Bihar District Hospitals in Dire Need of Doctors, Beds, Medical Equipment: CAG Report

Patna: Contrary to government claims, health infrastructure remains poor in Bihar; thousands of patients, primarily poor and marginalised, visit OPDs at different hospitals and return without treatment due to unavailability of doctors, defunct ultrasound, x-ray machines, etc.

Nearly a year after the second wave of COVID-19, the National Democratic Alliance (NDA) government led by Nitish Kumar failed to learn any lesson from the health crisis during the pandemic. Not much has changed in the government-run hospitals at district headquarters.

For instance, as per reports in the last three days, hundreds of patients who waited for hours in long queues in Sadar hospitals in Jamui, Lakhisarai, West Champaran, Aurangabad and Kaimur districts, had to return without even basic check-ups as doctors were absent from their duties.

Similarly, several seriously ailing patients failed to get admission to these owing to similar issues of either unavailability of medical staff or lack of equipment.

This is a typical scenario in district hospitals across the state. The poor who are forced to visit government-run hospitals have been left disappointed and without any other option as a health treatment is costly in privately-run hospitals. Rich and middle-class people hardly visit government-run hospitals.

Bihar's poor health infrastructure has grabbed headlines several times during the past few years. In April-May 2020, the first wave of COVID-19 had exposed loopholes in the existing infrastructure. The situation was worse during the second wave of the pandemic in April-May 2021 when hundreds died due to the lack of oxygen, beds, proper treatment and medicines. Earlier in 2019, more than 150 children had died due to Acute Encephalitis Syndrome (AES).

This factor was highlighted by the latest Comptroller and Auditor General of India (CAG) report presented in the state Assembly on Wednesday. The CAG report also exposed the state for its unpreparedness during the first wave of the COVID-19 pandemic in 2020.

The report stated that the government-run hospitals, mainly the district hospitals, suffered from a severe lack of resources, workforce and plans for the growing population. It also clarified that the number of doctors, nurses and other paramedic staff was significantly less.

"There was a persistent shortage of doctors, nurses, paramedical staffs, and technicians in Bihar from 2014 till 2020, but the department did not publish the total vacancies to get them filled," the report said.

As per the report, there is a shortfall of beds, ranging from 52% to 92%. Actual bed strength was not raised to the sanctioned level even as a decade has passed.

According to the CAG report, the district government-run hospitals hardly provide patients with basic health facilities. It was noticed during the audit of the functioning of hospitals in five districts- Biharsharif, Hajipur, Jehanabad, Madhepura, and Patna - for the period 2014-15 to 2019-20.

"The district hospitals did not provide 12-15 significant outpatient door curative services like cardiology, gastro, enterology, nephrology, ENT due to shortage of specialist doctors and infrastructure including building, equipment and furniture. The objective of providing free drugs to patients could not be ensured- as many as 59% of the OPD patients had to purchase medicines from their own pockets," the report said.

Much to their shock, the CAG audit team found street dogs and pigs freely roaming on the premises of district hospitals. Besides, they found open drains in these hospitals.

It further pointed out that accident/trauma and psychiatry wards were not found in any test checked district hospitals. Positive/negative isolation wards for infectious patients were also not found. This finding is especially concerning as it shows the state's health infrastructure was ill-prepared for the pandemic.

Similarly, there was no operation theatre (OT) for emergency services in these district hospitals. The intensive care unit (ICU) was found available at Jehanabad district hospital only, while no hospitals had the cardiac care unit (CCU). The report further states that nine of the DHs, including Patna, did not have any blood banks and the existing blood banks, barring two, had valid licenses during 2014-20.

The CAG report questioned Bihar Medical Services and Infrastructure Corporation Limited (BMSICL) for its failure to supply necessary drugs and medical equipment in the hospitals across the state.

"As many as 70 essential drug list (EDL) drugs were not supplied to the hospitals during 2017-18 and 66 EDLs drugs during 2018-19," the report said.

Ironically, last year also, the CAG report on the state, which was placed in the Assembly in March 2021, also painted a poor health infrastructure picture. It pointed out that vacancies for physicians are 61%, dentists are 69% and nurses are 92%, per one lakh population. The CAG report also observed that against the construction of 12 medical colleges (including a dental college) taken up during 2006-07 to 2016-17, only two medical colleges became functional till 2018. Construction of only two nursing institutes could be completed by 2018 against the planned 61.

It further said that the shortage of teaching and non-teaching staff in all streams of medical education ranged from 6% to 56% and 8% to 70%, respectively. Deficiencies have also been found in the infrastructure of medical institutions, which also face a shortage of medical equipment in 20 departments in test-checked five medical colleges (GMC Bettiah, DMCH-Darbhanga, IGIMS Patna, NMCH Patna, PMCH Patna).

Taking note of the government's failure to strengthen health infrastructure, opposition Rashtriya Janata Dal (RJD), Congress, and Left parties repeatedly targeted the government.