The Comptroller and Auditor General of India (CAG), in its latest report on Bihar’s state of finances for the fiscal 2018-19, has reprimanded the state government for failing to strategically implement budgeting norms and high expenditure in the last few months. It has also emphasised the deplorable state of medical education in Bihar and made recommendations to change the process of recruiting faculty and streamlining admissions in medical, ayurvedic and nursing institutes. The report highlights issues in building medical infrastructure and training of medical professionals in Bihar, which warrants attentions as these discrepancies adversely impact the quality of graduating professionals and more importantly, does not help address the growing demand for healthcare professionals.
The CAG is a Constitutional body established under Article 148 of the Constitution of India. It is empowered to Audit all receipts and expenditure of the Government of India and the State Governments, including those of autonomous bodies and corporations substantially financed by the Government.
Fraudulent Admission Process and Delay in Construction of Colleges
In the recent report tabled in Bihar’s legislative assembly, the CAG noted discrepancies with admissions, which include admissions in medical colleges on false mark sheets, admission through fraudulent practices, irregular admission on beyond sanctioned seats in the case of Patna Medical College (PMC) and so on among several drawbacks in the functioning of the Bihar Government.
The CAG report submitted before the State assembly state that only two out of twelve medical colleges (including one dental college) being constructed between 2006-07 to 2016-17 under State Plan and Centrally Sponsored scheme were completed by 2018. It also mentions that the Bihar Government made no efforts to increase the seats of the existing medical colleges.
Shortage of Medical Faculty and Medical Infrastructure
The CAG report mentioned that ‘Shortage of teaching and non-teaching staffs in all streams of medical education ranged from six to 56 per cent and eight to 70 per cent respectively against the prescribed norms.’ Additionally, training institutes for AYUSH institutions shared a similar predicament, the report states ‘Significant deficiencies in infrastructure (classroom, library, laboratory, hostels, etc.) vis-à-vis norm of regulatory bodies were noticed during joint physical verification, which created an environment not conducive to academic pursuit’.
Shortage of medical equipment in the medical colleges of the State, which also serve as health centres was shockingly reported by the CAG. Preliminary test of five medical colleges found that the shortage ranged between 38 to 92 per cent in 20 test-checked departments of medical colleges during 2017-18. Furthermore, equipment lying disused for years was common-place, part of the reason for medical equipment lying idle was lack of technical man-power to operate the equipment. The report stated ‘Instances of equipment lying idle or out of order for a period ranging from one to nine years. The machines were idle or out of order as there was unavailability of technical manpower to operate machines and effective steps not taken for repairing.’
In addition to this the report also noted financial mismanagement in infrastructure development, maintenance of medical institutions and procurement of equipment. While this helps assess the quality of medical education in the state, it also highlights this will invariably impact the quality of medical professionals not only in the state but the whole country. NITI AAYOG’s report of the state of health in Bihar, which has also been cited in the CAG report states that ‘Bihar was placed at lowest ranking in key inputs/processes domain which relates to the availability of health systems, service delivery, accreditation, etc. and third lowest in health outcomes domain which includes Still Birth Rate, Neonatal Mortality Rate, Under-five Mortality Rate, Maternal Mortality Ratio (MMR), Total Fertility Rate (TFR), Low Birth Rate, Sex Ratio at Birth, immunization coverage, institutional deliveries, tuberculosis cases and treatment success rate and HIV patients.” It also states the doctor-nurse midwife to population ratio of India was 221 for one lakh population against which Bihar’s ratio was 19.74 to one lakh Citizens. These numbers are alarming and highlights the need to ensure accountability of state finances, especially since this impacts the health sector at multiple levels on the long run.