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Health is loss of wealth in North East India State of Affairs
Meenakshi Deb
It is said health is wealth. Keeping this saying in mind Government of India since last many years is taking steps to improve the health of the country by providing the state government with sufficient funds to build infrastructure, procure equipment and machineries and availability of medicines for patients besides other logistics.
Fortunately, the Comptroller and Auditor General (CAG) of India in its report ended on 31st March 2014 has discovered serious lapses on the part of the Health and Family Welfare Department Meghalaya, where in there was a loss of Rs 4.03 crores.
In order to prevent losses and judicious use of the resources technical committees were formed under Rural Health Mission. Similarly a technical committee under Rural Health Mission was formed to guide the department in procuring medicines under National Rural Health Mission (NRHM). The committee in its second meeting held in September 2010 recommended that selection of items and the quantum of procurement of medicine should be need based to avoid wastage of medicine.
CAG while going through the records in August 2014 of Joint Mission Director, NRHM Meghalaya, revealed that during 2010-11 to 2012-13, it had procured medicines valuing Rs 16.65crore for distribution to various medical institutions such as District Hospitals, Community Health Centers (CHCs) and Primary Health Centers (PHCs) in the state. These medicines were procured without proper ascertaining the requirement from these medical institutions and also without coordinating with the Director of Health Services (Medical Institutions), (DHS-MI) Meghalaya to avoid overstocking and procurement of similar medicines which were already in stock. As a result the director NHRM, Meghalaya did not receive any indent from Medical Institutions (MIs) and consequently medicines valuing 4.03 crore lost their self life due to overstocking.
The state of affairs in Nagaland is no better. Examination of the records of the Directorate of the Family and Welfare revealed that Government of Nagaland sanctioned Rs 0.61 crore for construction of eight Sub- Centers (SCs) under “State Plan- Communitisation in convergence with Rural Development and Department of Under Developed areas”. It was seen that these eight Sub Centers were already shown as constructed under NRHM for Rs 0.93 crore during 2008-2012. Further, out of the eight, two Sub Centers were physically verified along with Departmental Officers and noted that both the Sub Centers had not been constructed which implies that Rs. 0.19crore shown as expenditure was fictitious.
Electricity and water are required to preserve medicines and equipment and for maintaining hygienic environment. It was observed that 36 Health Units (HUs) were functioning without basic facilities of electricity and water. Beneficiary survey conducted in Kohima also revealed that 149 beneficiary out of responses received from 457 beneficiaries stated that their HUs were without adequate water and electricity. Supply indicating the lack of basic facilities with the HUs.
Medicines and equipment are the integral part of the healthcare services. SHS formulated (December 2012) Nagaland Essential Drug List 2012-13 conveying a list of 282 essential drugs to be issued to HUs. The drug list was required to be framed by April 2009 which was framed after a delay of 43 months.
Furthermore, it was revealed that there was massive misutilisation of the scheme funds. Out of Rs. 74.63 crore, SHS incurred Rs. 13.71 crore for setting up of State Family Welfare Training Centre (SFWTC), Rs. 16.23 crore for setting up of Magnetic Resonance Imaging (MRI) Unit at Naga Hospital Authority Kohima (NHAK) and transferred Rs. 26.82 crore to EE, MEW for construction of two DHs.
In another case, it was noted that during 2012-13, Rs 0.04 crore was provisioned and utilized for construction of Biomedical Waste Storage (Rs.0.03 crore) and deep burial pit (Rs.0.01 crore) at the District Hospital, Tuensang. It was confirmed during the joint physical verification (June 2014) that Biomedical Waste Storage was constructed in the bushy jungle without any connectivity. The waste management continued in the landslide area behind the old building of the hospital.
The scenario of the Family Welfare Department in Manipur faced similar issues of irregular expenditure, excess expenditure, non-accountal of scheme funds, unfruitful expenditure so on and so forth.
Audit of records (October-November 2013) of Directorate of Family Welfare Department showed that expenditure of Rs. 1.05 crore was incurred through 42 bills during August 2012 to March 2013 towards local purchase of stationery, maintenance and repairs of vehicles, miscellaneous, original works, petty works and ordinary repairs, purchase of furniture and instruments. As per financial powers delegated the director was authorised to accord AA and ES of a total of only Rs.7.05 lakh. Thus, the expenditure incurred exceeded the financial powers delegated by Rs. 97.93 lakh.
Funds allocated under National School Safety Programme amounting to Rs 65.93 lakh were withdrawn but neither reflected in the cash book nor in the cheque issue register. There was no cash book entry after 3rd May 2013 where in the closing cash balance was stated as Rs. 1.03 crore.
Diversion of funds were also witnessed from the report, Mahatma Gandhi National Rural Employment Guarantee Scheme (MGNREGS) funds of Rs. 79.00 lakh was diverted from construction work which were not permissible as per scheme guidelines. Due to preparation of estimates of works at rates higher than those admissible under MGNREGS, there was excess expenditure to the tune of Rs. 2.83 crore.
A synopsis of the findings of Health and Family Welfare Department, Assam also projects negativity usage of funds and overstocking.
Expenditure of Rs. 2.04 crore, shown to have been incurred on procurement of surgical items, equipment, furniture deodorant cum cleaner etc., by the Joint Director of Health Services and Senior Medical and Health Officer. However, there was nothing on record to show that the actual requirement of items/equipments was assessed prior to going ahead with the procurement.
Similarly, the Joint Director of Health services, Diphu procured different furnitures worth Rs. 76.60 lakh during November 2010 to December 2012. Of these, furniture worth Rs. 23.6 lakh were shown to have been issued during January 2011 to February 2013 while balance furniture worth Rs.52.91 lakh were shown as kept in stock. However physical verification conducted by senior Medical and Health Officer at the instance of audit revealed that furniture worth Rs. 1.87 lakh only were physically available in the stock. Whereabouts of the balance furniture worth Rs 51.04 lakh were however not available on records.
Excess procurement of hospital items worth Rs.2.35 crore by the Karbi Anglong Autonomous Council and the Joint Director of Health Services, Diphu without assessing the actual requirement led to idling of stock of hospital items to that extent.
Scrutiny of the records of Joint DHS, Diphu revealed that the hospital items were procured without assessing the actual requirement and taking into consideration the available stock which led to idling of stones amounting to Rs. 2.35 crore without issue.
From the important findings it can be concluded that there is misutilisation of funds in the Health and Family Welfare Department of all the four Northeastern states. The findings reveal that there was deficiency in planning, shortfall in construction, misappropriation of funds, excess expenditure, and waste management was not proper etc.
To avoid such failures of the department proper planning and execution is necessary. This will not only benefit the general public to avail proper medical facilities but will also grow in the aid of the economy.
So, the challenges would be to increase spending on health infrastructure, reduce the gap between rural and urban areas when it comes to health outcomes, focus on curbing the spread of communicable diseases and above all, show greater efficiency in health spending.
Depth analysis of proper utilization of funds will enable the department to function properly not only that it will also help to reduce overstocking of medicines which is ultimately wasted benefitting to none.
