CAG finds large scale irregularities in Assam

Financial irregularities, procurement of substandard medicines and unsatisfactory maternal heath care achievement by the National Rural Health Mission programme in Assam are some of the findings of the CAG.

Last Updated: Dec 15, 2009, 18:07 PM IST

Guwahati: Financial irregularities,
procurement of substandard medicines and unsatisfactory
maternal heath care achievement by the National Rural Health
Mission programme in Assam are some of the findings of the

"Serious financial irregularities were noticed with fund
management being quite poor," Principal Accountant General
(Audit) Assam, Mukesh P Singh today said while speaking on the
Stand-alone Performance Audit Report of the Comptroller and
Auditor General of India.

"Basic accounting records were not maintained at both the
state and the district level, leaving scope for fraud and

"There were irregular and unauthorised release of
maintenance grant of Rs 2.77 crore to 2,794 health care
centres not housed in own/government buildings. Rupees 43.80
lakh was released during 2005-06 and 2006-07 to 180
non-existent centres," he pointed out.

"The state had not released its share of funds for
implementation of the National Rural Health Mission programme.
However, in some cases funds released to the health centres
were in excess of the prescribed norms," he said briefing the
media here on the CAG report, tabled in the assembly on
December 11.

Though the state government increased its outlay on
health during the review period in keeping with the programme
guidelines, "It failed to utilise the available funds
optimally to strengthen the healthcare infrastructure and
delivery at the grassroot level," he said quoting the report.

According to the CAG report: "41-65 per cent of the funds
remained unutilised with the government agency State Health
Society during 2005-08. In the five test-checked districts,
balance of Rs 1.48 crore of Reproductive and Child Health
programme was not carried forward to the NRHM programme".

"Procurement of medicines and medical equipment was ad-hoc
and the quality of drugs procured remained questionable.
Considering that drug management is a critical input, delays,
shortages or poor quality of drugs are likely to jeopardise
the implementation of the programme," it said.

The planning process was another area of concern for the
CAG, which, it felt, required the state government`s attention
on a priority basis.

"Community-owned, decentralised planning as envisaged by
NHRM was not achieved as yet in the state," the report said.

Household survey was not completed at the village, block
and district levels and time bound action plans were not drawn
up to achieve the programme`s objectives. Community based
monitoring committees were also not formed, Singh said.

"Infrastructure, both physical and human, was an area the
state fared badly in achieving targets set by NHRM. The number
of health centres, especially in the tribal areas, was
woefully inadequate resulting in non-achievement of the
primary objective of providing accessible health facilities to
the rural population", the report said.

In a number of the health centres sampled during audit,
the basic facilities and diagnostic services were not
available. This coupled with shortage of medical and support
staff affected the quality and reliability of health services
in rural areas, he said.

The report pointed out: There was considerable
improvement in the registration of pregnant women. But they
were not administered the prescribed dosage of medicines
apparently due to their non-availability in sufficient

"The overall achievement in terms of maternal health was
far from satisfactory and registration of pregnant women for
systematic ante-natal check up and tracking was not in place.
Scrutiny revealed that essential obstetrics care facilities
were lacking in almost all the health centres," it said.

With wide variations among the districts in achievement
of immunisation targets the overall achievement, especially
secondary immunisation, was quite poor.

Hundred per cent coverage of pulse polio immunisation was
not done for children below five years to achieve zero
transmission of polio by March 2008. Besides, the incidence of
malaria was high and many of the community and primary health
centres did not have full diagnostic services for treatment of
tuberculosis, the report said.

The state was also criticised for failing to spread
awareness about the rural people’s rights and available health
facilities owing to lack of planning and implementation

The performance review, however, brought out positives
relating to maternal and childcare services like increase in
institutional deliveries as envisaged in the programme.
Diseases like polio were contained and there were no cases of
`kala azar` during 2005-07, besides a significant improvement
in the cure rate of tuberculosis, the report said.