CAG report exposes gaps in Delhi's healthcare infrastructure

The 2025 CAG Report on Performance Audit on 'Public Health Infrastructure and Management of Health Services' (Report No. 3 of the year 2024) was placed in the Legislative Assembly of Delhi on February 28, 2025.

This audit aimed to assess the availability of health infrastructure, manpower, machinery, and equipment in health institutions, the adequacy of financial resources allocated, and the efficacy in managing health services in NCTD. This report contains audit findings pertaining to secondary and tertiary hospitals only.

The report, which covered the period from 2016-17 to 2021-22, found that there was a shortage of 21% of staff in the Health and Family Welfare Department of the Government of National Capital Territory of Delhi (GNCTD).

The report also highlighted the shortage of specialists, including super specialist doctors, was as high as 30%, as well as a shortage of essential medicines, equipment, and consumables in hospitals.

Many hospitals lacked basic facilities, including dietary services, radiological diagnostic services, and the waiting time for major surgeries was unacceptably long, ranging from 2-3 months to 6-8 months.

The report also highlighted issues with the management of healthcare services, including: Delays in the empanelment of drug testing laboratories; Shortages of staff in the Drugs Control Department and a lack of accreditation of hospitals and laboratories.

Waiting time for major surgeries in the Surgery Department and Burn & Plastic Surgery Departments of LNH was 2-3 months and 6-8 months respectively and at the same time, six out of 12 modular OTs in RGSSH and all the seven modular OTs in JSSH were found lying idle due to shortage of manpower.

Many Ambulances of Centralised Accident and Trauma Services (CATS) were running without essential equipment and devices.

While a huge waiting time was observed for radiological diagnostic services in LNH, radiological equipment was found to be underutilised in the other three hospitals (JSSH, RGSSH and CNBC) due to a shortage of manpower. Atomic Energy Regulatory Board guidelines were not fully adhered to in these hospitals to ensure the safety of staff and patients.

The Central Procurement Agency (CPA), which was entrusted with the duties of procurement of drugs and equipment for GNCTD hospitals, was not functioning optimally, as Hospitals had to procure 33 to 47 per cent of essential drugs from local chemists to meet their day-to-day requirements from 2016-17 to 2021-22.

Out of 86 tenders floated for the procurement of equipment by CPA, only 24 (28 per cent) were finally awarded. Audit also noticed procurement of medicines from blacklisted and debarred firms by CPA. There was also a shortage of injections for rare/fatal diseases like Haemophilia and Rabies.

Against the proposed addition of 10,000 hospital beds (Budget speech 2016-17), only 1,357 beds were added during 2016-17 to 2020-21. The Department was unable to utilize any of the 15 plots acquired (June 2007 and December 2015) for Rs 648.05 lakh for establishing hospitals and dispensaries, despite having possession for periods ranging between six to 15 years. Only three hospitals were completed out of the eight new hospitals under construction during the audit period.

Janakpuri Super Specialty Hospital (JSSH) and Rajiv Gandhi Super Specialty Hospital (RGSSH) could not provide Superspecialty tertiary care as envisaged in the Memorandum of Association due to weak monitoring and failure to develop a viable business model. There was also a delay in completing various building and infrastructural projects in test-checked Hospitals. Financial Management.

There were unspent/savings ranging from 8.64 per cent (2021-22) to 23.49 per cent (2016-17) against the budget allocated by GNCTD on Health sector during 2016-17 to 2021-22 and ranging from 13.29 per cent (2021-22) to 78.41 per cent (2018-19) against the budget for healthcare infrastructure during 2016-17 to 2021-22.

The Delhi State Health Mission (DSHM) could not utilize the funds released under the National Health Mission as Rs 510.71 crore was lying unspent in the bank accounts of the Delhi State Health Society and its 11 Integrated District Health Societies (March 2022). Outcome of selected Centrally Sponsored Schemes

Reproductive, Maternal, Newborn Child, and Adolescent Health (RMNCH+A) is the most important component/programme under the National Health Mission (NHM) for improving Maternal and Child Health care. From 2016-17 to 2021-22, 57.79% of the total funds available for RMNCH remained unutilised.

There were shortfalls in providing Ante Natal Care, Tetanus Toxoid (TT) shots, Iron folic acid tablets to pregnant women (PW), and also testing them for HIV and Sexually Transmitted Infection/ Reproductive Tract Infection (STI/RTI). Coverage for providing free diet and other facilities (free diagnostic) to pregnant women under Janani Shishu Suraksha Karyakram (JSSK) was also inadequate as only 30% of PW had availed the benefits.

Only 10 per cent of Medical Officers and 16 per cent of Auxiliary Nursing Midwives/health workers were given training for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke. Adequacy and effectiveness of the regulatory mechanisms for ensuring quality healthcare services

The Delhi Nursing Council was not reconstituted regularly by holding elections and notifying fresh members after three years. Only 20 out of 37 Nursing Training Institutions functioning in Delhi were inspected, and that too, with delays of seven to 41 months. Pharmacy Practice Regulations (PPR) notified by GoI in January 2015 have not yet been notified by GNCTD. There was an overall shortage of 52 percent of staff in different cadres, including a 63 percent shortage in key staff of Drug Inspectors in the Drugs Control Department.

There was a huge shortfall in the mandatory inspections of drug selling and manufacturing units and Blood Banks by the Drugs Control Department. The Drug Testing Laboratory (DTL) was not accredited by the National Accreditation Board of Laboratories (NABL) and did not have modern equipment and manpower. NABH did not accredit two test-checked hospitals. NABL accredited none of the four labs of LNH/MAMC. NABL did not accredit two out of three labs in the case of RGSSH.

Achievement of Sustainable Development Goals related to the Health sector. The Sustainable Development Goals (SDG) adopted in September 2015 set out a vision for a world free of poverty, hunger, disease and want. Examination of individual indicators, however, revealed that Delhi lacked under two indicators, viz. the case notification rate of Tuberculosis and the suicide rate.

Audit observed deficiencies in implementation of Revised National Tuberculosis Control Programme (RNTCP) such as lack of awareness about TB, non-formation/ delay in formation of District DR-TB Committees, inadequate monitoring of scheme implementation, etc. Implementation of Programmes, Schemes/Projects/Services of GNCTD. All private hospitals which were allotted land on concessional rates were to provide 25 per cent of their OPD facilities and reserve 10 per cent of their IPD beds for free treatment of patients from Economically Weaker Sections (EWS).

Information about the total OPD patients treated by these Identified Private Hospitals (IPHs) were not provided by DGHS. The audit noted that 19 out of 47 Government Hospitals (GHs) in Delhi had not established referral centres to refer EWS patients to Identified Private Hospitals (IPHs) even after a delay of 15 years (June 2022).

The audit also observed shortcomings in the functioning of the Delhi Arogya Kosh (DAK) constituted (September 2011) to assist poor patients financially. It did not maintain scheme-wise details of beneficiaries, did not regularly seek details of unspent amount lying with government hospitals and also did not implement online Aadhar-based/biometric tracking of patients to ensure proper follow-up and to prevent malpractices.

The free surgery scheme of DAK provides for sending eligible patients from Delhi Government Hospitals to empanelled hospitals when the allotted date for a specified surgery is beyond one month or specified surgery is not performed in a Government Hospital. DAK did not carry out any assessment to verify the effectiveness of the scheme for sending eligible patients to private hospitals to reduce the waiting period for surgeries.

One condition for reimbursement of bills of Medico-legal victims is that the victim is not covered in any insurance scheme. No mechanism was in place to check this before making the payment. AYUSH The Number of IPD and OPD patients visiting AYUSH hospitals declined during 2016-22. The pathology lab, maternity ward, and radiology departments in one of the test-checked hospitals were not functional or were partially functional. There was also a shortage of essential medicines in the test-checked hospitals in spite of the availability of funds.

There were shortages in the cadres of doctors (51.89 per cent), paramedical staff (55.93 per cent) and nurses (32.21 per cent) in the four Medical Colleges with attached Hospitals (Ayurvedic and Unani Tibbia College, BR Sur Homoeopathic Medical College & Research Centre, Nehru Homoeopathic Medical College and Hospital and Choudhary Brahm Prakash Ayurvedic Charak Sansthan).

Four Equipment (a Fully Automatic Biochemistry Analyzer, Hematology Analyzer, Electrolyte Analyzer and Immunoassay CLIA System) costing Rs 45.98 lakh procured (March 2018) for the Pathology lab in Tibbic College & Hospital were not put to use. GNCTD did not set up a State Ayush Society, nor did it submit a State Annual Action plan to GoI for availing financial benefit under the National Ayush Mission.

Delhi Bhartiya Chikitsa Parishad (DBCP), intended to provide registration of medical practitioners of Indian Systems of Medicines, was not reconstituted since July 2015. Delhi Homoeopathy Anusandhan Parishad (DHAP), constituted to develop and coordinate research in Homoeopathy, was not functional since 2017-18.

The CAG report has raised concerns about the ability of Delhi's healthcare infrastructure to meet the needs of its growing population. The report's findings have significant implications for the city's healthcare system and highlight the need for urgent reforms to address these gaps. (ANI)