machine etc. and is lying idle. Hence, it was locked from 2014 till the physical verification in 2021 by the CAG officials.

Bihar has 38 districts and nine of them, including Patna, do not have blood banks. The two blood banks operational in district hospitals do not have valid licenses.

In the four test check district hospitals, four blood banks did not have facilities to test Hepatitis A.

In district hospital Hajipur, all four ANC check ups were ensured in only 4 per cent cases. In other district hospitals, it was not ensured.

High stillbirth rate was observed in the district hospital Madhepura with 2.17 out of 100 live births. In the Biharsharif district hospital, the stillbirth rate is 1.63 per cent. The state average stillbirth rate is 0.96 per 100 live births.

Meanwhile, it was also found that TT injection was not given to all pregnant women in the test-checked district hospitals during the period between 2014 to 2020 except Biharsharif, despite availability in stock.

Significant shortage of equipment (9 to 16 out of 28) was observed in all district hospitals which compromised the ability of the hospitals to provide emergency and critical care in maternity cases leading to 21 maternal deaths in three test-checked district hospitals. Biharsharif registered 9 maternal deaths, Jehanabad 7, and Hajipur 5 during the period 2014-20.

The Bihar Medical Services and Infrastructure Corporation Ltd (BMSICL) was entrusted in March 2014 to ensure uninterrupted supply of drugs and medical equipment in all the hospitals of 38 districts in the state. However, it could not supply all the indented drugs, among other districts, most notably in Patna where 70 drugs came under Essential Drug List (EDL), but 42 per cent and 30 per cent were not supplied at all during 2017-18 and 2018-19, respectively.

The BMSICL could only spend 29 per cent, that is Rs 3,103 crore, against the available funds of Rs 10,743 crore. Out of the total 1,097 projects undertaken by it during 2014-20, only 187 could be completed while 523 were still in progress and 387 were yet to commence.