1 doctor per 2,339 people in Panchkula, for 9,999 in Faridabad: CAG report

Haryana has a total of 5,721 sanctioned posts of allopathic doctors under director general, health services (DGHS), that is, one government doctor for 4,431 people. The report mentioned: “It has been observed that sanctioned posts of doctors have no correlation with the population. One doctor is sanctioned for 2,339 persons in Panchkula district whereas one doctor is sanctioned for 9,999 persons in Faridabad district.”

According to the report, in 15 districts, fewer doctors are sanctioned than the state-sanctioned average of one doctor for 4,431 people. These districts are: Charkhi Dadri, Faridabad, Gurugram, Hisar, Jind, Kaithal, Karnal, Nuh, Palwal, Panipat, Rewari, Rohtak, Sirsa, Sonipat and Yamunanagar.

According to the auditors, it was observed that 7,270 posts of doctors, nurses and paramedics (as of October 2022) under the DGHS were vacant and the available manpower for these categories was unevenly distributed. The vacancy position varied from as low as 14.92% in Rohtak district to 57.48% in Yamunanagar district.

In DGHS, doctors have several designations like Medical Officer, Senior Medical Officer, Additional Medical Officer, Dental Surgeon, Senior Dental Surgeon, Deputy Civil Surgeon, Civil Surgeon and Principal Medical Officer. Overall, DGHS has a total of 4,081 doctors (allopathic) available against their total sanctioned strength of 5,721 (including specialist doctors). Thus, the report says, 28.7% posts of doctors are lying vacant in the state.

The CAG report says: “Posts of doctors were lying vacant in all the districts except in Panchkula district where 12 doctors are posted in excess of the sanctioned strength. Vacancies at district level range from lowest (12) in Rewari to highest (121) in Hisar.”

In terms of percentage, 6.3 per cent to 49.3% posts of doctors are vacant in the districts of Haryana, mentions the report, adding “this shows a skewed distribution of available doctors across districts in Haryana”.

As per 2011 Census, the population of Haryana state was 2.53 crore. World Health Organization (WHO) has recommended one doctor for every 1,000 people. Accordingly, the CAG report says, the state should have 25,351 doctors. But as per Haryana Medical Council records, the state has a total of 20,891 registered doctors (public & private) as of June 2022. This indicates availability of one doctor for 1,214 people which is less than WHO recommendation. Haryana state has a total of 6,006 public doctors, including under the DGHS, in medical colleges and under National Health Mission as of October 2022. “This denotes availability of one public doctor for 4,221 persons in Haryana state.”

The CAG report also says that there is shortage in available manpower against the sanctioned strength, adversely affecting health services. “This shortage is quite high in several key posts such as doctors, staff nurses, radiographers/ ultrasound technicians, pharmacists which play a very important role in delivering comprehensive healthcare to the beneficiaries. Moreover, available manpower has not been distributed uniformly across the districts and this trend has been witnessed across all the departments and in most of the crucial posts as well. Though the overall availability of specialists in DHs (district hospitals) is good, there is a wide variation across districts leading to shortage in many DHs. The SDCHs (Sub Divisional Civil Hospital) have very few specialists when compared to IPHS (Indian Public Health Standards) norms.”

The CAG report has asked the government to focus on expediting recruitment process in order to fill vacancies in the sector. The report also suggested: “In the short term, the existing staff should be rationalised across districts and health institutions. While rationalising, it should be ensured that the postings are done in such a way that complementary healthcare professionals i.e., doctors, nurses, paramedics, technicians, and other support staff are posted in each health institution. Availability of infrastructure and other crucial components should be considered during such rationalisation.”

The CAG report also said that there was a shortage of doctors in 21 district hospitals, with Panipat hospital topping the shortage table at 43%. In its response to the CAG, the Haryana health department in July 2023 replied that some vacant posts are filled as per government policies of outsourcing and contractual engagement.

The health department said: “The National Health Mission (NHM) also supports health department to provide specialists, MBBS doctors, staff nurses, lab technicians, multi-purpose health worker (female), etc. to run first referral units, labour rooms, special newborn care units and other health facilities up to sub-health centre as per guidelines of Ministry of Health and Family Welfare.” The department also insisted that the services of this manpower are utilised for the health services, adding that “they are serving the same patients as served by the regular staff”.

However, the CAG auditors did not agree with the health department’s assertion, pointing out that “the purpose of manpower engaged under NHM is to provide health services for various vertical programmes such as non-communicable disease, Janani Shishu Suraksha Karyakarm and Special Newborn Care Units”. “Such manpower is not engaged against the vacant posts of regular staff,” mentioned the CAG report.