CAG study reveals Jharkhand’s health infrastructure, including expired vaccinations and unutilized funding

On Wednesday, the Comptroller and Auditor General of India (CAG) chastised a Jharkhand government organisation tasked with procuring pharmaceuticals, surgical products, and medical equipment for failing to use 88% of the Rs 100.31 crore cash granted to it.

The auditor further noted that during the 2016-19 fiscal year, Jharkhand Medical & Health Infrastructure Development & Procurement Corporation Ltd used just 79 percent of available National Health Mission funding on medicine purchases.
Under the auspices of the state health department, MHIDPCL was founded in 2013.

“JMHIDPCL was unable to use state funds totaling Rs 87.85 crore (88%) out of Rs 100.31 crore for drug purchase, which was reimbursed to the department in June 2020.”

“Further, between 2016-19, only Rs 40.54 crore (79%) of available NHM funds were used on medicine purchases, leaving a balance of Rs 12.243 crore in JMHIDPCL’s bank account,” the CAG stated in its latest report, which was submitted before the Jharkhand parliament.

In 2019-20, the CAG conducted a performance audit of district hospital outcomes in Jharkhand, covering the years 2014 to 2019, with the goal of analysing the quality of medical services and patient care delivered by state-run health institutions.

In the lack of a centralised medication procurement by JMHIDPCL, district hospitals (DHs) bought pharmaceuticals from local vendors without quality testing, according to the CAG.

“DHs had access to only 11 to 23% of necessary medications between 2017 and 2019. Due to insufficient procurement relative to demand, accessible pharmaceuticals were also out of stock for a long time “It was stated.

The authorities of DHs failed to follow medicine storage regulations, which were directly connected to drug efficacy and shelf life reduction, according to the report.

The auditor suggested that the authorities establish clear timeframes for the acquisition and testing of vital pharmaceuticals and enforce adherence to them, failing which accountability should be assigned and action taken against any officials who fail to do so.

To ensure drug efficacy, the administration is urged to store pharmaceuticals under correct conditions as provided in the Drugs and Cosmetics Rules, 1945.

The Comptroller and Auditor General of India (CAG) slammed the Jharkhand Health Department in its latest report on Wednesday for giving children outdated and substandard vaccinations in several district hospitals.

It also charged Jharkhand Medical and Health Infrastructure Development and Procurement Corporation Limited (JMHIDPCL), an institution under the state Health Department, with causing pharmaceuticals worth Rs 82.40 lakh to expire due to unreasonable delays in completing quality test procedures.

During 2019-20, a performance audit of district hospital outcomes in Jharkhand was conducted with the goal of examining the quality of medical services and patient care delivered by the state’s district hospitals for the years 2014-19.

Between November 2018 and January 2019, 410 doses of Hepatitis-B vaccinations with a shelf life of up to October 2018 were provided to children at the district hospital (DH) in Ramgarh, according to the CAG’s audit report filed before the parliament.

When questioned, the hospital’s deputy superintendent said that a mistake in the vaccination supply registry had resulted in the erroneous expiry date being reported.

“The response is unacceptable because the vaccination had the same expiry date (October 2018) and the same batch number in the stock book of the DH, East Singhbhum.” The department failed to respond to the audit observation, according to the report. It was also mentioned that at DH, Ramgarh, Acyclovir 200 mg tablet (Batch T-15818) was available.

“However, 140 out of 5,000 pills of the same batch were provided to OPD patients (between November 23, 2018 and March 27, 2019), and the remaining 4,860 tablets remained lying in store as of February 2020,” according to the study.

Similarly, the report stated that between July 25, 2018 and January 23, 2019, the CS-cum-CMO (civil surgeon cum chief medical officer) provided 17,500 vials of Dexamethasone Sodium Phosphate (Dexona) 2 ml injections to DH, Deoghar.

Deoghar, a drug inspector, took samples of the same batch of injection from the CS-cum-CMO shop on July 30, 2018, which were confirmed fake by the Regional Drug Testing Laboratory in Guwahati on March 8, 2019.

“However, 140 out of 5,000 pills of the same batch were provided to OPD patients (between November 23, 2018 and March 27, 2019), and the remaining 4,860 tablets remained lying in store as of February 2020,” according to the study.

Similarly, the report stated that between July 25, 2018 and January 23, 2019, the CS-cum-CMO (civil surgeon cum chief medical officer) provided 17,500 vials of Dexamethasone Sodium Phosphate (Dexona) 2 ml injections to DH, Deoghar.

Deoghar, a drug inspector, took samples of the same batch of injection from the CS-cum-CMO shop on July 30, 2018, which were confirmed fake by the Regional Drug Testing Laboratory in Guwahati on March 8, 2019.

On the directions of the Civil Court in Deoghar, the samples were re-tested by CDL in Kolkata, which declared them to be “not of standard quality” on September 11, 2019.

It was discovered that 4,185 injectable vials out of 17,500 were given to various wards from the DH, Deoghar store between July 28, 2018 and March 12, 2019 and were administered to patients till March 2019.

“Audit also discovered that 309 vials were administered (between March 12 and March 31, 2019) despite the fact that the injection had been detected as bogus by the Regional Drug Testing Laboratory, Guwahati, as reported by the drug inspector, Deoghar (on March 12, 2019).”

“On September 11, 2019, the Central Drug Laboratory in Kolkata labelled the injection’sub-standard,” according to the newspaper.

According to the CAG, a purchase order for 24.71 lakh Amoxicillin with Potassium Clavulanate 625 mg tablets worth Rs 1.11 crore was issued in March 2017 to a vendor, who supplied 24.47 lakh tablets in five batches with a manufacturing date of May 2017 and an expiry date of October 2018, as well as quality certificates, in June 2017.

JMHIDPCL had the sample examined by an empanelled laboratory, which discovered (on July 27, 2017) that all of the batches were “not of standard quality.”

After a 45-day delay, JMHIDPCL informed the vendor of the unsatisfactory test findings (on September 11, 2017).

The vendor challenged the test report (in September 2017), and samples from all five batches were transferred to the Central Drug Laboratory (CDL) in Kolkata for re-testing by JMHIDPCL with a three-month delay (in December 2017).

In July 2018, CDL, Kolkata, determined that all five batches were of “standard quality.”

“In the end, only 6.08 lakh pills with a three-month shelf life were distributed to the districts, while the remaining 18.39 lakh tablets priced at Rs 82.40 lakh expired in October 2018 and were languishing in the warehouse (June 2020),” according to the CAG report.