A Comptroller and Auditor General (CAG) report on Delhi’s health infrastructure alleged deep-rooted deficiencies in government hospitals, including lack of essential medical services such as ICUs, staff shortages, procurement of medicines from blacklisted firms, and long wait times for tests and surgeries, according to people familiar with the findings of the agency.
To be sure, the report – Health Infrastructure and Management of Health Services, prepared in 2022, and cover the period between 2016-17 to 2021-2022 – is one of the 14 such filings prepared by CAG between 2017 and 2024. However, despite court intervention, it was not tabled in the Delhi assembly along with 13 other CAG reports.
The Aam Aadmi Party (AAP), which governed Delhi during the audited period, said that most of the issues raised were not under its purview, and blamed the Centre for the situation.
One glaring issue flagged in the report, according to officials who are privy to CAG’s findings, was the lack of life-saving infrastructure across city hospitals. Among other issues, it flagged that several hospitals did not have functioning operation theatres (OTs). It also pointed out that a sizeable proportion of hospitals did not have critical facilities such as Intensive Care Units (ICUs) and oxygen services, and Trauma Services (CATS) ambulances were not found up to the mark.
Further, it flagged that as of March 2022, there was a deficit of about 21% in staff in government hospitals, and stated that the government did not undertake any assessment to identify regions deficient in health care facilities. It also assessed shortage of essential facilities like toilets in Mohalla Clinics.
The AAP, on its part, said that recruitment for health-related services lie “solely” under the lieutenant governor (LG) and the central government, who “deliberately” did not hire staff. It also claimed that procurements of medicine were slow became “certain firms were blacklisted based on fabricated documents”.
The LG office refused to comment on the issue.
A major concern raised in the audit report, according to the people cited above, was the unavailability of critical life-saving infrastructure at dozens of government hospitals in the city, which serve as a sole line of treatment for millions of Delhi residents.
According to officials familiar with the CAG report’s findings, out of 27 hospitals of the Delhi government in the city, ICU services were not available in 14 hospitals. Sixteen did not have blood banks, eight had no oxygen services, and 15 did not have mortuary services. It also found that a “major portion” of the fleet of CATS ambulances was operating without essential equipment and devices.
Long wait times for surgeries in government hospitals were another concern, according to the people cited above. The report stated that patients at Lok Nayak Hospital waited two to three months for general surgeries, and six to eight months for burn and plastic surgery procedures.
It added that six of the 12 modular operation theatres (OTs) at Rajiv Gandhi Super Specialty Hospital (RGSSH) and all seven at Janakpuri Super Specialty Hospital remained unused due to a shortage of medical staff, the people cited above said.
The report, according to the people familiar with its findings, flagged a significant shortage in manpower across the Delhi government’s health facilities. It said that hospitals were not adequately staffed with medical professionals, including doctors and nurses, due to which both patients and doctors had to suffer – it translated to shorter consultation time for patients, and a higher workload for doctors.
There was a 30% vacancy rate for teaching specialists in 28 hospitals and medical colleges, a 28% vacancy for non-teaching specialists, and a 9% shortage of medical officers. The deficit extended to nurses (21%) and paramedics (38%).
Furthermore, there was a 36% shortage of staff needed to implement the National Health Mission (NHM) scheme – a program by the central government to provide universal access to quality health care.
According to officials, the absence of promotions, career advancement opportunities, and stagnant salary structures contributed to a severe shortage of super-specialist doctors at RGSSH and JSSH.
The AAP said in a statement: “It is a well known fact that recruitment of doctors and paramedical staff in hospitals of Delhi government was solely a subject of the lieutenant governor and the central government. And it is also known that the central government and the LG deliberately did not hire doctors, paramedic staff just to create problems in health-related services. It is shameful that they can stoop to such levels that they would stop the recruitment of doctors just to create problems for the people of Delhi.”
Another important issue raised in the report was the apparent shortage of medicines, while CAG also flagged the apparent mismanagement in the procurement of medicines for government hospitals. The report states that some drugs supplied by the Central Procurement Agency (CPA) were found to be of inferior quality in laboratory tests. But due to delays in checks, in some cases, inferior quality drugs were administered in hospitals, the report stated.
It stated that the Essential Drug List (EDL), a list of medicines prepared for the needs of a population in government hospitals, was not prepared annually, and in the last 10 years (2021-22), the list was prepared only thrice. Hospitals were found to be purchasing essential drugs from local chemists to meet their day-to-day requirements, it highlighted.
The AAP demanded a probe into why firms were blacklisted, “It is also to be investigated how certain firms were blacklisted based on fabricated documents. How was a deliberate deficiency of medicines created in the hospitals, dispensaries and mohalla clinics of Delhi based on fraudulent documents. It is surprising that LG has still not ordered any inquiry into the conduct of officials who had deliberately blacklisted dozens of firms just to prevent medicines from coming into the hospitals of Delhi.”
The officials said the report underscored that the government did not undertake a need-based assessment to identify areas deficient in health facilities. Against the promised addition of 10,000 hospital beds (as per the 2016-17 Budget), only 1,357 beds were added between 2016 and 2021.
Despite acquiring 15 plots of land between 2007 and 2015 at a cost of ₹648.05 lakh, the government failed to utilise them for setting up new hospitals and dispensaries, the report found. The audit found that these plots remained unused for six to 15 years.
It added that the government failed to enforce a Delhi high court directive from 2007 that mandated private hospitals — built on subsidised government land — to reserve 25% of outpatient, or OPD, services and 10% of inpatient, or IPD, beds for free treatment of economically weaker section (EWS) patients.
As of June 2022, 19 of 47 government hospitals had not set up referral centres to facilitate EWS patients’ access to these private hospitals, despite a delay of over 15 years as of June 2022.
The audit report, people quoted above said, also raised a string of concerns about Aam Aadmi Mohalla Clinics (AAMCs) not being disabled-friendly and lacking toilets. At least 21 clinics lacked toilet facilities, and 12 were not disabled-friendly due to the absence of ramps. Additionally, fire extinguishers were missing in 29 clinics.
Mohalla Clinics and dispensaries are supposed to function six days a week, but due to staffing shortages, many AYUSH dispensaries operated for fewer days as of March 2023, it reported.
The audit also found that the Department of Social Welfare (DSW) failed to construct old age homes at three locations, even after holding possession of the land for seven to eight years, the people said. The report said that this resulted in a wasteful expenditure of ₹2.92 crore and deprived Delhi’s destitute elderly population of much-needed social support.
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