PARLIAMENT OF INDIA
RAJYA SABHA
DEPARTMENT-RELATED PARLIAMENTARY STANDING
COMMITTEE ON HEALTH AND FAMILY WELFARE
SIXTEENTH REPORT
ON
DEMANDS FOR GRANTS 2006-2007 (DEMAND NO. 46) OF
THE DEPARTMENT OF HEALTH AND FAMILY WELFARE
(MINISTRY OF HEALTH AND FAMILY WELFARE)
(PRESENTED TO THE RAJYA SABHA ON 22ndMAY, 2006)
(LAID ON THE TABLE OF LOK SABHA ON 22ndMAY, 2006)
RAJYA SABHA SECRETARIAT
NEW DELHI
May, 2006/ Jyaistha,1928 (SAKA)
CONTENTS
COMPOSITION OF THE COMMITTEE
PREFACE
REPORT
OBSERVATIONS/RECOMMENDATIONS AT A GLANCE
*MINUTES
* To be appended at the printing stage
COMPOSITION OF THE COMMITTEE
Shri Amar Singh ¾ Chairman
MEMBERS
RAJYA SABHA
Shrimati Sukhbuns Kaur
$3. Shri Yusuf Sarwar Khan alias Dilip Kumar
$4. Dr. A.K. Patel
5. Prof. P. J. Kurian
6. Shrimati Maya Singh
7. Dr. M.A.M. Ramaswamy
Shri R. Sarath Kumar
Shri Lalhming Liana
*10. Shri Digvijay Singh
LOK SABHA
Shri M. Ambareesh
Shri D.K. Audikesavulu
Dr. Ram Chandra Dome
Smt. Maneka Gandhi
Smt. Bhavana P. Gawali
Shri Rajendra Kumar
Smt. Sushila Bangaru Laxman
Shri S. Mallikarjuniah
Shri Rasheed Masood
Dr. Babu Rao Mediyam
Dr. Chinta Mohan
Smt. Archana Nayak
Shri D.B. Patil
Shri Nakul Das Rai
(i)
Smt. K. Rani
Dr. Mohd. Shahabuddin
Dr. Arvind Kumar Sharma
Shri Uday Singh
Smt. V. Radhika Selvi
Shri Kailash Nath Singh Yadav
Dr. Karan Singh Yadav
SECRETARIAT
Shri N.C. Joshi, Additional Secretary
Smt. Vandana Garg, Joint Secretary
Shri H.C. Sethi, Deputy Secretary
Shri Momraj Singh, Under Secretary
Shri S.C. Dixit, Committee Officer
----------------------------------------------------------------------------------------
*Nominated w.e.f. 13th December, 2005
$ Ceased to be Member w.e.f. 2nd April, 2006
PREFACE
I, the Chairman of the Department-related Parliamentary Standing Committee on Health and Family Welfare, having been authorized by the Committee to present the Report on its behalf, do hereby present this Sixteenth Report of the Committee on the Demands for Grants (Demand No.46) of the Department of Health & Family Welfare, Ministry of Health and Family Welfare for the year 2006-2007.
2. The Committee considered the various documents and relevant papers received from the Department of Health & Family Welfare, Ministry of Health and Family Welfare and also heard the Secretary and other officials of that Department on the said Demands for Grants in its meeting held on 13th April, 2006.
3. The Committee considered the Draft Report and adopted the same in its meeting held on 17th May, 2006.
NEW DELHI;
May 17, 2006
Jyaistha 27, 1928 (Saka)
AMAR SINGH
Chairman,
Department-related Parliamentary
Standing Committee on Health and Family Welfare
REPORT
INTRODUCTION
1.1 The Ministry of Health and Family Welfare earlier comprised three Departments viz. Department of Health, Department of Family Welfare and Department of AYUSH. The Department of Health and Department of Family Welfare have been merged into single line Department under the modified version of the Allocation of Business Rules, on 21st January, 2005. The budget provision for the Departments of Health and Family Welfare were dealt separately for the year 2005-06 due to non-merger of Demands-for-Grants. However the Demands-for-Grants for the year 2006-07 have been merged. As a result, the Ministry now consists of two Departments, namely the Department of Health and Family Welfare and the Department of AYUSH.
1.2 The Central Government has the sole executive responsibility in respect of subjects included in the Union List such as Port Quarantine including hospitals connected therewith, seaman’s and marine hospitals and union agencies for professional training and research. In regard to items included in the State list, such as Public Health, Hospitals and dispensaries, the Central Government’s direct responsibility is restricted to the Union Territories without legislature. The Central Government regulates standards through legislation and provides an enabling framework for development of infrastructure in respect of matters falling under the concurrent list e.g. Medical Education, Prevention of Food Adulteration, Quality Control in the manufacture of drugs etc. The Central Government evolves broad policies and plans through the Central Council of Health set up under Article 263 of the Constitution, arranges for collection and exchange of information and renders financial and technical assistance to States, Union Territories (UTs) and other bodies for the implementation of important health programmes and various Centrally Sponsored Schemes (CCS), including control of epidemics throughout the country.
1.3 In his presentation before the Committee, the Secretary gave an overview of the functioning of the Department. The National Common Minimum Programme (NCMP) of the United Progressive Alliance (UPA) Government identifies health as an important thrust area. At 0.9% of GDP, which translates into Rs. 200 per capita, the total investment on health in India is among the lowest in the family of nations. In fact, the allocations for health have decreased from the level of 1.3% of GDP in 1990 to 0.9% in 1999. The Secretary emphasized that the Government was committed to raise public spending on health from the current 0.9% to 2-3% GDP over the next five years with focus on primary health care. The main objectives of the Department were improving access to healthcare delivery and promoting health care, developing availability of super-specialty and tertiary care in deficient areas, attaining of targets set for communicable diseases, addressing emerging concerns like lifestyle diseases, avian flu, public health institutions and involving private sector through Public Private Partnership.
II BUDGETARY ALLOCATION
2.1 Total allocation for the Department of Health and Family Welfare for the year 2006-07 is Rs. 12545.88 crores against the provision of Rs. 10307.30 crores in 2005-06. The Committee notes that year wise trend of both allocation and expenditure during Ninth and Tenth Plan shows a steady enhancement. Expenditure reported in 1997-98 (first year of Ninth Plan) was Rs. 3476.12 crores which has reached to Rs. 9210.46 crores in 2005-06 (Fourth year of the Tenth Plan). Committee’s attention has, however, been constantly drawn by one disturbing factor. Over the years, the Department has not been able to keep pace with the enhanced allocation of plan funds. Every year, invariably, BE allocation gets reduced at the RE stage and expenditure reported is even lesser. Year 2005-06 was no exception. Plan allocation of Rs. 9332.00 crore was brought down by almost Rs. 1000.00 crores (Rs. 8500.00 crores) at the RE stage and the actual expenditure reported was only Rs. 8076.76 crores. The Committee, however, notes that the position is entirely different with regard to the trend of allocation and utilization of non-plan funds. Against a non-plan allocation of Rs. 943.09 crores in 2004-05, expenditure reported was Rs. 1227.81 crores. Similarly in 2005-06, there was an expenditure of Rs. 1133.70 crores against BE provision of Rs. 975.36 crores. What is more worrisome is that shortfall of non-plan allocation has been made good by appropriating funds from plan allocation. Details made available to the Committee clearly indicate that position has deteriorated over the years. Diversion of plan funds under health schemes of Rs. 68.43 crores to non-plan in 2002-03, has reached the figure of Rs. 289.13 crores in 2005-06. The Committee finds that premier institutions like AIIMS continue to be deprived of required non-plan funds. Position was the same with CGHS. The Committee apprehends that position may be the same more or less in respect of other institutions and schemes. The Committee fails to comprehend the reasons for non- provision of required non-plan funds. The Committee understands that as a result of concerted efforts made at the Secretary and Ministerial level by the Department, there has been some increase in the allocation of non-plan funds in 2005-06 which however proved to be inadequate. The Committee would like to emphasize that there is an urgent need to curb the trend of diversion of plan funds to non-plan side. Such a position cannot be considered advisable for the successful implementation of any plan scheme.
2.2 To ensure optimum and judicious utilization of allocated funds, for any scheme, prescribed financial norms need to be strictly adhered to. Non-existence of pending utilization certificates and non-availability of unspent balances are the two visible symptoms thereof. The Committee is, however, constrained to observe that both pending UCs and unspent balances continue to persist. This clearly indicates the failure of implementing agencies both in the private and Govt. Sector to successfully handle the schemes and also likelihood of inherent flaws in the schemes/projects. The Committee has been given to understand that level of pendency of UCs/unspent balances has been reduced due to the constant efforts made by the Department. However, UCs amounting to Rs. 1675.00 crores as on 31st March, 2006 and availability of unspent balances of Rs. 15.35 crores as on 1st January, 2006 cannot be considered a negligible amount. The Committee is of the view that the Department needs to make all conceivable efforts to eliminate such pendency, by making the monitoring mechanism at all levels more effective and result oriented.
2.3 The Committee would like to recall its observation made in the 7th Report that “to meet the target contained in the National Health Policy 2002, health sector needs manifold increase in budgetary support and recommended that external grant should be taken over and above the budgetary support”. The Committee, however, finds that the past practice of including external assistance in the gross Budget of the Department is still continuing. In the domestic Budget for the year 2006-07, an external aid component of Rs.1299.07 crores has been included. The Committee in this connection is constrained to observe that if the practice of including external aid in domestic Budget continues, then the commitment of the Govt. to raise the allocation in the health sector to 2-3% of GDP will remain only on paper and not be realized in actual practice. Moreover, the Committee also feels that financing the non-plan expenditure by external aid is not a healthy practice. The Committee therefore, again recommends that the matter must be vigorously pursued with the Planning Commission and the Ministry of Finance to consider the external assistance over and above the gross budgetary support.
III CENTRAL GOVERNMENT HEALTH SCHEME
3.1 Plan allocation for the CGHS during 2005-06 was Rs. 26.00 crores which has been increased to Rs. 32.00 crores in 2006-07 with an additional allocation of Rs. 3.00 crores for NE Region. The Committee was given to understand that the enhanced allocation of plan funds in 2006-07 was meant for the on-going schemes as well as for modernization/computerization of CGHS. The Committee observes that computerization of CGHS dispensaries will substantially enhance the efficiency of the system which was very much required. The Committee would, however, like to point out that the Department should take all steps so that the proposed computerization is completed during the current financial year itself.
3.2 The Committee observes that trend of utilization of non-plan funds indicates that required funds are not being made available to CGHS. As per the details made available to the Committee, substantive and increasing expenditure is being incurred under non-plan, which has reached from Rs. 381.73 crores in 2002-03 to Rs. 565.00 crores during 2005-06. Keeping in view this trend of expenditure, the Committee strongly feels that non-plan provision of Rs. 276.50 crores in 2006-07 will drastically fall short of the required funds. These non-plan funds, in addition to maintenance of infrastructure of CGHS dispensaries and pay & allowances of its employees, are also meant for settlement of medical claims of CGHS beneficiaries. The Committee, therefore, recommends that provision for non-plan funds should be strictly in accordance with the actual requirements.
3.3 Committee’s attention has been constantly drawn by the shortage of medical/para-medical personnel both for the existing and proposed dispensaries. On a specific query about the status of implementation of SIU Report on Norms of study of CGHS (Allopathic) dispensaries, the Department has submitted the following :_
“This Ministry has accepted the work study report of 1999 by Staff Inspection Unit (SIU), Ministry of Finance, Department of Expenditure in its totality on 16th February, 2001. However, the norms given in the report of 1999 were not acceptable to the CGHS Employees Association on the ground that the SIU had not included a technical expert from the hospitals/dispensaries in its study team. The All India CGHS Employees Association filed a petition in the CAT, Principal Bench, New Delhi. The CAT in its order dated 21st March, 2002 has quashed the SIU recommendations relating to the categories of Chowkidar, Safaiwala and laboratory staff and directed the Government to conduct a fresh SIU study regarding workload in relation to these categories in CGHS dispensaries. The recommendations of the SIU report of November, 2002 in respect of Safaiwala, Laboratory Technician, Laboratory Assistant and Laboratory Attendant were accepted by the Government in January, 2003. In respect of Safaiwala (453 posts) and Chowkidar (284 posts) Govt. has decided in August, 2004 that these posts are to be progressively outsourced.
The Staff Inspection Unit Report on norms of study of Allopathic Dispensaries is under final stage of implementation. As the SIU assessed sanctioned strength is to be treated as present sanctioned strength, which if implemented will lead to a number of posts being declared surplus affecting some working personnel in the CGHS dispensaries with a view to adjust the surplus staff, information on existing strength in the dispensaries have been sought from CGHS units so that a clear picture as to the surplus/additional requirements would emerge.”
3.4 The Committee expresses its deep sense of concern on the status of implementation of SIU Report on CGHS. This exercise has been going on for the last so many years. The Committee finds that it was only after a fresh SIU study conducted on the orders of CAT that a final decision with regard to the posts of Safaiwala, Chowkidar, Lab technician, Lab Assistant and Lab Attendant could be arrived at which was accepted by the Central Govt. in January, 2003. The Committee is, however, given to understand that as in August, 2004, 453 posts of Safaiwala and 284 posts of Chowkidar are to be progressively outsourced. Latest feedback in this regard as well as in respect of Lab staff still remains unavailable to the Committee. Not only this, SIU Report may lead to another dispute. It has been informed that a number of posts are likely to be declared surplus on the basis of SIU Report. Accordingly, information on existing strength in the dispensaries have been sought from CGHS units. The Committee takes a strong exception to this approach. The Committee is of the view that had there been regular interaction between the Ministry of Finance and Ministry of Health and Family Welfare, this kind of uncertainty would not have prevailed for so long. The Committee, therefore, recommends that the Department should complete the exercise of implementation of SIU Report without any further delay.
3.5 On a specific query by the Committee, status of CGHS buildings under construction in Delhi have been made available to the Committee. A perusal of the status report of these 8 CGHS buildings clearly indicates in all the cases in spite of administrative approval being given in 2003, work has either not started or if started, a number of formalities still remain to be complied with.
3.6 The Committee was informed that a Committee has been set up on the 6th May, 2005 under the Chairmanship of Shri P.K. Kaul, former Cabinet Secretary to review the functioning of CGHS and make recommendations for making it more user-friendly. The Committee will also look into and suggest changes with respect to the financial viability of the scheme in view of the rapidly increasing expenditure in CGHS. The Committee may suggest alternative cost effective models of health care provisioning to Govt. employees as well as alternative source of financing the CGHS. The Committee notes that the European Commission is also funding a separate study of CGHS functioning to be conducted by the A.E Ferguson& Company. As per the Performance Budget (2006-07) of the Ministry, the report was expected in the next three weeks. The Committee would, like to be apprised about the findings of EC study of CGHS which must have been received by the Ministry by now.
3.7 The Committee fails to understand the rationale for having two studies on the functioning of CGHS being conducted simultaneously specially in view of the mandate of the Kaul Committee covering all aspects of CGHS functioning. The Committee is surprised to note that although almost a year has passed since the setting up of the Kaul Committee, it has met only on three occasions. It seems only preliminary exercise has been done by this Committee so far. What is more surprising is that no time-frame has been fixed for this Committee. The Committee views this with serious concern. This does not leave any hope for any significant improvement in the functioning of CGHS providing medical services to Central Govt. employees in the near future.
3.8 The Committee finds that in view of the study being conducted by the Kaul Committee, all expansion/strengthening of infrastructure work of CGHS dispensaries has been brought to virtually a stand-still. The Committee would like to quote two instances in this regard. Proposal for construction of building of CGHS dispensary No. 73 in Gurgaon, Haryana for which land has already been purchased will be taken up only after the receipt of report of the Kaul Committee and reaction of the Department thereon. Same is the fate of the proposal initiated in 2005 for construction of a new building for CGHS headquarter at Kidwai Nagar, New Delhi. The Committee would like to emphasize that basic purpose of any study can only be achieved if it is conducted within a prescribed time-frame. The Department should ensure that the report of the Kaul Committee is received at the earliest and action initiated immediately thereafter.
3.9 The status of vacancies of doctors under CGHS Delhi is another area of concern. Position as on 1st March, 2006 is as follows:-
Name of the post
Sanctioned strength
In position
Vacancy position
SAG
33
4
29
GDMOs
660
567
103
Non Teaching
101
83
18
The Department has informed that it has received 468 nominations for appointment as Medical Officers on the basis of Combined Medical Service Examination, 2004 and 2005. Offers of appointment in respect of CMSE, 2004 (168 candidates) were under issue wherein pre-appointment formalities were complete. Nomination of CMSE 2005 (300 candidates) was under process. Vacancies in CGHS will be filled up as and when the medical officers/specialists become available. The Committee apprehends that this would again be a long drawn exercise. As 168 candidate of CMSE, 2004 were still to join service, there was little likelihood of 300 successful candidates of CMSE, 2005 joining in the near future. The Committee strongly feels that urgent action needs to be taken in this vital area. Simultaneously, a review of the existing procedure is also required to be taken so that bottlenecks therein are eliminated.
IV SAFDARJUNG HOSPITAL
4.1 The plan allocation for Sufdarjung Hospital for the year 2006-07 is Rs. 48.00 crores which is at a reduced level when compared with the plan allocation of Rs. 55.54 crores in 2005-06. Reasons given by the Department are that equipment like Theraton, Elite 80, Operating Microscope, Carm Mobile Image Intensifier, MRI System and Brechytherapy which are high cost instruments and involve one time expenditure for about ten years for which funds were provided in 2005-06 have already been procured. As per the information made available to the Committee, expenditure reported up to 13th March, 2006 has been Rs. 47.70 crore.
4.2 The Committee, while appreciating the level of utilization of plan funds allocated for Sufdarjung Hospital during 2005-06, also notes that as compared to Rs. 12.88 crores worth equipment purchased in 2005-06, it is proposed to purchase equipment costing Rs. 15.00 crores during 2006-07. The Committee, therefore is of the view that required funds for procurement of equipments in Safdarjung Hospital need to be provided in 2006-07. The Committee also observes that against 153 number of equipments to be purchased during 2005-06, number of equipments purchased was only 98. Additional efforts should, therefore, be made to expedite the proposed formalities so that targets set for 2006-07 are achievable.
4.3 The Committee notes that there has been a marginal increase in the allocation of non-plan funds for Safdarjung Hospital from Rs. 72.42 crores in 2005-06 to Rs. 74.58 crores in 2006-07. The Committee has been observing that every year, pressure on Safdarjung Hospital has been growing. Following indicators in respect of different services are self-revealing:-
(2004-05) Actual
2005-06 (Estimated)
2006-07 (Estimated)
Admissions
1,12,557
1,23,813
1,36,194
Emergency Attendance
2,68,341
2,95,175
3,24,693
Total operations
72,215
84,937
93,430
General OPD Attendance
14,02,074
15,42,281
16,96,510
Cost Indicators (Cost per patient per bed per day)
1485
1634
1797
4.4 The Committee strongly feels that in view of overall anticipated increase in the various medical services being provided by Safdarjung Hospital, proportionate increase in the non-plan funds also needs to be made. The Committee observes that whereas patient load and resultant pressure on various services being provided by the hospital has been steadily increasing, bed strength remains stuck at 1531 for the last so many years. It has not been possible to add even a single bed so far. The Committee wonders whether anybody has given a thought in this direction. The Committee is of the firm opinion that there is an urgent need to provide more beds so that better health care may be provided to the patients at Safdarjung Hospital.
4.5 The Committee understands that evening OPDs are also being run at Safdarjung Hospital for quite some time. The Committee would, however, like to point out that public at large is perhaps not aware about evening OPDs. The Committee is of the view that adequate publicity needs to be given to such services.
V DR. RAM MANOHAR LOHIA HOSPITAL
5.1 Plan allocation for Dr. Ram Manohar Lohia Hospital, Delhi for the year 2005-06 was Rs. 35.49 crores which has been reduced to Rs. 25.49 crore at the RE stage. Explaining the under utilization. The Department has submitted the following information:-
“The plan allocation for Dr. Ram Manohar Lohia Hospital for the year 2005-06 was Rs. 35.49 crores. In view of the delay in finalization of the procurement procedure in respect of certain costly imported equipments (1000 m A digital Radiography System, 16 Slice CT Scanner, 32 Slice CT Scanner, CATH Lab), the allocation was reduced by Rs. 10 crores. The procurement procedure for these equipments is however continuing and the same will be procured in the next financial year. The estimated total plan expenditure of Dr. Ram Manohar Lohia Hospital during the year 2005-06 is expected to be Rs. 26.41 crores.”
5.2 The Committee notes that sixteen projects/schemes were approved under the Tenth Plan. Their latest status report, however, does not seem to be very encouraging. Setting up of the Post Graduate Institute of Medical Education and Research at the hospital is the most ambitions project. The Committee is constrained to observe that this project seems to have been entangled in the numerous procedural formalities. Designated plot was handed over to M/s HSCC (India) Ltd. on the 14th June, 2005 for demolition of old barracks and construction of the institute building. Although about one year has passed since then but only around 65% of the demolition work has been completed. The Committee is not satisfied by the reply of the Ministry that the tendering work is in process and actual construction is likely to commence shortly. The Committee feels that the present pace of construction clearly gives an indication that it may perhaps take another plan period (Eleventh Plan commences from 2007-08) to get the building of PGIMER ready and functional. The Committee, accordingly, recommends that the construction project may be completed under a prescribed time-schedule closely monitored by a designated group of authorities.
5.3 Strengthening of Emergency and Trauma services at Dr. Ram Manhor Lohia hospital is another prestigious project of the Hospital. As per the status report furnished by the Department, the 78 bedded Trauma center is nearing completion. Action has been initiated both for procurement of equipment and requirement of manpower for the Centre. The Committee would, however, like to point out that the initial target date for completion of the Trauma Centre building was October, 2004. Department has indicated that there was delay in starting the construction work due to some procedural formalities to be gone through. The Committee would, however, like to point out that position remains to be the same when the Trauma Centre project is nearing completion. In spite of intimation given by the CPWD on 1st March, 2006 that the building would be ready for operational use, so far, the building has not been handed over by CPWD to hospital authorities. The Committee apprehends that the original estimated cost of Rs. 30.11 crores for the Trauma Centre building is bound to increase which shows that this project was being constructed without adhering to a prescribed time-schedule. The Committee, therefore, reiterates its earlier observation that every effort should be made to make the Trauma Centre fully functional without any further delay.
5.4 The Committee observes that out of the remaining projects in hand, preliminary exercise of getting the approval of the competent authorities is going on in respect of the following:-
Setting up of Nuclear Medicine Department
Setting up of Thoracic Science Department
Setting up of Neuro Science Centre
Upgradation of School of Nursing to College of Nursing
The Committee hopes that every effort would be made to expedite the process so that construction work on the project starts at the earliest. The Committee would also like to emphasise that the progress of the other technically feasible projects in hand should be closely monitored to avoid any undue delay.
5.5 The Committee has also observed that the Performance Budget (2006-07) indicates the statistical data about various services being provided at Dr. Ram Manhor Lohia hospital for 2004-05 only. No details about 2005-06 either actual about the first three quarters/first half or estimated data have been given, as done in respect of Safdarjung hospital. The Committee strongly feels that this data can prove to be very useful for making an assessment about additional infrastructure/manpower/funds required for the running of the hospital. The Committee, therefore, recommends that these details for the last 3-5 years may be collected and analysed for making a proper assessment of the needs of the hospital.
VI CENTRAL INSTITUTE OF PSYCHIATRY, RANCHI
6.1 Central Institute of Psychiatry, Ranchi is a premier institute in the field of mental health in India. It offers clinical services to mentally ill, trains manpower in the field of mental health and carries out various research programmes. Committee has been observing that this premier institute has not been taking the benefit of plan funds earmarked for it for one reason or the other for the past few years. Details regarding the last three years are self-revealing:-
(Rs. in crores)
2003-04 2004-05 2005-06
Approved outlay
8.00
AE
4.33
Approved outlay
9.00
AE
2.83
Approved outlay
18.50
RE
10.26
Achievement level of financial targets has been very disappointing. Approved outlay of Rs. 18.50 crore in 2005-06 had to be reduced to Rs. 10.26 crore at the RE stage and actual utilization figures are not known to the Committee. The Committee is not optimistic about full utilization of Rs. 10.65 crore plan funds allocated for the institute for 2006-07 in view of its past track record.
6.2 Progress made in the procurement of some medical equipment during 2005-06 supports Committee’s apprehension. In respect of equipment like Colour Doppler and Campus Server although approved by SFC in 2001-02 (February, 2002), orders could be placed at the end of the fourth year (last quarter of financial year 2005-06). In the case of procurement of another equipment, Spiral CT Scan also cleared by SFC in February, 2002, advice of Ministry of Law has been sought on some procedural matter on 1st March, 2006. The Committee takes a serious view of this. The Committee reiterates that there is an urgent need for streamlining the procurement procedure so that premier institutes like CIP, Ranchi do not continue to suffer.
VII JIPMER, PONDICHERRY
7.1 Plan allocation for JIPMER, Pondicherry during BE 2005-06 was Rs. 62.00 crore which was substantially reduced to Rs. 42.00 crore at the RE stage. Explaining the reasons for the reduced allocation, the Department submitted that besides the ongoing activities, the plan allocation for 2005-06 was meant for the establishment of a Super Specialty Centre and Trauma Care Centre. These new proposals involving financial implication worth Rs. 118.00 crore although cleared by the C.C.E.A had to go through a number of procedural formalities. As these activities would take considerable time, the provision in RE was made to the tune of Rs. 42.00 crore. The latest position indicated by the Department was that selection of executing agency was going on which is expected to be finalized by early April, 2006. The Committee appreciates the preparedness shown by the Department in fixing a time schedule for completion of Super Specialty and Trauma Centre. The Committee, however, recommends that the Department should closely monitor the progress in this regard so that the projects can be completed on time.
7.2 On a specific query, the Committee was informed that against the sanctioned faculty strength of 175, there were 89 vacancies at present. Not only this, as per the information made available in the Performance Budget (2006-07), against the original sanctioned strength of total posts of 3185, the existing strength is only 2465. The Committee has been given to understand that since its inception in April, 1956, the Institute has grown to become a premier institute providing most modern allopathic treatment for all diseases and disorders. Through its Regional Cancer Centre status and also Cardiac Cath- Laboratory, the institute has been serving the cause of poor and down-trodden patients by providing free but quality medical care to them. During 2005-06, 221 major operations including 120 open-heart operations were conducted totally free of cost. Its status as the leading teaching institute is well-established. An institute of such a high standard continuing with a depleted staff strength is however, a cause of serious concern. The Committee, accordingly, observes that the Department should take immediate steps for providing the necessary infrastructure and required faculty. If need be, a review of both recruitment and procurement procedure may also be made by the Department.
VIII POST GRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH, CHANDIGARH
8.1 PGI Chandigarh, an institute of ‘National Importance’ as declared way back in April, 1967, has been providing exemplary service to the country, both in the field of health care and medical education. The Committee observes that the Institute continues to make optimum and judicious utilization of allocated plan funds. However, the Committee has been given to understand that plan funds allocated to the Institute are not in accordance with its requirements. Against the proposed Tenth Plan outlay of Rs. 401.50 crore, an outlay of only Rs. 200.00 crore was approved. The Committee has its own doubts about the actual release of these approved funds to the Institute. As per the details available about the last four years of Tenth Plan (2003-07), only Rs. 133.00 crore have been allocated during this period. It cannot be that in the very first year of the plan period, an amount of Rs. 67.00 crore were placed at the disposal of the Institute. As many as 11 project works have been proposed for 2006-07 by the Institute. The Committee hopes that plan funds of Rs. 40.00 crore for 2006-07 will prove to be adequate for these projects. If not, required funds at the RE stage may be provided to the institute.
8.2 With regard to non-plan funds, the Committee observes that there is only a marginal increase of Rs. 1.00 crore in 2006-07 when compared with the non-plan provision of Rs. 121.00 crore in 2005-06. As per the data regarding patient care and other cost indices, 10% increase has to be added in the expenditure incurred during 2005-06. The Committee, therefore, recommends that there should not be any mismatch between the requirement and allocation of non-plan funds for the Institute.
8.3 The Committee is surprised to note that against the total sanctioned 5585 posts for the Institute, there are only 4805 posts filled up as on 31st March, 2005. The Committee is of the view that as many as 780 posts lying unfilled cannot be considered a healthy sign. The Committee would like to be apprised about the category-wise status of these vacant posts and efforts made for filling them up.
IX ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
9.1 AIIMS is a leader in the field of teaching and research which are conducted in 50 disciplines. Being a premier tertiary care hospital, it caters not only to the patients from the country but also from neighbouring countries like Nepal, Bangladesh, Sri Lanka, Bhutan and other Asian Countries. AIIMS, conceived to be a Center of Excellence in modern medicine with comprehensive training has established its credentials in its 50 years of existence.
9.2 Plan allocation for 2006-07 for the Institute stands at Rs. 205.86 crore which is higher than the Plan allocation of Rs. 163.36 crores at the RE stage of 2005-06. Non-receipt of approval of competent authority to the EFC proposal for expansion of Dr. B.R.A. Institute Rotary Cancer Hospital and delay in the starting of construction work for Centre for Dental Education and Research are the two main factors because of which allocation had to be reduced during 2005-06.
9.3 On a specific query about the delay taking place in making the Trauma Centre at AIIMS functional, the Committee was given an idea about the facilities to be made available at the center. Apart from the 186 bed Trauma Centre, additional areas would be available to handle about 100 affected/injured persons affected by natural calamities. Not only this, in an emergency, the 186 beds at the Centre could be converted into ICU like facility within a short time. The Centre would also be having the facility of two helipads to evacuate the injured. Along with the six OTs of the centre, services of multi-discipline super specialty available at AIIMS will also be easily available. The Committee has been given to understand that manpower for the Trauma Centre has already been recruited and hired, the building component was complete and all the machinery would be installed in a short time. Appreciating the progress made in the project on Trauma Centre at AIIMS, the Committee hopes it would be made functional without any further delay.
9.4 Committee’s attention has been drawn by the fact that in spite of AIIMS being a super-speciality hospital, it lacks the facilities to treat burn patients. It was clarified that AIIMS has never been envisaged to have burn speciality, and the nearby Safdurjung Hospital is fully equipped to treat burn cases. The Committee, however, strongly feels that a premier institution should be having every kind of facility. The Committee hopes that as assured by the Director, AIIMS, its suggestion would be placed before the Governing Body at the earliest for an early decision in the matter.
9.5 The Committee observes that a number of path-breaking initiatives have been taken by AIIMS in the recent past. These include the concept of inter-departmental core group, development of protocol for integrated patient management and collaborated research programme with IIT, Delhi and other universities. The Committee was also informed that during the last two years, more than 20 delegations from Harvard University and various colleges of London, China, Sweeden, Taiwan etc. have approached AIIMS not only for technology transfer but also for work being done by AIIMS in research in Stem Cell Therapy is another area worth mentioning.
9.6 Committee’s attention has been drawn by another disturbing development with regard to procurement of medical equipment. The Committee is surprised to learn that the earlier practice of tax exemption for imported medical equipment and life-saving devices was withdrawn few year ago. Since then, tax has to be paid for imported medical equipment/life-saving devices which has been gradually increasing. The present rate is 9.5% tax plus VAT of 4%. As a result, poor patients are facing problems in getting treatment. The Committee strongly feels that this issue of tax imposition on medical equipment/life-saving devices should be examined afresh. Govt. medical institutions and private hospitals need to be treated on a different footing in such matter.
X SHORTAGE OF REQUIRED MANPOWER AT CENTRAL GOVT. HOSPITALS/INSTITUTES
10.1 For the last two-three years, the Committee has been monitoring the ever-increasing shortage of manpower-both medical and para-medical at Premier Institutes/Central Govt. Hospitals. The Committee observes that significant development has taken place in this crucial area during 2005-06. Applicability of Department of Personnel and Training O.M. dated 16.05.2001 would no longer be there on technical posts lying vacant for more than three years. As per the revised decision of the Cabinet, these technical posts could not be filled up without referring them to the Screening Committee. Not only this, future vacancies of scientific and technical posts can remain unfilled for a period of three years, instead of the earlier period of one year. The Committee feels that this was a step in the right direction. The Committee notes that 69 vacant technical (para-medical) posts were advertised during the last year. Selection process in respect of some posts has been completed and in respect of the remaining posts also, the selection process is expected to be completed very soon. The Committee is of the view that the process of filling up of all the vacant technical posts should be closely monitored so as to get the desired result at the earliest.
10.2 Committee’s attention has been drawn by a disturbing development as reported in media. When asked to clarify, the Department confirmed that there have been instances of AIIMS doctors belonging to CHS leaving their jobs for assignments in private sector. The Committee was informed that a committee was constituted in September, 2005 under Shri Javed A. Chowdhary, former Health Secretary to look into the problem of CHS doctors seeking voluntary retirement/ resignation. As per the details collected by the Javed Chowdhury Committee, during the period 2001-05, as many as 294 doctors left CHS against 3825 in position. During the same period, 27 doctors left AIIMS against 495 in position and 22 doctors left PGI, Chandigarh against 232 in position.
10.3 The Committee notes that the Javed Chowdhury Committee in its report has given separate recommendations for CHS officers and AIIMS/PGI doctors which include better service conditions, enhanced allowances, including NPA etc. The Committee is of the firm view that implementation of the recommendations of Javed Chowdhury Committee’s Report should be carried out at the earliest. It is not inclined to agree with the Department’s contention that in public service, one should not think about salaries and facilities etc. Our doctors in Govt. Institutes are indeed doing a commendable job working under tremendous pressure. Nobody should object better service conditions for them. At the same time, the Committee would also like to point out that there is an urgent need for having a mechanism in place, where-under doctors serving Govt. institutes do not have the liberty to leave their service for better placements. Various options can be made applicable. Minimum Service Bond can be one.
10.4 The Committee has also been observing media reports both for and against levying of user charges for diagnostic and other procedures at AIIMS. The Committee does not appreciate the disturbing trend of politicization of this reputed Institute. The Committee has been given to understand that this decision was the result of a detailed examination at various fora and necessary approval of all competent authorities including ratification by the Governing Body of the Institute on 5.7.05. The Committee, is however surprised to note that all these details furnished to the Committee have found no mention in the media reports. The Committee would like to emphasize that premier Institutes like AIIMS need to react in an objective manner to the media reports appearing from time to time which at times are not based on facts.
XI SETTING UP OF AIIMS LIKE INSTITUTIONS (PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA) PMSSY
11.1 The scheme envisages to set up one AIIMS like institution each in the States of Bihar (Patna), Chhattisgarh (Raipur), MP (Bhopal), Orissa (Bhubaneshwar), Rajasthan (Jodhpur) and Uttaranchal (Rishikesh) . It is also proposed to upgrade eleven medical institutions to AIIMS like institutions under the scheme. Seven such institutions have already been identified in Lucknow (UP), Ranchi (Jharkhand), Jammu (J&K), Kolkata (W. Bengal), Salem (Tamil Nadu), Shri Venkateshwara Institute of Medical Sciences (SVIMS), Tirupathi and Hyderabad (Andhra Pradesh). Remaining four institutions in Karnataka, Maharashtra, Kerala and Gujarat are in the process of being identified in consultation with the concerned State Govts.
11.2 The Committee observes that approved outlay for Tenth Plan for this scheme was Rs. 999.00 crore. Preliminary exercise for getting the approval of the competent authority has been continuing since the beginning of the Tenth Plan. However, it was only during 2005-06 (fourth year of the Tenth Plan) that the approval from CCEA could be obtained. The primary factor for delay in getting the approval of CCEA was non-availability of required funds for the scheme during the Tenth Plan and subsequent availability of funds from within the overall Tenth Plan allocation of the Ministry. However, this exercise ultimately did not make available the required funds for PMSSY for the simple reason that the funds were directed for another ambitious project of the Ministry, namely National Rural Health Mission. Hence, the delay in getting the approval of CCEA. Subsequent modification of the scheme by way of addition of institutes for up-gradation was another delaying factor. The Committee has now been given to understand that approval of CCEA has finally been obtained. The Committee is not very happy with the way things have moved after launching of PMSSY. During the course of discussions, the Secretary gave an indication that availability of funds was not an issue, rather institutional capacity to build would be an issue. The Secretary also highlighted the fact that to plan and implement seventeen sites simultaneously was a tall order. A Cell in the Ministry with a designated officer heading the same has been set up with Directors of AIIMS and PGI, Chandigadh also being included to closely monitor this ambitious scheme.
11.3 The Committee would like to reiterate its earlier recommendation that a scheme should be launched only after completing all the ground work and preparatory exercise. It has taken almost four years in getting the CCEA approval for PMSSY. The Committee now apprehends that management of such a big project may prove to be too difficult to be handled effectively by the Ministry in spite of their having set-up a designated Cell for the same. The Committee is not inclined to agree with the Department’s contention that in view of the track record of State Govts not being able to manage their own institutions, the scheme needs to be implemented by the Centre directly. The Committee is of the firm view that the concerned State Govts should be involved in the setting up/upgrading of institutes in their States. The Committee appreciated the PMSSY. This needs to be started immediately without any delay. First upgradation of hospitals to be started immediately. For this allocation of Rs.300 crore to be allotted without any delay.
11.4 The Committee is concerned about one crucial financial aspect of PMSSY. There is a ceiling of Rs. 330 crore per institute, out of which Rs. 110 crore will be the contribution from Centre and States pooling Rs. 20 crores. Remaining Rs. 200 crore are to come from other sources. The Committee feels that this is a grey area and every attempt should be made to restrict the role of private sector in PMSSY. With the private sector being the major fund-raiser, there is a distinct possibility of management slipping into their hands. The Committee, therefore, recommends that the Centre should be more generous by increasing its share and respective State Govts should also be pursued to contribute more. The Committee is also of the view that the exercise of recruiting the required manpower for the proposed institutes should also begin at the earliest. If that does not happen, the Committee has little hope of these institutes becoming functional in the near future.
11.5 The Committee has also observed that N.E Region has remained un represented in the PMSSY which cannot be considered a happy sign. The Committee, therefore, urges upon the Department to identify one state in the N.E. Region for inclusion in PMSSY.
XII INDIAN COUNCIL OF MEDICAL RESEARCH
12.1 ICMR is the apex body for formulation, co-ordination and promotion of bio-medical research in the country. The Committee was given an idea about some of the research activities undertaken by the Council during 2005-06. In the area of HIV, two vaccines have been introduced in two different phases. One vaccine has completed phase –I in Pune . Phase –I of the other vaccine made by an Indian Company has started in Chennai. Another achievement was introduction of microbial male condom which was entering Phase -3. A similar female condom is being made by Reddy’s Lab in South India. For TB treatment, a new drug having four months regimen has been developed by LUPEN in collaboration with CSIR. Similarly, for Malaria treatment, a synthetic drug was under Phase I trial with Ranbaxy.
12.2 The Committee is happy to know that pioneering work is being done by ICMR in the emerging area of Stem Cell Therapy. Under a joint ICMR –DBT initiative draft guidelines for regulatory aspects of Stem Cell research have been finalized and will be released to wider circulation and national debates. ICMR has taken a leading role with its institutes like National Institute of Immunohaematology, National Institute for Research in Reproductive Health and National Institute of Nutrition actively involved in various aspects of Stem Cell Research and Therapy. The Committee understands that as many as 17 research proposals, are at different stages of implementation. The Committee sees it as a very encouraging sign for modern medical science and impresses upon the Department to encourage such activities whole-heartedly.
12.3 The Committee observes that approved outlay of Rs. 870 crore for ICMR during Tenth Plan has not proved to be adequate. This is corroborated by a review done by the Performance Appraisal Board under the Chairmanship of Dr. Kasturirangan and having two foreign experts. The projected requirement of ICMR for 2006-07 as assessed by the Board was Rs. 510 crores. However, an allocation of Rs. 217 crore has been made which is less than half of the requirement assessed by the Board. The Committee fails to comprehend the purpose of setting up an expert body for the Premier Research Council of the country if its recommendations are not given due consideration. This trend of allocation of funds is all the more disturbing when compared with Tenth Plan outlays of other Science and Technology agencies like ICAR, CSIR, DST and DBT which have been on the higher side for the last so many decades. The Committee, accordingly, recommends that as advocated by the Performance Appraisal Board, funding for ICMR for 2006-07 should be enhanced at the RE stage. Eleventh Plan allocation should also reflect the enhanced pattern of funding.
12.4 The Committee was informed that against a proposed Plan allocation of Rs. 255 crore for 2005-06, the Council was released Central assistance of only Rs. 190 crore. Reason being grant of Rs. 66 crore given by Govt. of Japan to the Council after competing internationally. The Committee finds it rather strange that instead of maintaining the level of approved outlay, grants being released by other countries are being taken into account by the Government. It would not be wrong to conclude that securing of foreign funds by a body after striving very hard for the same acts as a deterrent instead of boosting its resources. The Committee is disturbed to note that instead of taking any remedial action in the matter as earlier suggested by it, another adverse condition has been put into effect. Under the new international arrangements, instead of donor country paying the taxes, the recipient body is to pay taxes. The Committee was informed that during 2005-06 ICMR had to pay Rs. 6 crore as taxes on the foreign funding received by them. The Committee is of the firm opinion that the existing practice of adjustment of foreign grants against the domestic funding and also levy of tax on foreign grants should be reviewed afresh and withdrawn at the earliest.
XIII RASHTRIYA AROGYA NIDHI
Rashtriya Arogya Nidhi was launched in 1996-97 and has been constituted with the objective of providing financial assistance to the BPL population for meeting the expenses on treatment for life threatening diseases in the Government hospitals. At the state level, similar societies have been constituted in the various States/UTs which provide the financial assistance to BPL patients upto Rs. 1.50 lakh. The Central Government provides the funds to these societies to the extent of 50% of the amount contributed by the respective State Government and subject to a maximum of Rs. 5.00 crore for bigger states and Rs. 2.00 crore for smaller states. The Committee notes that 21 states have been the beneficiaries of the Nidhi with Karnataka, Madhya Pradesh, Andhra Pradesh, Tamil Nadu and Rajasthan getting the maximum funds. The Committee notes that although the scheme was launched in 1997, all the N.E States with the exception of Tripura and Mizoram have remained outside the ambit of the scheme so far. The Committee is not aware about the reasons therefor. It seems that one obvious reason must be the weak financial position of such States. The Committee feels that the Department has to make vigorous efforts to prevail upon these states to join the scheme.
XIV OTHER EDUCATIONAL INSTITUTIONS/BODIES
14.1 Plan allocation of Rs. 11.81 crore in 2005-06 was meant for a number of educational institutions. The Committee, however, notes that this allocation had to be reduced to Rs. 9.93 crore at the RE Stage and the actual expenditure at the end of the year amounted to only Rs. 2.08 crore. Details in respect of some of the institutions made available to the Committee are self-revealing-
(Rs. in crores)
Name of the Institute
BE 2005-06
RE 2005-06
Actuals
RAK college of Nursing
0.85
0.57
0.40
Medical Council of India
1.00
1.00
0.50
Lady Reading Health school
0.60
0.60
0.18
National Board of Examinations
6.77
6.77
0.20
Medical Grants Commission
1.00
0.00
0.00
Decrease in allocation has been mainly attributed to non-filling up/non-creation of Plan posts under various educational institutions and also unspent balances lying with the autonomous bodies included under this Head. The Committee is of the view that reasons given for under utilization clearly indicate towards bad management. The Committee strongly feels that the Centre needs to play a more pro-active role and make an assessment about the problems being faced by these institutions/bodies and take remedial steps.
14.2 The Committee’s attention has also been drawn by the air of indecisiveness lying around the matter of setting up of Medical Grants Commission. Rs. 5.00 crore were earmarked for Tenth Plan. The Committee has been observing that year after year an amount of Rs. 1 crore is being allocated. Last year of the Tenth Plan has arrived and the idea still remains on proper. The Committee is of the view that this indecisiveness should not continue in the Eleventh Plan. Planning Commission in its Mid Term Appraisal of Tenth Plan has observed that the Ministry may concretize suggestions and current thinking about setting up of a Medical Grants Commission.
XV NATIONAL AIDS CONTROL PROGRAMME
15.1 The Programme is implemented by the National AIDS Control Organisation at the national level and State AIDS Control Societies at state level. The main components under the Programme include Interventions with the Vulnerable Groups, Preventive Interventions with the General Community, Low Cost AIDS Care, Institutional Strengthening and Inter Sectoral Collaboration and Mainstreaming HIV through various other Departments.
15.2 The Committee notes that against an approved Tenth Plan outlay of Rs. 1392.80 crore for the Programme, during the first four years of the plan period itself, Rs. 1426.50 crore have been released which have been fully utilized. Proposed allocation for 2006-07 stands at Rs. 900.00 crore. Achievement level of Physical Targets during 2005-06 also shows a commendable performance, with achievements exceeding the targets in respect of Community Care Centres, Drop-in Centers, Training of Teachers and New Schools covered. Only shortfall noticed is in the coverage of Patients on ART. Against a target of 50,000 patients, only 23,000 could be covered during 2005-06. The Committee is, however, surprised to note that no targets were set in 2005-06 with regard to the following:-
* Condom use among high risk groups
* Awareness about protective role of condoms and
* Awareness in rural areas.
The only data available with the Ministry pertains to a Survey done in 2001 which is not very encouraging.
15.3 As per the details made available to the Committee, rate of HIV infection is showing a gradual increase with estimated number of 3.5 million HIV infected persons in 1998 to 5.13 million in 2004. This rate of increase cannot be taken lightly because of large population in the country. Secondly, one cannot deny that people infected with HIV during the 1980s and 1990s will progress to AIDS, resulting in a steep increase in the number of AIDS patients. Not only this, another alarming development noticed is that one in every four cases reported is a woman which indicates the movement of epidemic from high risk to general population.
15.4 Committee’s attention has been drawn by a number of as many as 15 very valuable suggestions made by the Planning Commission in its Mid Term Appraisal of Tenth Plan, some of which are as follows-
assigning the sentinel surveillance of HIV to professional groups under the overall supervision of ICMR and the Integrated Disease Surveillance Programme.
using diverse channels like private sector, local bodies, elected representatives, celebrities, sports icons and film stars for outreach, messaging and behavioural change in respect of use of condom.
developing a policy framework and a range of Programme interventions to address children affected with AIDS, currently not specially included under the Programme.
expediting the legislation on HIV/AIDS which has been finalized after over 18 months of deliberation.
research on improved management and treatment of HIV/STDs would also expand the range of prevention options for women in particular.
The Committee hopes that the Department must have already initiated required action on these suggestions made in the Mid Term Appraisal of Tenth Plan .
15.5 Committee has observed that considerable expenditure is being incurred on Mass Media /REC activities under the Programme. As per the figures available with the Committee, out of total allocation of Rs. 289.37 crore and 285.98 crore in 2004-05 and 2005-06 respectively, expenditure on IEC activities has been Rs. 35.98 crore and 68.98 crore in the two years. The Committee observes that whereas total allocation level has remained the same, allocation for IEC component has almost doubled in 2005-06 when compared with 2004-05. State-wise details for 2005-06 reveal a more alarming position-
(Rs. in crores)
State
Total releases
(2005-06)
Expenditure on Mass Media IEC
Andhra Pradesh
50.98
11.68
Assam
6.97
3.89
Bihar
11.78
7.47
Chattisgarh
3.50
1.90
Daman & Diu
0.25
0.16
Haryana
0.00
0.63
J & K
0.50
0.16
Karnataka
11.75
1.52
Maharashtra
17.00
3.30
Manipur
4.50
1.88
Mizoram
3.80
1.28
Nagaland
7.00
2.04
Punjab
0.00
0.48
Tamil Nadu
26.25
4.79
Uttaranchal
36.87
10.72
The Committee would like to be apprised about the status of other components/infrastructure under the programme in respect of the above-mentioned states. The Committee would also like to know about criteria/ceiling on IEC activities in accordance with the Programme as a whole.
15.6 The Committee also takes note of the fact that the issue of revealing of HIV status to donors was discussed in the 16th Governing Body meeting of National Blood Transfusion Council. The Committee has been given to understand that the Council was of the opinion that all out efforts should be made to ensure provision of facilities in terms of pre-testing, counseling and HIV testing so that more and more donors will come forward to know their HIV status and can access these services as and when required. The Department has also accepted that revealing of HIV status can follow the effective prevention practices by the individual found to be positive. On a specific query in this regard, officials of NACO informed the Committee that its suggestion has been agreed to. The Committee hopes that this change in the policy must have been conveyed to all the implementing authorities across the country. If not, action should be taken at the earliest.
XVI NATIONAL MENTAL HEALTH PROGRAMME
16.1 The Programme envisages a community based approach to the problem which includes training of the mental health workers at the identified nodal institutes within the State, increasing awareness about mental health problems, providing services for early detection and treatment to community and providing valuable data and experience for future planning improvement in service and research.
16.2 Tenth Plan outlay of Rs. 139 crore was approved for the National Mental Health Programme. However, the Committee notes that although funds were released every year during the Plan period, utilization figures reveal a very discouraging picture. During the first three years of the Plan period, against an allocation of Rs. 90.00 crore, expenditure reported is only Rs. 33.55 crores. The Committee apprehends that expenditure would not have shown any increasing trend in 2005-06 in spite of there being an enhanced allocation of Rs. 40.00 crore. The main factor responsible for this state of affairs was the delay in approval of the revised District Mental Health Programme. As a result, against a target of up gradation of 37 Govt. Mental Hospitals and 75 medical colleges during the Tenth Plan period, only 18 Govt. Mental Hospitals and 13 medical colleges could be funded, as per the latest reports. The Committee hopes that during the last year of the Tenth Plan, the programme would ultimately take off and implemented as envisaged. The Committee is also of the view that shortage of trained psychiatric manpower and lack of awareness regarding treatment, the two major constraints of the programme need to be addressed without any further delay.
XVII NATIONAL CANCER CONTROL PROGRAMME
17.1 Cancer is an important public health problem in India with nearly 7-9 lakh new cases occurring every year in the country. It is estimated that there are 20-25 lakh cases of cancer in the country at any given point of time. With the objectives of prevention, early diagnosis and treatment, the National Cancer Control Programme (NCCP) was launched in 1975-76. The Programme was revised in 1984-85 and subsequently in December 2004. There are 5 schemes under the revised Programme.
(i) Recognition of New Regional Cancer Centres (RCCs):
In order to augment comprehensive cancer care facilities in regions of the country lacking them, New RCCs afre being recognized. A one-time grant of Rs. 5.00 crores is being provided for New RCCs.
For the year 2006-07 four new Regional Cancer Centres have been recognized . They are:
Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh
Post Graduate Institute of Medical Education and Research, Chandigarh
Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir
Arignar Anna Memorial Cancer Research Institute and Hospital, Kancheepuram, Tamil Nadu.
(ii) Strengthening of Existing RCCs:
A one time grant of Rs. 3.00 crores is provided to the existing RCCs in order to further strengthen the cancer treatment facilities in the existing centers.
(iii) Development of Oncology Wing:
The scheme aims to correct the geographical imbalance by providing financial assistance to Government institutions (Medical Colleges as well as government hospitals) for enhancing the cancer care facilities. The one-time grant has been enhanced from Rs. 2.00 crores to Rs. 3.00 crores. Under the Oncology Wing scheme 13 proposals worth Rs. 26.46 crores have been cleared for financial assistance till date for the year 2005-06.
(iv) Decentralized NGO Scheme:
This scheme has been devised to promote prevention and early detection of cancers. Non-government organizations (NGO) will implement these activities under the coordination of the Nodal Agency, which will be an RCC or an Oncology Wing. A grant of Rs. 8000/- per camp will be provided for organizing camps for IEC and early detection activities.
(v) This scheme lays focus on presentation, screening, early detection and treatment of Cancer. The programme would be managed and operationalized by nodal institutions, e.g. RCCs or Government Medical Colleges and Government Hospitals which have well developed radiotherapy/oncology facilities. The districts would be selected on the recommendation of the State Govt. and a financial assistance of Rs. 22.00 lakhs in the first year and Rs. 17.00 lakhs in each of the next four years would be released to the nodal institution for implementation of the scheme over a period of 5 years, whereafter it is expected that the project would be taken over by the Government. It is proposed that the activities will be carried out in two or three districts congruent to the district selected for DCCP. The nodal institutions would carry out training of health workers, ANMs, self-help groups etc. Under the DCCP IEC activities would also be carried out for promoting Prevention, awareness, self-breast examination, early detection of cancer, anti-tobacco activities etc, in which NGOs would be involved. It is proposed to cover 80 districts under the scheme in the last 3 years of 10th Plan. An amount of Rs. 44.00 lakhs has been sanctioned in respect of two DCCP projects covering congruent districts in Kerala and Mizoram during the financial year 2005-06.
The Committee would like to be informed about the number of districts covered in various states, activities done, amount spent and over all physical and financial performance in respect of DCCP.
17.2 The Committee understands that delayed detection is one of main reasons of mortality due cancer in our country. If detected early, a number of these precious human lives could be saved. The Committee therefore, appreciates the urgency shown by the Deptt. to make intervention down at the district level. The Committee in this regard takes note of the scheme to involve NGOs who will be organizing camps to promote prevention and early detection of cancer. The Committee also takes note that Training manuals have been developed under the NCCP for capacity building in cancer control at the District level:
Manual for Health Professionals
Manual for Cytology
Manual for Palliative care
Manual for Tobacco Cessation
The Committee however, feels that the vision and effort shown by the Department to detect this life threatening disease early will bear fruit only it good and credit worthy NGOs are involved and oncology wings are properly strengthened at the District Level. The Committee also feels that personnel in these district hospitals should be specially trained to detect most common types of Cancer in out country e.g. breast and cervix cancer in women.
XVIII AVIAN INFLUENZA
18.1 The first case of Avian Influenza in chicken in the country was reported in February, 2006 from the state of Maharastra. Since then sporadic incidence of bird flu has been reported from many other parts of the country. The Department in the meeting of the Committee on Demands-for-Grants informed that mortality due to bird flu is confined to poultry only and no case of human infection has so far been reported. The Department has also informed that wherever any case of bird flu is reported, the Central Govt. sends a rapid response team to supervise whether all the prescribed protocols for culling or clean up are being followed. The Department also monitors the health status of the people who are involved in culling and provide them personal protection equipment and “Tamiflu” as coverage.
18.2 The Committee feels that though bird flu till now has not claimed any human life, but its potential to take a toll on the same is very high. Therefore, before this epidemic occurs, Govt. should be prepared in every respect to tackle any emergency situation. Further more, as the number of laboratories to test avian flu cases are few, there is a need for strengthening the same.
18.3 The Committee has been informed that the Ministry has spent a large amount of money to procure medicine for bird flu from one particular firm namely – Hetro Drugs. This medicine, however, has an expiry period of six months after which it will be unfit for human consumption. Although no human case of bird flu has been reported so far, it is understood that an order for 1 lakh vials of vaccine (one vial costing about 12 dollars) has been placed. The Committee therefore strongly feels that an enquiry may be carried out by the Department. Committee may be apprised about the outcome thereof.
18.4 The Committee has been informed about an advertisement in the media which promotes the consumption of Indian Chicken. The advertisement shows popular cine stars vouchsafing that there is no health hazard involved in eating chicken. This advertisement was sponsored by the Ministry of Health and Family Welfare. The Committee understands that the promotion of any general food item does not fall within the domain of Ministry of Health and Family Welfare whose mandate is to regulate the medical sector and not the cause of some other agency. This, the Committee feels is sheer wastage of money.
XIX NEW INITIATIVES
The Committee in its 7th and 15th reports had commented upon six new initiatives/pilot projects to be launched during the Ninth Plan. Having observed that these projects have not taken off so far, the Committee in both the Reports recommended that instead of six projects, focus should be concentrated only on two programmes namely Diabetes Control Programme and Cardiovascular Disease Control Programme including the control of Rheumatic Fever. The Committee, however, finds that this specific recommendation of the Committee has escaped the attention of the Department. The Committee therefore, reiterates its earlier recommendation to give priority to the Diabetes control programme and cardiovascular Disease control Programme.
XX NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL SCIENCES, SHILLONG
The main objective of the institute is to provide advanced specialized health care to the people of N-E Region. The Committee has been observing the progress being made in making this ambitious project fully operational. Out of the original approved cost of Rs. 422.60 crore since 1997-98, expenditure incurred upto 2004-05 is Rs. 201.90 crore. The Committee understands that the project is being constantly monitored by various agencies including the PMO and the Ministry of Statistics and Programme Implementation. The Committee is, however, disturbed by the level of achievement of financial targets during 2005-06. Against an allocation of Rs. 126.51 crore reduced to Rs. 86.98 crore at the RE stage, funds released by the end of the financial year amount to only Rs. 30.00 lakhs. Revised date of completion of different phases of project which was to be made functional by mid 2005 is now June/July, 2006. In the absence of details about the progress made under the different phases of project, and also in view of the level of expenditure during 2005-06 the Committee can only conclude that chances of this National level Institute primarily meant for the people of N-E Region becoming fully functional seem to be very dim. The Committee observes that status of manpower as on 31.12.05 is even more disturbing. Out of total sanctioned 1520 posts, only 198 posts could be filled up to 31.12.05. This is confirmed by the statement of the Department that all sanctioned posts subject to availability of applicants in super specialty Departments are expected to be filled up during 2006-07. The Committee is of the view that an intensive drive needs to be initiated, if not already done so far. Other wise the situation that will finally emerge will be that at least another Plan period will be required for acquiring the required manpower for the Institute.
XXI PUBLIC PRIVATE PARTNERSHIP
21.1 The Secretary gave an idea to the Committee about an initiative recently taken in the area of Public Private Partnership in Health Sector. Public Health Foundation of India, an autonomous Public-Private Partnership has been launched by the Prime Minister on 28th March, 2006. The Institute will be having a Corpus of Rs. 200 crore with additional one time contribution of Rs. 65 crore by the Govt. The Committee was informed that EFC has recommended the proposal and the matter is to be placed before CCEA. Initially, two world class Institutes of Public Health are proposed to be established. The Committee was given to understand that a lot of Indian Corporates had shown their interest.
21.2 While welcoming the initiative, the Committee has a word of caution for the Govt. The track record of private sector participation in health sector has not been very helpful so far as public at large is concerned. A number of corporate Hospitals have come up on Govt. land acquired at nominal rates. However, the management of such Hospitals has miserably failed to provide free treatment to the poor as agreed to by them at the time of starting such hospitals. The Committee would like to point out that this so-called public-private sector has now penetrated in the State Health Systems also. The Committee is not much convinced by the contention of the Department that this experiment will be confined to the area of public (medical) education only. The Committee would like to be apprised about the full details of this initiative.
XXII SERVICES AVAILABLE FOR CRITICAL PATIENTS IN GOVT. HOSPITALS
22.1 Committee’s attention has been drawn by the plight of serious patients in need of ICU facilities at govt. hospitals. As per the information available with the Committee, there are about 70,000 ICU beds in govt. hospitals spread across the country, out of which only 8000 could be considered to be good. On an average, about 50,000 patients are in the need of ICU services per day out of which only 15% patients can avail of such services. On a specific query about the existence of any guidelines about maintenance of ICU services in govt. hospitals, the Committee was given to understand that the guidelines do exist for making available facility of medical equipment like Ventilator, Blood Analyser, Portable X-ray machine along with adequate strength of attending medical/para-medical personnel. There is a prescribed ratio of doctors/nurses per patient in ICU. It was also clarified that number of ICU beds in a hospital depends on the capacity of the hospital and the type of specialty they are dealing with.
22.2 The Committee, however, observes that round realities specially in govt. hospitals are entirely different. Firstly, there is acute shortage of ICU beds even in Central Govt. hospitals like Dr. RML hospital and Safdarjung hospital in Delhi. The Committee can well understand the condition of hospitals in States. The Committee would like to point out that hospitals like Dr. RML Hospital and Safdarjung Hospital receive a huge number of patients from all over the country generally in a very serious/critical condition. The Committee is of the firm view that there is a need for having a review of ICU services available in govt. hospitals in the country. A beginning can be made by conducting such an exercise for the two premier hospitals namely Dr. RML Hospital and Safdarjung Hospital located in Delhi. The Committee would appreciate if this exercise is undertaken within a prescribed time schedule so that remedial steps can be initiated at the earliest.
XXIII UPGRADATION/STRENGTHENING OF EMERGENCY FACILITIES AT
STATE GOVT. HOSPITALS LOCATED ALONG NATIONAL HIGHWAYS
The Committee notes that a provision of Rs. 35 crores was made in 2005-06 for up-gradation/strengthening of emergency facilities at State Govt. hospitals located along with national highways. As per the information with the Committee, Rs. 35.86 crores were released to 22 State Govt. hospitals spread over 11 States in the country, with Tamil Nadu getting the assistance for maximum number of hospitals (7 govt. hospitals). The Committee notes a new initiative has been taken by the Department under this scheme. The National Highways Authority which has been entrusted with the 3500 kms. of the Golden Quadrilateral have been requested to identify hospitals along the national highways for funding under the scheme. Besides that, it was proposed to involve NHAI in providing services to the victims of road accidents and needing trauma services urgently. Reason being the financial constraints and lack of manpower available with the state govts. The Committee, while welcoming the proposed revision of the scheme, would like to point out that the Centre need to play a more pro-active role in the implementation of a scheme meant for welfare of general public. The Committee would also like to be apprised about the status of hospitals opened so far (state-wise) under the scheme of Up-gradation/Strengthening of Emergency Facilities at State govt. hospitals located along with National Highways.
XXIV. NATIONAL RURAL HEALTH MISSION
24.1 The National Rural Health Mission was launched in the country on the 12th April 2005. The main aim of the Mission is to provide accessible, affordable, accountable, equitable and reliable primary health care facilities, especially to the poor and vulnerable sections of the population. It also aims at bridging the gap in rural health care services through creation of a cadre of Accredited Social Health Activist (ASHA), improved hospital care, decentralization of programme to district level to improve intra and inter sectoral convergence and effective utilization of resources. The Mission further aims to provide an overarching umbrella to many of the existing programmes of the Ministry including RCH-II, Vector Borne Disease Control, Blindness, T.B., Leprosy, Iodine Deficiency and Integrated Disease Surveillance. It is operational throughout the entire country with special focus in 18 States viz. eight Empowered Action Group States (Bihar, Jharkhand, M.P, Chhattisgarh, U.P., Uttranchal, Orissa and Rajasthan), eight North East States (Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura), Himachal Pradesh and Jammu & Kashmir.
24.2 The year 2005-06 was the preparatory year for the Mission and the institutional framework of the Mission has been set up in the Centre as well as in various States. The Committee was informed that the Planning Commission had accorded in principle the approval of Rs. 900 crore as addtionality for various activities under NRHM at RE stage in 2005-06. The Committee, however, notes that due to savings being available in other schemes, the additionally of Rs. 900 crore was adjusted in the savings. Out of Rs. 928.88 crore available in 2005-06, the major funding, i.e. Rs. 334.70 crore was meant for selection and training of ASHA, upgradation of CHCs to IPHS and untied funds for Sub-Centres. The Committee, however, notes that although funds have been released to all States, especially the targeted States under NRHM, expenditure reported upto December 2005, clearly shows that the Programme has not taken off in the real sense. Details of allocation made under NRHM (component wise) and utilization thereof are as follows: -
(Rs. In crores)
Selection and Training of ASHA
Upgradation of
CHCs to IPHS
Untied fund for Sub-Centre
ASHA Kit
Drug Supply to CHC
Releases
Exp.
Releases
Exp.
Releases
Exp.
Releases
Exp.
Releases
Exp.
81.08
1.10
394.60
11.55
139.99
17.33
15.00
0
190.40
0
Out of eight EAG States, Rajasthan and Orissa are the only States that have shown a nominal expenditure. Similarly, Assam is the only NE State, which seems to have made a beginning.
24.3 Implementation status of key NRHM activities during 2005-06 is as follows:-
Sl. No.
Key Activities
High Focus States
Non-High Focus States
Total
1.
Departments of Health and Family Welfare merged
17
15
32
2.
State Health Missions constituted
18
16
34
3.
District Health Missions constituted
18
12
30
4.
Mission Directors appointed
15
14
29
5.
Merger of Societies – State level
- District level
12
11
14
13
26
24
6.
Registration of Rogi Kalyan Samiti
District Hospital
CHC/SOH/Others
148
2211
90
747
238
2958
7.
MOUs with GOI signed
14
9
23
8.
No. of ASHA proposed to be selected by 31.03.2006
2,28,327
2,28,327
9.
No. of ASHAs selected till date
1,45,546
1,45,546
10.
No. of ASHAs trained till date
32,000
32,000
11.
No. of CHCs selected @ 2 per districts for upgradation to IPHS
720
426
1146
24.4 The Committee observes that analysis of state-wise implementation of key activities during 2005-06 clearly indicates that in a few High Focus States, NRHM is yet to take off. Status of activities in Uttar Pradesh, the most crucial State under the Mission reveals a very discouraging scenario. Neither the Departments of Health and Family Welfare have been merged nor merger of Societies and registration of Rogi Kalyan Samitis have taken place. Even MOU with GOI has not been signed. Status of selection process of ASHA, the most innovative component of the Mission is yet another non-starter in the State. Against 65,000 ASHAS to be selected, only 9548 ASHAs could be selected, with not even a single ASHA getting trained. Position is more or less the same in respect of other components. Jharkhand, Rajasthan and Chattisgarh are the other States where preparatory exercise has barely started. Status of NRHM is equally worrying. Out of total 2,28, 327 ASHAs proposed to be selected, only 1,45,546 ASHAs have been selected as on 21.3.2006 with Rajasthan, Bihar, Orissa and Chattisgarh almost meeting the target and UP and MP remaining way behind their target. In the case of NE States, H.P and J&K, Assam is the only State which is almost touching its target, in respect of other States, selection of ASHAs is not even envisaged. What is more striking is that training of selected ASHAs is simply missing. Out of 1,45,546 selected ASHAs, only 32,000 could be trained and these 32,000 are from one single state of Chattisgarh. In the case of NE states, HP and J&K, nobody seems to have given a thought to the most important aspect of training of ASHA under NRHM. The Committee observes that preparatory activities have taken place in most of seventeen Non High Focus States. However, in Delhi, the capital of the country and nearest to the Department, it seems that the message has not reached so far.
24.5 The Committee understands that the State and District Health Missions are envisaged to be the central players in the monitoring of the performance level of the various initiatives under the Mission. Both State and District Missions have been set up in all the states with a few exceptions. However, with only six State Action Plans and 151 District Action Plans prepared so far, one cannot say that any monitoring is being done so far. The Committee is of the firm opinion that the Department should continue making persistent efforts with all the concerned States so that NRHM takes off in the real sense. The Committee would also like to point out that NRHM is a well-conceived Programme but the fact remains that it is the State Govts. that would be the implementing agencies. Not only the flagship programmes of Family Welfare but also some of the major Disease Control Programmes have been brought under one Umbrella Programme. Experience with regard to implementation of National Health Programmes and Family Welfare Programmes on individual programme basis has varied so far from State to State. Status of various Health Indicators and availability of unspent balances with the implementing agencies clearly indicates lack of effective monitoring mechanism. The Committee is not very convinced especially in view of so many programmes. Another complex dimension of the Mission will be inter-sectoral convergence, with the concerned Ministries. The Committee, therefore, is of the view that a highly dedicated team at the Centre alongwith its counterparts in States can only be effective.
XXV. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME
25.1 The National Vector Borne Disease Control Programm is one of the most comprehensive and multi-faceted Public Health activities in the country and concerned with prevention and control of Vector borne diseases, namely Malaria, Filariasis, Kala-Azar, Dengue and Japanese Encephalitis (JE). The Direcorate of NVBDCP is the nodal agency for Programme implementation. States are responsible for Planning, implementation and monitoring of the Programme.
25.2 MALARIA
25.2.1 Among the Vector Borne diseases, malaria continues to pose a serious public health threat in different parts of the country. Since December 1994, 100% Central assistance for Programme implementation is being provided to the N-E States. Funds amounting to Rs. 348.45 crore were released to States during 2005-06 under NVBDCP.
25.2.2 The Committee has been informed that NE States together contributed 40% of the country’s malaria population, 7% of malaria cases and 19% of malaria deaths reported in the country during 2004. The Committee notes that besides NE States, Orissa and West Bengal reported the maximum number of deaths in 2004. As per the records made available to the Committee, incidence of Malaria cases in 2005 (upto August 2005) indicates no improvement whatsoever in respect of these States. Details of 295 deaths (State-wise) reported till August, 2005 reveal that maximum 90 deaths have occurred in Orissa, followed by West Bengal (81), Mizoram (50) and Assam (45). As per the Performance Budget 2006-07, details available till November, 2005 shows the number of deaths reaching 530. When compared with the details available since 2001, the Committee can only conclude that N-E States, Orissa and W. Bengal continue to perform badly. The Committee observes that funds are being duly allocated to these States by the Centre. The Committee strongly feels that level of implementation needs strengthening in these vulnerable States. It seems that neither the funds are being released by State Govts to districts nor there is adequate supervision and monitoring being done by them. The Committee also notes that in Assam and Orissa, another handicap noticed is that there is acute shortage of Health Workers responsible for surveillance and detection of malaria in villages. Overall shortage of Health Workers in these few states is very high especially as per the required norms as indicated below.
State Required Sanctioned In position
Assam 5104 638 320
Orissa 5927 628 337
25.2.3 The Committee’s attention has been drawn by another significant drawback being noticed in carrying out malaria control measures. The operational performance indicator for malaria is screening of minimum 10% of the population living in malaria prone areas. The indicator is Annual Blood Examination Rate (ABER). The impact indicator is Annual Parasite Incidence viz. the number of malaria cases per year per 1000 population. The Committee notes that achievement level of both of these indicators varies from State to State. Latest figures in respect of some of the States showing less number of cases /deaths available to the Committee for the year 2004 are as indicated below-
State Achieved ABER Achieved API Positive cases Death
Bihar 0.33 0.02 1872 0
Kerala 5.39 0.09 2790 12
Nagaland 3.74 1.38 2486 1
Manipur 5.84 1.04 2736 8
Uttaranchal 3.77 0.14 1255 0
U.P 2.46 0.52 85,868 0
Lakshadweep 2.42 0.03 2 0
All India 9.17 1.75
Position is more or less the same in respect of 2002 and 2003 also. It is evident that in all these States, the basic exercise of identification of suspected cases of Malaria is simply not being carried out and hence less number of cases and deaths reported in these States.
25.2.4 The Committee understands that use of Insecticide Treated Bed Nets is an alternative and cost effective vector control measure which is being supplied free or at highly subsidized rates to the high risk areas of endemic states. Committee has made a specific query about adverse Report of CAG about allotment of 5.20 lakh mosquito nets to Assam by the Center in 2000. These nets were handed over to the State Govt. between 7th February and 7th April 2000. As per CAG Report, out of 5.20 lakh mosquito nets, 4,86,133 nets were distributed to 22 districts from 7th to 11th April 2001. The Committee, however, notes that instead of being distributed, these nets had to be kept in the health department stores and godowns of the State Warehouse Corporation till February 2005 at a monthly rent of Rs. 82,500 since February 2001.
25.2.5 From the detailed note submitted by the Department, the Committee could infer that prescribed norms were not adhered to while negotiating the procurement of 8 lakh single bed nets and 2 lakh double bed nets. The Committee notes that supply orders were placed with three different firms based in Guwahati, Kolkata and Delhi. During the process, a complaint about the sub-standard quality of bed nets was received from CVC. After preliminary inspection by the central team, distribution of bed nets was stopped till further directions from the Centre. Analysis of samples of bed nets was got done by IIT, Delhi that confirmed the bad quality of nets. On being asked to lift the bed nets, the concerned firm went to court. Subsequently, one of the firms went to the Indian Council of Arbitration and the matter hangs there. The Committee notes that only one Delhi based firm has received the payment. The Committee takes a serious view of this development. The Department has chosen not to reply to the specific query about the rent being paid for storage of bed nets in the state warehouse and godowns. The Committee strongly feels that the Department has to be very cautious while entering into any procurement procedure involving such big amount of funds. Non-adherence to procurement procedure has resulted not only in financial losses but also depriving the most vulnerable class of society. Payment of rent to godowns for keeping safe mosquito nets certified and fit for use is a classic case of mismanagement. The Committee, therefore, recommends that the Department should make all conceivable efforts for settlement of case so as to stop incurring of unnecessary expenditures.
25.3 KALA –AZAR
25.3.1 Kala-Azar is endemic in 31 districts of Bihar, 6 districts of Jharkhand, 11 districts of West Bengal and 8 districts of U.P, besides sporadic occurrences in a few other areas. Rs. 58.86 crore was approved in BE 2005-06 for Kala-Azar control in four endemic states- Bihar, U.P., Jharkhand and West Bengal, which was reduced to Rs.17.62 crore in RE 2005-06. The Committee observes that the disease incidence has reduced to 24,340 cases in 2004 from 77,099 cases in 1992 and confirmed deaths from 1419 to 156. However, the Committee is constrained to note that by October 2005, 24,105 cases and 139 deaths have already been reported from the affected States. Details available for the last five years leave no doubt about the fact that all the endemic states have miserably failed to check the rate of cases/deaths reported. Details about 2005 are especially alarming, with incidence rate by October 2005 already touching the previous year cases of deaths.
C- cases , D- deaths
States
2001
C D
2002
C D
2003
C D
2004
C D
2005 (upto October)
C D
Bihar
10327
204
9684
160
13960
187
17324
107
16558
110
Jharkhand
589
0
758
0
2607
5
4028
14
5185
9
West Bengal
1238
4
1592
5
1487
7
2876
24
2242
15
Uttar Pradesh
22
3
32
1
34
1
34
2
68
2
All India
12239
213
12140
168
18214
210
24340
156
24105
139
25.3.2 The Committee is constrained to note that in spite of funds being made available to the states, they are somehow not making an optimum and judicious utilization of allocated funds. Result is that provision of Rs. 58.86 crores in 2005-06 had to be brought down to Rs. 17.62 crore at the RE stage. What is more worrying is that cash assistance could not be released to Bihar, Jharkhand and West Bengal for want of Utilization Certificates for the previous years. The Committee understands that Rs. 20.00 crore have been provided under the programmes for the four endemic states. The Committee hopes that Bihar, Jharkhand and West Bengal must have submitted Utilization Certificates by now. The Committee is of the view that in order to achieve the elimination of Kala-azar by 2010 vigorous efforts needs to be made with special focus on endemic States.
25.4 JAPANESE ENCEPHALITIS
25.4.1 Japanese Encephalitis (JE) is a viral disease with a tendency of seasonal outbreaks. JE has been reported repeatedly from 15 States. During the year 2004, 1714 cases and 367 deaths due to suspected JE were reported from the States. In 2005 (up to 5.12.2005), 6550 cases and 1645 deaths have been reported due to outbreak in eastern part of Uttar Pradesh. The strategy for control includes strengthening the surveillance activities and integrated vector control, capacity building and Behavior Change communication.
25.4.2 The Committee is constrained to note that despite continuous efforts made by the Department, number of cases of JE infection is on the rise. Year 2005 was exceptionally bad. Upto December 2005, as many as 6550 cases were already reported with 1645 cases of deaths. In UP, major outbreak of JE was reported with number of cases/deaths being 5978 and 1458 respectively. The Committee observes that UP has been the most endemic state for quite a few years. The Committee is not aware whether any special drive has been launched in UP to contain the spread of disease. The Committee also observes that Haryana seems to be poised for increase in the number of cases reported.
25.4.3 The Committee’s attention has been drawn by media reports saying that about 3.4 crore children between the age of 1 and 15 need to be vaccinated. The Committee has been informed that vaccine worth Rs. 50.00 crore has been imported from China and a massive immunization programme has been planned. The Committee has been given to understand that an inexpensive vaccine for JE is available which other JE affected countries are currently using to control the disease. The Secretary assured the Committee that appropriate measures have been taken by the Centre to effectively control any epidemic outbreak of JE in any part of the country. The Committee would like be informed about the vaccine that is available in the international market and what has been its success rate in controlling JE in the user countries. The Committee hopes that all preventive measures will continue to be made on a sustained basis so that epidemic of J.E. which occurred in UP in 2005 may not recur.
25.5 CHICKEN GUINEA
25.5.1 The Committee then drew the attention of the Secretary towards the outbreak of Chicken Guinea epidemic in some parts of the country that was widely spreading. The Committee was informed that three states, Andhra Pradesh, Karnataka and Maharashtra were affected. Nearly 25,000 people were suspected to be affected by Chicken Guinea virus. Nearly 50% positivity has been confirmed by NICD, Delhi and 35% by NIV, Pune. The Committee was given to understand that State Govt. was taking appropriate steps.
25.5.2 The Committee is however, not inclined to agree with the reported cases of Chicken Guinea disease in Andhra Pradesh. The Committee’s apprehensions are based on first hand information reports being received from the affected districts of Andhra Pradesh as per which the disease has already affected a very large number of people and spreading fast. The Committee is of the firm opinion that required steps need to be initiated by the centre on an urgent basis.
25.5.3 The Committee was informed by the Director of ICMR that a research team has been sent to the affected district, which will be sending its reports about the actual number of cases in Chittoor district and adjoining areas in Andhra Pradesh. The Committee would like to point out that along with the assessment of epidemic outbreak, preventive measures were required to be initiated without any further delay. Health education and water management system are the two priority areas which need to be attended to, to prevent the ongoing epidemic as well as such outbreaks in future. The Committee would, therefore, recommend that the Department now take a pro-active approach towards preventive measures in active co-ordination with state and local authorities. Otherwise such outbreaks of epidemic would continue to occur.
25.5.4 On a specific query, the Committee was informed that out of Rs. 371 crore provided for Vector Disease Control Programme, no specific provision is there for control of Chicken Guinea, as it is an unforeseen situation. However, the Secretary assured the Committee that a contingency plan has been drawn for making available necessary funds for this endemic outbreak.
25.5.5 The Committee observes that the National Institute of Communicable Diseases (NICD) is an apex referral organization meant for prevention and control of communicable diseases is the country. Its most important mandate is to evolve an integrated approach for early warning signals and surveillance of diseases of major public health importance. Govt. has also initiated the Integrated Disease Surveillance Programme since 2004-05. The Committee feels that with such an effective mechanism in place, instances like recent out-break of Chicken Guinea in Andhra Pradesh and other adjoining states should not be allowed to reach such a serious dimension. The Committee hopes that all possible measures would be affected promptly. The Committee strongly feels that a suitable amount may be allotted for the total eradication of chicken guinea fever in districts of Chittoor of Andhra Pradesh and Bangalore city.
XXVI. REVISED NATIONAL T.B. CONTROL PROGRAMME
26.1 India is the highest TB burden country globally, accounting for one-fifth of the global incidence. To control the problem of TB, revised National TB Control Programme (RNTCP), an application of WHO recommended Directly Observed Treatment with objective of achieving cure rate of 85% of new sputum positive cases and to detect at least 70% of such cases, is being implemented in the country since year 1997 in a phased manner. The Committee was informed that the entire country except for 14 districts of Bihar were implementing the programme with a total coverage of 1083 million population as on 31.12.2005. The remaining districts of Bihar were to reach the target by 31.3.2006. The Committee was also informed that cure rate of 84% and case detection rate of 69% has been achieved upto December, 2005. The Committee was given to understand that overall performance of the Programme in the country has been excellent. Till date, the Programme has placed more than 49,00,000 patients on treatment, averting more than 8,80,000 deaths. During the year 2005, 12,93,083 TB cases were detected and put on treatment under the Programme. The Committee notes that the states where maximum number of TB cases have been detected during 2005 and 2006 are UP, Maharastra, AndhraPradesh, West Bengal, Rajasthan and Tamil Nadu.
26.2 The Committee observes that assessment of the TB Control Programme during 2005-06 after being brought under NRHM does not show a satisfactory level in respect of few states. Against a percentage of TB suspects examined, out of total new adult out-patients (target to 2%-3%), Andhra Pradesh, Kerala and Tripura have shown only 1% achievement. Similarly, against Annualized total case detection rate of 115 (per 1 lakh population), achievement level remained at 61 in respect of Bihar, J&K and Tripura, 77 and 25 in respect of Kerala and Lakshadweep respectively.
26.3 The Committee’s attention has also been drawn by unspent balances lying with NE states under the programme. The Committee notes that Rs. 360 crore were available with NE states as on 1.04.2005. Another Rs. 360.00 crore was duly released during 2005-06, thus making total funds amounting to Rs. 720.68 crore available with the NE states. However, the Committee notes that till June, 2005, expenditure of only Rs. 165.85 crore could be incurred. Actual utilization figures are not available with the Committee. Even then availability of unspent balances clearly indicates that some constraints are definitely there in the implementation of this programme in NE region. The Committee, therefore, strongly feels that more focused attention needs to be given to NE states so as to ensure better performance of all disease control programmes including TB.
XXVII. NATIONAL PROGAMME FOR CONTROL OF BLINDNESS
27.1 India has nearly 15 percent of the world’s visually handicapped. The programme was launched in 1976 throughout the country with the goal to reduce the prevalence of blindness from 1.4% to 0.3%
27.2 Total Tenth Plan allocation for the programme was Rs. 445.00 crore. During the first four years of the plan period (2002-07), an expenditure of Rs. 302.74 crore has already been incurred. Achievement level of various components under the programme has also steadily maintained gradual increase rate over the years. The Committee, however, notes that as per details available during the first three quarters of 2005-06, there seems to be gap between the targets set for different components and fulfilled as indicated below:-
2005-06 (up till 31.12.2005)
Target
Achievement
Achievement upto February, 2006
Cataract Surgeory- 44 lakhs
26 lakhs
35.20 lakhs
School eye screening programme- children to be screened- 350 lakhs
76 children screened
181 lakhs
Children to be detected with refractive errors-24.5 lakhs
3.4 lakhs
-
Free spectacles to be provided- 7.35 lakhs
1.5 lakhs
2.30 lakhs
Training of eye surgeons- 980
175 ophthalmic surgeons trained
200
27.3 The Committee notes that identical targets have been set for 2006-07 also. However, the level of achievement during 2005-06 does not give much hope to the Committee. Even if last quarter of the year 2005-06 shows a high achievement level, that cannot be considered a balanced progress. The Committee, therefore, recommends that progress of different targets should be monitored every quarter to ensure better implementation of the programme.
27.4 Training of Eye Surgeons in IOL surgery is the most crucial activity under the programme. The Committee, however, notes that since 1996-97 up till 2004-05, only 1974 eye surgeons have been trained. The Committee strongly feels that number of eye surgeons trained in IOL surgery is too small for such a big country. This is all the more a cause for concern as at least 62 percent of blindness in the country is attributed to cataract. The Committee, therefore, recommends that the Departments should initiate time bound targeted training programme for eye surgeons with focus on districts suffering from lack of good eye-care. The Committee would also take the opportunity to draw the attention of the Department about the specific suggestion made by the Planning Commission that quality of Intra-Ocular Lenses (IDLSI) produced indigenously needs to be improved in view of very high demand for the same.
27.5 As per a survey in 2001-02, prevalence of blindness in the country is estimated to be 1.1%. Target for the Tenth Plan is to reduce the same to 0.8% by 2007. The Committee notes that a national survey is planned to obtain the status of target of reduction by 2007. The Committee is of the view that impact of the programme would vary from State to State. Data regarding NE states confirms Committee’s observation. The Committee observes that as per a survey conducted in 2003, states like Arunachal Pradesh, Assam and Manipur show the blindness prevalence rate to be much higher than the national rate, i.e. 2.28%, 3.05% and 1.38% respectively. The Committee is worried by the low performance level of NE states except Tripura. During the entire Tenth Plan, performance level of cataract operation has been about 50% with Manipur and Sikkim even less then 50%. The Committee finds the utilization of cash grants also equally worrisome. Overall figures show that almost the double of allocated funds have been utilized during the Plan period. However, Assam and Manipur are the two exceptions as they have not succeeded in utilizing the cash grants for reasons unknown to the Committee. Position is the same in the level of utilization of Grants-in-Aid released to District Blindness Control Societies in NE region. The Committee has been highlighting the discouraging status of Blindness Control Programme in NE region. But is seems no visible remedial steps have been initiated so far. The Committee once again urges the Department to concentrate its attention on the remote inaccessible region of the country.
XXVIII. INFRASTRUCTURE
28.1 In rural areas, Primary health care services are provided through a network of 1,42,653 Sub-Centres, 23,109 Primary Health Centres and 3222 Community Health Centres. Though there has been an increase in the number of Centres, the position at ground level shows a wide gap between the infrastructures in-position and required, meant for basic Health Services for the really needy. Following figures are self-revealing: -
Short fall as per Shortfall as per
1991 population 2001 Population
Health Sub-Centres 4822 21,983
Primary Health Centres 1374 4436
Community Health Centres 2474 3332
28.2 The Committee notes that out of the Tenth Plan target of setting up of 8669 Sub-Centres in the Country, only 6552 Sub-Centres have been opened so far. The Committee is constrained to observe that Bihar, Meghalaya, Tripura and Delhi are the four States which have failed to set up even one Sub-Centre against the targetted 1218, 5140 and 148 respectively. The Committee has been observing that inspite of Central funding available for Sub-Centres, States continue to fail miserably on this account. The Committee strongly feels that drastic action is required to be taken at the earliest to improve at least the quantity aspect of Primary health infrastructure. The Committee finds that the position is equally discouraging in respect of PHCs. Against the Tenth Plan target of 1714 PHCs in different states, only 81 PHCs could be set up, that too, by two states, Andhra Pradesh and Chattisgarh. CHCs also continue to fall way behind the required/targeted number.
28.3 The Committee observes that one of the goals of NRHM is to consider setting up of new CHCs to meet the population norms of Census 2001. This seems to be an ambitious plan in view of the ground realities. This is corroborated by the fact that out of 720 districts of the 18 High Focus States and 426 of 17 Non High Focus States selected for up-gradation to Indian Public Health Standards during 2005-06 under NRHM, facility survey could be done only in 11 and 6 districts respectively. The Committee fails to comprehend the constraints being faced by respective State Govts. to initiate preparatory exercises inspite of Rs. 20 lakhs per CHC duly released by the Centre to all States/UTs. They have also been sent the formats for facility survey. It seems that either the State Govts are not interested or there are too many complexities involved in conducting a facility survey. Whatever may be the situation, the Committee is of the strong opinion that it is time that defaulting States are held accountable. The Committee strongly feels that different key activities under NRHM cannot be carried out in a mission mode in a fixed time frame, if even the preparatory exercises cannot be accomplished timely.
28.4 The Committee understands that a Task force has been set up on review of Population norms for Setting up of Health Centre. The Committee would like to be informed about the major recommendations of this Task Force as and when made.
28.5 The Committee has been observing that Sub-Centres, PHCs and CHCs continue to suffer from the perennial problem of shortage of required Staff. As per the latest position available, against the required number of 1,69,261 Multipurpose Workers (female)/ANMs, sanctioned number of posts is 1,39,840 with number of ANMs in position being 1,33,232 as on September 2005. Status of ANMs appointed on contract basis is no better. Out of total 14,101 ANMs appointed on contract basis, in-position are only 6096 with Bihar having not even one ANM against 1516 to be hired on contract. The Committee has also observed that state wise details about ANMs reveals a more disturbing trend with some of the States sanctioning and recruiting more than the required number of ANMs, and in contrast, some States lagging far behind the target of even less than required sanctioned posts. Position is the same in respect of the other key functionaries like Health Assistants (Male) at PHCs. The Committee has been constantly bringing this disturbing trend to the notice of Central Govt. But it seems that the Central Govt. is helpless before the State Govts. The Committee can only conclude that all the planning at Central level, if not implemented by the State Govts in the right spirit as envisaged, will defeat the very objective for which the funds have been provided. It is high time that with the NRHM in its second year, the Central Govt. sits up and persuades the States to strengthen the health care infrastructure in rural areas. Constraints/drawbacks of the existing as well as new programmes need to be eliminated at the earliest.
28.6 Acute shortage/non-availability of specialists at CHCs is another serious problem that remains unresolved till date. As on date, 3222 CHCs are functioning in the country with 3332 additional CHCs required as per 2001 population. Vacancy Position is 51.8%, 43.6%, 56.5% and 56% in respect of the posts of Surgeons, Obstetricians & Gynaecologists, Physicians and Pediatricians respectively as on September 2005 in the existing CHCs.
28.7 Non-availability of doctors in SCs/PHCs/CHCs is another major problem area noticed by the Committee. Lack of proper residential and other facilities at such Centres has been responsible for the non-availability of doctors to a large extent.
28.8 The Committee understands that a Task Force constituted under NRHM has given a number of very crucial recommendations to ensure availability of doctors in rural areas. The Committee would appreciate if follow-up action is initiated both at the Central and State level at the earliest. The Committee is happy to learn that number of States like Punjab, Arunachal Pradesh, Tripura, Sikkim, Himachal Pradesh, Tamil Nadu, Orissa and Gujarat have come forward in formulating strategic policies to attract and persuade doctors to serve in rural areas. The Committee hopes that such initiatives will result in marked improvement in quality of Primary Health Care. The Committee finds that Tamil Nadu is the only State which has provided residential accommodation to doctors in most of the PHCs. While making the stay of doctors compulsory, strict action is also reputed to be taken against the erring doctors. The Committee is of the view that similar action needs to be taken by other states also. The Committee would appreciate if the Centre takes a pro-active approach in this regard by taking up with other States to follow the above example. Another initiative that has come to the notice of the Committee is handing over of PHCs to selected NGOs by States like Orissa, Bihar, Uttaranchal, Delhi, Jharkhand and Karnataka. The Committee is of the view that performance of such PHCs needs to be monitored to assess the outcome of such experiments for further improvement and diversification, if necessary. The Committee would like to be apprised about the performance level of such NGOs during the year 2005-06.
As per the census of 2001, due to increase of population, proportionate new Primary Health Centres and Sub-centres need to be started all over the country. This needs budget allocation. The Committee therefore recommends that budget allocation should be suitably enhanced.
XXIX. REPRODUCTIVE AND CHILD HEALTH CARE- RCH-II
29.1 Promotion of maternal and child health was one of the most important objectives of the Family Welfare Programme. The national average of MMR is 407 per 1,00,000 live births which in itself is very high compared to the international scenario like Sweden (8), UK (10) and even in neighboring countries China (60) Sri Lanka ((60) and Thailand (54). Within the country, states showing the above average are UP (707), Rajasthan (670), Bihar (451), MP (498) and Assam (409). The major causes of these deaths are haemorrhage, anemia, obstructed and unsafe abortion etc. As per the National Family Health Survey (NFHS) conducted for the period 1992-93, and 1998-99 and Rapid Household Survey of 1998-99 and 2002-03, the position in respect of other indicators of maternal health status show a gradual improvement as given in the table.
Sl. No
Indicator
NFHS-I
1992-93
NFHS-II
1998-99
DLHS (Rapid Household Survey)
1998-99 2002-03
1.
Ante-natal care
(i) Any visit
(ii) Three or more ANC
62.3
--------
65.4
43.8
65.3
44.2
74.0
44.5
2.
Deliveries
(i) Institutional
(ii) Safe delivery
25.5
34.2
33.6
42.3
34.0
40.2
39.8
54.0
3.
Anemia (women)
--------
51.8
-------
-------
4.
TT (Pregnant women)
53.8
66.8
74.7
79.7
29.2 RCH-II is the flagship programme on Reproductive Child and Maternal Health under NRHM, with components like Essential Obstetric Care which include (i) institutional delivery and (ii) skilled birth attendants. Under RCH-II, states have been encouraged to evolve district plans based upon a situation as analysis of ground realities and requirements. Accordingly, during 2005-06 PIPs have been obtained from all States/UTs and appraised and approved by the Department. As per the Performance Budget (2006-07) PIPs for Rs. 1523.75 crore have been approved by the Department against which estimates for Flexi-Pool Budget 2005-06 were of Rs. 762.94 crore and releases made amounted to Rs. 685.52 crore. As per the latest position as on 15.03.2006, made available to the Committee, it is observed that out of Rs. 726.89 crore released under RCH-II Flexi-Pool, expenditure reported upto December 2005 was only Rs. 141.63 crore. The Committee finds that although trend of under-utilization is there in respect of all the states, position is very bad in some of the EAG states: -
(Rs. in crores)
States
Funds released
(15.3.2006)
Expenditure upto December, 2005
Bihar
24.38
0.46
MP
56.20
1.32
UP
169.73
8.56
Uttaranchal
6.96
0.91
In absence of utilization figures for NE states, assessment about their performance cannot be made. The Committee, however, understands that a mid-term review of the programme was scheduled in January–February 2006. The Committee would like to be apprised about the outcome thereof.
29.3 The Committee understands that a provision of Rs. 235 crores was kept under World Bank assisted RCH-II project during 2005-06 for procurement of supplies and material including medicines for sub-centre, PHCs and CHCs could not be utilized as M/s HSCC agency of the Department could not float tenders due to delayed receipt of No Objection from the World Bank. The Committee takes a serious view of this. It seems delay in receipt of NOC from World Bank must have occurred due to want of some required information by the World Bank. If that be so, the department should make efforts so that such instances do not occur in future.
29.4 Another disturbing trend that has come to the notice of the Committee is availability of unspent balance of Rs. 201.16 crore under the Programme with various States. Out of total release of Rs. 1019.94 crore, expenditure of Rs. 818.83 crore has been incurred so far, thus leaving an unspent balance of Rs. 201.15 crore. Bihar and Orissa are the two States that could utilize only less than half of the allocated funds.
29.5 The Committee would like to draw the attention of the Department towards overall achievement level of Financial Targets under Family Welfare Programme as indicated in its Performance Budget 2006-07. The Committee observes that as on 31.1.06 as many as 968 Utilisation Certificates amounting to Rs. 398.88 crore are pending which date back to 1976-93. The Committee strongly feels that such a position can only be considered to be very alarming. This clearly indicates that in the absence of Utilization Certificates for huge sums, showing a steady increase over the years, quality of services being provided under the various Programme cannot be judged properly. The Committee would like to have full details (State wise) in this regard.
29.6 Submission of Utilization Certificates in respect of Grants-in-Aid of recurring nature released to the State Societies during the preceding financial year is necessary for release of Grants-in-Aid to them during the subsequent financial year under Rule 212 of General Financial Rules, 2005. The Committee understands that a special dispensation has been sought from the Ministry of Finance keeping in view the complex funds flow involving multi-tier structure and the time taken thereby and the reporting of expenditure from the end-use of funds upto the level of Central Govt. and reporting infrastructures available in the States/UTs. The Committee is not inclined to agree with the contention of the Department. The Committee strongly feels that adherence to GFRs is very much required not only for making accountable all concerned - both Central Govt and implementing agencies, but also for optimum and judicious utilization of allocated funds. The Committee would therefore recommend that the Department instead of asking for such a dispensation should take measures for streamlining the accounting procedure.
XXX. ROUTINE IMMUNIZATION PROGRAMME
30.1 Immunization Strengthening Programme is an important part of RCH-II project under the NRHM. Under the Programme, vaccines are given to infants and pregnant women for controlling vaccine preventable diseases. The Committee has been observing that despite funds being duly allocated for carrying out various activities under the Programme, utilization level shows a very unsatisfactory performance, as indicated below: -
(Rs. in crores)
2003-04
2004-05
2005-06
BE
RE
Actual
BE
RE
Actual
BE
RE
Actual
250.50
201.75
127.70
259.00
167.50
149.23
507.00
164.94
164.94
30.2 State wise figures of funds released and utilization thereof (till December, 2005) during 2005-06 establishes the varying standard of implementation of the Programme. Following performance indicators are self-explanatory:-
(Rs. in crore)
State
Funds released as on 15.03.2006
Expenditure upto December, 2005
Gujarat
2.73
4.74
Maharashtra
4.97
9.29
W. Best Bengal
4.61
9.30
Bihar
13.65
27.80
UP
29.86
0.16
Rajasthan
11.4
2.05
MP
8.56
0.03
AP
4.15
0.20
Karnataka
3.52
0.46
Whereas some states have miserably failed to take benefit of allocated funds, there are states that have exceeded the allocated funds. The Committee strongly feels that this imbalance in performance level of different states needs to be removed without any further delay.
30.3 As reported in the Annual Report of the Ministry (2005-06), Household Survey (2002-03) has indicated that the coverage levels in most of the districts have been declining with respect to district level coverage reported in 1998-99. Staff vacancies, inadequate mobility of the health workers/supervisory staff, problem of delivery of vaccines and reporting of actual number of children vaccinated are the major factors cited as responsible for poor performance level of the Programme. The Committee is, however, surprised to note that from 2003-04 onwards upto December 2005, reported immunization coverage as reported by various states shows completely different status. Percentage of coverage for different vaccines has reached the level of 90% and above during this period. The Committee would like to be apprised about the percentage of coverage as per household survey 2002-03 and 2003-04 (state-wise). The Committee has been given to understand that a number of measures have been initiated by the Department to ensure better coverage of Routine Immunizations Programme. The Committee would appreciate if the state figures were verified by an independent survey.
30.4 Cold Chain System is required to be in place for storage and transportation of vaccines. The Committee notes that out of 67,173 units consisting of various cold chain equipment, a large number were supplied prior to 1992 and have thus outlived their normal life. The Committee is of the view that the process of replacement of cold chain system already started by Govt. needs to be expedited.
30.5 Pulse Polio Immunization Programme started in 1995-96 has made an impressive progress since then. As against 1600 cases in 2002, 134 cases were detected in 2004. There has been 92% decline in polio cases. The Committee has been informed that 24 districts in UP, all in Western UP and 14 districts in Bihar can be considered to be very high risk. The Committee notes that although funds have been duly released to Bihar and UP during 2004-05 and 2005-06 and there has been optimum expenditure thereof, in respect of Bihar for 2005-06, Expenditure Status has not been received.
30.6 The Committee observes that inspite of unsatisfactory performance level, funds are being duly released to UP. The Committee is of the opinion that remedial action in the light of constraints being faced in Pulse Polio Programme in the two most affected states of UP and Bihar needs to be taken. This is all the more required in view of sporadic cases of polio being reported from UP. This year 17 cases have already been reported from there. The Committee is of the view that sustained efforts need to be made in UP and Bihar otherwise the goal of Eradication of Polio from the country will remain unfulfilled.
XXXI. FOREIGN FUNDING
31.1 Committee’s attention has been drawn by recent media reports about stoppage of funds by World Bank on a number of projects in the Health and Family Welfare sector in the country. Details of funds reported to be put on hold are as follows:-
Reproductive and Child Health (Phase-II) -350 million dollars
Vector Borne Disease Control Programme -200 million dollars
HIV/AIDS-III, National AIDS Control Organization -200 million dollars
Second National TB Control Project -170 million dollars
Karnataka Health Systems -141.83million dollars
W. Bengal Health Systems -75 million dollars.
31.2 The Committee has been given to understand that since June, 2005, funding for the above programmes have been put on hold. The background of this development is that in March 2005, on the basis of complaints alleging fraud and corruption in the procurement of Pharmaceuticals for the RCH – I, World Bank Integrity Department began investigations that are still continuing. The specific complaint received by World Bank in 2005 was about two Delhi based Pharmaceutical Companies being allegedly followed in procurement of medical equipments, drugs and contraceptives. All contracts with these two companies are reported to be cancelled by the Department and CBI has been asked to investigate. Two officers of the Department have also been suspended and penal action is being taken against them.
31.3 The Committee can comprehend the wider ramifications and seriousness of the problem by the fact that Ministry of Finance had to write to all States and Central Departments to ensure complete transparency and integrity in awarding contracts. All implementing agencies have been directed to issue directions to all project authorities to strictly adhere to the norms for World Bank sponsored projects.
31.4 During the course of discussions when this matter was raised, Secretary admitted before the Committee that doubts were raised about transparency in some procurements and CBI was asked to investigate and the legal process was going on. Some companies have been blacklisted also. The Secretary, however, pointed out that World Bank funding accounted for only 15% of the total budget for RCH and out of that only 7-8% was being accessed by the Ministry. As a corrective measure, an Empowered Procurement Committee has been put in place to streamline the procurement procedure. The Committee was also given to understand that inspite of RCH-II put on hold due to stoppage of World Bank Funding, Govt. was going ahead with RCH - II. European Commission and other Foreign Agencies have also evinced interest in funding the programme.
31.5 The Committee observes that damage-control exercise has been started by the Department in the matter of World Bank funding for various projects being put on hold. The Committee is of the view that the very fact that instances of corruption and fraud in a number of projects during a prolonged time-frame being noticed by World Bank and its funding being put on hold establishes that there were inherent flaws in the procurement system which went unnoticed for a considerable period of time. Quantum of World Bank funding being too small or Govt. ability to manage in the absence of the same cannot bring back the loss of prestige of the country world over and setback to various projects in Health and Family Welfare sector. The Committee is of the opinion that a thorough assessment of procurement procedure in respect of all projects whether foreign funded or otherwise needs to be made. This task can be entrusted to the Empowered Procurement Committee of the Ministry and some independent experts should also be involved in this exercise. The Committee would also like to reiterate that monitoring mechanism needs to be further strengthened and activated. The Committee would like to be apprised about the final outcome of ongoing CBI investigation in the matter of World Bank funding.
XXXII. DECLINING SEX RATIO
32.1 Declining trend in the child sex ratio has been a matter of serious concern. Child sex ratio in the age group of 0-6 years has been showing a continuous decline over the decades, from 976 in 1961to 927 in 2001. Specially vulnerable states have been Punjab, Haryana, Chandigarh and Himachal Pradesh showing more than 50 points decline during the decade 1991-2001.
32.2 The Committee observes that besides the age-old factors responsible for this dismal situation, easy availability of sex determination tests across the country can be considered as a reason behind the declining sex ratio. Coming into force of the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act in 1996 and subsequent amendments made to remove the inherent inadequacies has so far failed to make any impact in checking this malaise.
32.3 The Committee notes that there are as many as 27,228 bodies (Genetic Counseling Centers, clinics, labs, ultrasound, machines/ image centers etc.) registered in the country as on 31.07.2005. The Committee would, however, like to point out that there might be equal number of, if not more, unregistered clinics doing their business. Total number of 322 complaints filed in the courts/police stations against the violators of law and sealing and seizure of 33 ultrasound machines during 2005-06 can only be termed as a very small and insignificant attempt to solve a sensitive problem, which indicates a dark future for our country. The Committee appreciates that the Govt has initiated a number of measures, at both state and central level. The Committee, however, feels that these measures can only bring about a change if sustained initiatives are put into effect by all concerned. One should also not forget that social awareness about the implications of this problem has to be built up. The Committee would also like to point out that our medical community is in need of sensitizing the public so that they start playing a pro-active role. The Committee understands that a survey of ultrasound centres was undertaken during 2004-05 in the most vulnerable states and findings of this survey have been sent to the concerned states for taking necessary action on 30.03.2005. The Committee would like to be apprised about full details in this regard.
XXXIII MISCELLANEOUS
33.1 There is acute shortage of trained nurses in the world. Many nurses from India are going abroad for jobs, with the result that there is shortage of nurses in the country. The Committee understands that there is a certain ratio of bed strength: trainee-nurses, for training these nurses. The present ratio is that for five beds, one nurse can be trained. The Committee understands that suddenly we cannot improve the bed strength in order to overcome the shortages. Hence, the ratio of 5:1 can be relaxed to 3:1 from this academic year itself.
33.2 The Committee further contends that in our country, there are about 100 Government Medical Colleges and hospitals. The burns wards, trauma wards, children wards in these government medical colleges, can be given a one-time suitable grant by the government for the maintenance of basic amenities inside such wards. Similarly, in Primary Health Centers, many of the refrigerators are not in working condition. Government can add one more refrigerator for storage of vaccines and important medicines that require suitable conditions for shelf life.
RECOMMENDATIONS /OBSERVATIONS AT A GLANCE
II BUDGETARY ALLOCATION
The Committee fails to comprehend the reasons for non- provision of required non-plan funds. The Committee understands that as a result of concerted efforts made at the Secretary and Ministerial level by the Department, there has been some increase in the allocation of non-plan funds in 2005-06 which however proved to be inadequate. The Committee would like to emphasize that there is an urgent need to curb the trend of diversion of plan funds to non-plan side. Such a position cannot be considered advisable for the successful implementation of any plan scheme. (Para 2.1)
The Committee has been given to understand that level of pendency of UCs/unspent balances has been reduced due to the constant efforts made by the Department. However, UCs amounting to Rs. 1675.00 crores as on 31st March, 2006 and availability of unspent balances of Rs. 15.35 crores as on 1st January, 2006 cannot be considered a negligible amount. The Committee is of the view that the Department needs to make all conceivable efforts to eliminate such pendency, by making the monitoring mechanism at all levels more effective and result oriented. (Para 2.2)
The Committee in this connection is constrained to observe that if the practice of including external aid in domestic Budget continues, then the commitment of the Govt. to raise the allocation in the health sector to 2-3% of GDP will remain only on paper and not be realized in actual practice. Moreover, the Committee also feels that financing the non-plan expenditure by external aid is not a healthy practice. The Committee therefore, again recommends that the matter must be vigorously pursued with the Planning Commission and the Ministry of Finance to consider the external assistance over and above the gross budgetary support. (Para 2.3)
III CENTRAL GOVERNMENT HEALTH SCHEME
The Committee observes that computerization of CGHS dispensaries will substantially enhance the efficiency of the system which was very much required. The Committee would, however, like to point out that the Department should take all steps so that the proposed computerization is completed during the current financial year itself. (Para 2.3)
The Committee, therefore, recommends that provision for non-plan funds should be strictly in accordance with the actual requirements. (Para 3.2)
The Committee expresses its deep sense of concern on the status of implementation of SIU Report on CGHS. This exercise has been going on for the last so many years. The Committee finds that it was only after a fresh SIU study conducted on the orders of CAT that a final decision with regard to the posts of Safaiwala, Chowkidar, Lab technician, Lab Assistant and Lab Attendant could be arrived at which was accepted by the Central Govt. in January, 2003. The Committee is, however, given to understand that as in August, 2004, 453 posts of Safaiwala and 284 posts of Chowkidar are to be progressively outsourced. Latest feedback in this regard as well as in respect of Lab staff still remains unavailable to the Committee. Not only this, SIU Report may lead to another dispute. It has been informed that a number of posts are likely to be declared surplus on the basis of SIU Report. Accordingly, information on existing strength in the dispensaries have been sought from CGHS units. The Committee takes a strong exception to this approach. The Committee is of the view that had there been regular interaction between the Ministry of Finance and Ministry of Health and Family Welfare, this kind of uncertainty would not have prevailed for so long. The Committee, therefore, recommends that the Department should complete the exercise of implementation of SIU Report without any further delay. (Para 3.4)
The Committee fails to understand the rationale for having two studies on the functioning of CGHS being conducted simultaneously specially in view of the mandate of the Kaul Committee covering all aspects of CGHS functioning. The Committee is surprised to note that although almost a year has passed since the setting up of the Kaul Committee, it has met only on three occasions. It seems only preliminary exercise has been done by this Committee so far. What is more surprising is that no time-frame has been fixed for this Committee. The Committee views this with serious concern. This does not leave any hope for any significant improvement in the functioning of CGHS providing medical services to Central Govt. employees in the near future. (Para 3.7)
The Committee finds that in view of the study being conducted by the Kaul Committee, all expansion/strengthening of infrastructure work of CGHS dispensaries has been brought to virtually a stand-still. The Committee would like to quote two instances in this regard. Proposal for construction of building of CGHS dispensary No. 73 in Gurgaon, Haryana for which land has already been purchased will be taken up only after the receipt of report of the Kaul Committee and reaction of the Department thereon. Same is the fate of the proposal initiated in 2005 for construction of a new building for CGHS headquarter at Kidwai Nagar, New Delhi. The Committee would like to emphasize that basic purpose of any study can only be achieved if it is conducted within a prescribed time-frame. The Department should ensure that the report of the Kaul Committee is received at the earliest and action initiated immediately thereafter. (Para 3.8)
The Committee apprehends that this would again be a long drawn exercise. As 168 candidate of CMSE, 2004 were still to join service, there was little likelihood of 300 successful candidates of CMSE, 2005 joining in the near future. The Committee strongly feels that urgent action needs to be taken in this vital area. Simultaneously, a review of the existing procedure is also required to be taken so that bottlenecks therein are eliminated. (Para 3.9)
IV SAFDARJUNG HOSPITAL
The Committee, while appreciating the level of utilization of plan funds allocated for Sufdarjung Hospital during 2005-06, also notes that as compared to Rs. 12.88 crores worth equipment purchased in 2005-06, it is proposed to purchase equipment costing Rs. 15.00 crores during 2006-07. The Committee, therefore is of the view that required funds for procurement of equipments in Safdarjung Hospital need to be provided in 2006-07. The Committee also observes that against 153 number of equipments to be purchased during 2005-06, number of equipments purchased was only 98. Additional efforts should, therefore, be made to expedite the proposed formalities so that targets set for 2006-07 are achievable. (Para 4.2)
The Committee strongly feels that in view of overall anticipated increase in the various medical services being provided by Safdarjung Hospital, proportionate increase in the non-plan funds also needs to be made. The Committee observes that whereas patient load and resultant pressure on various services being provided by the hospital has been steadily increasing, bed strength remains stuck at 1531 for the last so many years. It has not been possible to add even a single bed so far. The Committee wonders whether anybody has given a thought in this direction. The Committee is of the firm opinion that there is an urgent need to provide more beds so that better health care may be provided to the patients at Safdarjung Hospital. (Para 4.4)
The Committee understands that evening OPDs are also being run at Safdarjung Hospital for quite some time. The Committee would, however, like to point out that public at large is perhaps not aware about evening OPDs. The Committee is of the view that adequate publicity needs to be given to such services. (Para 4.5)
V DR. RAM MANOHAR LOHIA HOSPITAL
The Committee notes that sixteen projects/schemes were approved under the Tenth Plan. Their latest status report, however, does not seem to be very encouraging. Setting up of the Post Graduate Institute of Medical Education and Research at the hospital is the most ambitions project. The Committee is constrained to observe that this project seems to have been entangled in the numerous procedural formalities. Designated plot was handed over to M/s HSCC (India) Ltd. on the 14th June, 2005 for demolition of old barracks and construction of the institute building. Although about one year has passed since then but only around 65% of the demolition work has been completed. The Committee is not satisfied by the reply of the Ministry that the tendering work is in process and actual construction is likely to commence shortly. The Committee feels that the present pace of construction clearly gives an indication that it may perhaps take another plan period (Eleventh Plan commences from 2007-08) to get the building of PGIMER ready and functional. The Committee, accordingly, recommends that the construction project may be completed under a prescribed time-schedule closely monitored by a designated group of authorities. (Para 5.2)
The Committee would, however, like to point out that the initial target date for completion of the Trauma Centre building was October, 2004. Department has indicated that there was delay in starting the construction work due to some procedural formalities to be gone through. The Committee would, however, like to point out that position remains to be the same when the Trauma Centre project is nearing completion. In spite of intimation given by the CPWD on 1st March, 2006 that the building would be ready for operational use, so far, the building has not been handed over by CPWD to hospital authorities. The Committee apprehends that the original estimated cost of Rs. 30.11 crores for the Trauma Centre building is bound to increase which shows that this project was being constructed without adhering to a prescribed time-schedule. The Committee, therefore, reiterates its earlier observation that every effort should be made to make the Trauma Centre fully functional without any further delay. (Para 5.3)
The Committee hopes that every effort would be made to expedite the process so that construction work on the project starts at the earliest. The Committee would also like to emphasise that the progress of the other technically feasible projects in hand should be closely monitored to avoid any undue delay. (Para 5.4)
The Committee strongly feels that this data can prove to be very useful for making an assessment about additional infrastructure/manpower/funds required for the running of the hospital. The Committee, therefore, recommends that these details for the last 3-5 years may be collected and analysed for making a proper assessment of the needs of the hospital. (Para 5.5)
VI CENTRAL INSTITUTE OF PSYCHIATRY, RANCHI
Achievement level of financial targets has been very disappointing. Approved outlay of Rs. 18.50 crore in 2005-06 had to be reduced to Rs. 10.26 crore at the RE stage and actual utilization figures are not known to the Committee. The Committee is not optimistic about full utilization of Rs. 10.65 crore plan funds allocated for the institute for 2006-07 in view of its past track record. (Para 6.1)
The Committee takes a serious view of this. The Committee reiterates that there is an urgent need for streamlining the procurement procedure so that premier institutes like CIP, Ranchi do not continue to suffer. (Para 6.2)
VII JIPMER, PONDICHERRY
The Committee appreciates the preparedness shown by the Department in fixing a time schedule for completion of Super Specialty and Trauma Centre. The Committee, however, recommends that the Department should closely monitor the progress in this regard so that the projects can be completed on time. (Para 7.1)
The Committee, accordingly, observes that the Department should take immediate steps for providing the necessary infrastructure and required faculty. If need be, a review of both recruitment and procurement procedure may also be made by the Department. (Para 7.2)
VIII POST GRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH, CHANDIGARH
The Committee hopes that plan funds of Rs. 40.00 crore for 2006-07 will prove to be adequate for these projects. If not, required funds at the RE stage may be provided to the institute. (Para 8.1)
The Committee, therefore, recommends that there should not be any mismatch between the requirement and allocation of non-plan funds for the Institute. (Para 8.2)
The Committee is surprised to note that against the total sanctioned 5585 posts for the Institute, there are only 4805 posts filled up as on 31st March, 2005. The Committee is of the view that as many as 780 posts lying unfilled cannot be considered a healthy sign. The Committee would like to be apprised about the category-wise status of these vacant posts and efforts made for filling them up. (Para 8.3)
IX ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
Appreciating the progress made in the project on Trauma Centre at AIIMS, the Committee hopes it would be made functional without any further delay. (Para 9.3)
The Committee, however, strongly feels that a premier institution should be having every kind of facility. The Committee hopes that as assured by the Director, AIIMS, its suggestion would be placed before the Governing Body at the earliest for an early decision in the matter. (Para 9.4)
The Committee strongly feels that this issue of tax imposition on medical equipment/life-saving devices should be examined afresh. Govt. medical institutions and private hospitals need to be treated on a different footing in such matter. (Para 9.6)
X SHORTAGE OF REQUIRED MANPOWER AT CENTRAL GOVT. HOSPITALS/INSTITUTES
The Committee is of the view that the process of filling up of all the vacant technical posts should be closely monitored so as to get the desired result at the earliest. (Para 10.1)
The Committee is of the firm view that implementation of the recommendations of Javed Chowdhury Committee’s Report should be carried out at the earliest. It is not inclined to agree with the Department’s contention that in public service, one should not think about salaries and facilities etc. Our doctors in Govt. Institutes are indeed doing a commendable job working under tremendous pressure. Nobody should object better service conditions for them. At the same time, the Committee would also like to point out that there is an urgent need for having a mechanism in place, where-under doctors serving Govt. institutes do not have the liberty to leave their service for better placements. Various options can be made applicable. Minimum Service Bond can be one. (Para 10.3)
The Committee, is however surprised to note that all these details furnished to the Committee have found no mention in the media reports. The Committee would like to emphasize that premier Institutes like AIIMS need to react in an objective manner to the media reports appearing from time to time which at times are not based on facts. (Para 10.4)
XI SETTING UP OF AIIMS LIKE INSTITUTIONS (PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA) PMSSY
The Committee would like to reiterate its earlier recommendation that a scheme should be launched only after completing all the ground work and preparatory exercise. It has taken almost four years in getting the CCEA approval for PMSSY. The Committee now apprehends that management of such a big project may prove to be too difficult to be handled effectively by the Ministry in spite of their having set-up a designated Cell for the same. The Committee is not inclined to agree with the Department’s contention that in view of the track record of State Govts not being able to manage their own institutions, the scheme needs to be implemented by the Centre directly. The Committee is of the firm view that the concerned State Govts should be involved in the setting up/upgrading of institutes in their States. The Committee appreciated the PMSSY. This needs to be started immediately without any delay. First upgradation of hospitals to be started immediately. For this allocation of Rs.300 crore to be allotted without any delay. (Para 11.3)
The Committee is concerned about one crucial financial aspect of PMSSY. There is a ceiling of Rs. 330 crore per institute, out of which Rs. 110 crore will be the contribution from Centre and States pooling Rs. 20 crores. Remaining Rs. 200 crore are to come from other sources. The Committee feels that this is a grey area and every attempt should be made to restrict the role of private sector in PMSSY. With the private sector being the major fund-raiser, there is a distinct possibility of management slipping into their hands. The Committee, therefore, recommends that the Centre should be more generous by increasing its share and respective State Govts should also be pursued to contribute more. The Committee is also of the view that the exercise of recruiting the required manpower for the proposed institutes should also begin at the earliest. If that does not happen, the Committee has little hope of these institutes becoming functional in the near future. (Para 11.4)
The Committee has also observed that N.E Region has remained un represented in the PMSSY which cannot be considered a happy sign. The Committee, therefore, urges upon the Department to identify one state in the N.E. Region for inclusion in PMSSY. (Para 11.5)
XII INDIAN COUNCIL OF MEDICAL RESEARCH
The Committee understands that as many as 17 research proposals, are at different stages of implementation. The Committee sees it as a very encouraging sign for modern medical science and impresses upon the Department to encourage such activities whole-heartedly. (Para 12.2)
The Committee fails to comprehend the purpose of setting up an expert body for the Premier Research Council of the country if its recommendations are not given due consideration. This trend of allocation of funds is all the more disturbing when compared with Tenth Plan outlays of other Science and Technology agencies like ICAR, CSIR, DST and DBT which have been on the higher side for the last so many decades. The Committee, accordingly, recommends that as advocated by the Performance Appraisal Board, funding for ICMR for 2006-07 should be enhanced at the RE stage. Eleventh Plan allocation should also reflect the enhanced pattern of funding. (Para 12.3)
The Committee finds it rather strange that instead of maintaining the level of approved outlay, grants being released by other countries are being taken into account by the Government. It would not be wrong to conclude that securing of foreign funds by a body after striving very hard for the same acts as a deterrent instead of boosting its resources. The Committee is disturbed to note that instead of taking any remedial action in the matter as earlier suggested by it, another adverse condition has been put into effect. Under the new international arrangements, instead of donor country paying the taxes, the recipient body is to pay taxes. The Committee was informed that during 2005-06 ICMR had to pay Rs. 6 crore as taxes on the foreign funding received by them. The Committee is of the firm opinion that the existing practice of adjustment of foreign grants against the domestic funding and also levy of tax on foreign grants should be reviewed afresh and withdrawn at the earliest. (Para 12.4)
XIII RASHTRIYA AROGYA NIDHI
The Committee notes that although the scheme was launched in 1997, all the N.E States with the exception of Tripura and Mizoram have remained outside the ambit of the scheme so far. The Committee is not aware about the reasons therefor. It seems that one obvious reason must be the weak financial position of such States. The Committee feels that the Department has to make vigorous efforts to prevail upon these states to join the scheme.
XIV OTHER EDUCATIONAL INSTITUTIONS/BODIES
The Committee strongly feels that the Centre needs to play a more pro-active role and make an assessment about the problems being faced by these institutions/bodies and take remedial steps. (Para 14.1)
The Committee has been observing that year after year an amount of Rs. 1 crore is being allocated. Last year of the Tenth Plan has arrived and the idea still remains on proper. The Committee is of the view that this indecisiveness should not continue in the Eleventh Plan. Planning Commission in its Mid Term Appraisal of Tenth Plan has observed that the Ministry may concretize suggestions and current thinking about setting up of a Medical Grants Commission. (Para 14.3)
XV NATIONAL AIDS CONTROL PROGRAMME
The Committee is, however, surprised to note that no targets were set in 2005-06 with regard to the following:-
* Condom use among high risk groups
* Awareness about protective role of condoms and
* Awareness in rural areas.
The only data available with the Ministry pertains to a Survey done in 2001 which is not very encouraging. (Para 15.2)
The Committee hopes that the Department must have already initiated required action on these suggestions made in the Mid Term Appraisal of Tenth Plan. (Para 15.4)
The Committee would like to be apprised about the status of other components/infrastructure under the programme in respect of the above-mentioned states. The Committee would also like to know about criteria/ceiling on IEC activities in accordance with the Programme as a whole. (Para 15.5)
The Committee hopes that this change in the policy must have been conveyed to all the implementing authorities across the country. If not, action should be taken at the earliest. (Para 15.6)
XVI NATIONAL MENTAL HEALTH PROGRAMME
The Committee hopes that during the last year of the Tenth Plan, the programme would ultimately take off and implemented as envisaged. The Committee is also of the view that shortage of trained psychiatric manpower and lack of awareness regarding treatment, the two major constraints of the programme need to be addressed without any further delay. (Para 16.2)
XVII NATIONAL CANCER CONTROL PROGRAMME
The Committee would like to be informed about the number of districts covered in various states, activities done, amount spent and over all physical and financial performance in respect of DCCP. (Para 17.1)
The Committee understands that delayed detection is one of main reasons of mortality due cancer in our country. If detected early, a number of these precious human lives could be saved. The Committee therefore, appreciates the urgency shown by the Deptt. to make intervention down at the district level. The Committee in this regard takes note of the scheme to involve NGOs who will be organizing camps to promote prevention and early detection of cancer. The Committee also takes note that Training manuals have been developed under the NCCP for capacity building in cancer control at the District level:
Manual for Health Professionals
Manual for Cytology
Manual for Palliative care
Manual for Tobacco Cessation
The Committee however, feels that the vision and effort shown by the Department to detect this life threatening disease early will bear fruit only it good and credit worthy NGOs are involved and oncology wings are properly strengthened at the District Level. The Committee also feels that personnel in these district hospitals should be specially trained to detect most common types of Cancer in out country e.g. breast and cervix cancer in women. (Para 17.2)
XVIII AVIAN INFLUENZA
The Committee feels that though bird flu till now has not claimed any human life, but its potential to take a toll on the same is very high. Therefore, before this epidemic occurs, Govt. should be prepared in every respect to tackle any emergency situation. Further more, as the number of laboratories to test avian flu cases are few, there is a need for strengthening the same. (Para 18.2)
The Committee has been informed that the Ministry has spent a large amount of money to procure medicine for bird flu from one particular firm namely – Hetro Drugs. This medicine, however, has an expiry period of six months after which it will be unfit for human consumption. Although no human case of bird flu has been reported so far, it is understood that an order for 1 lakh vials of vaccine (one vial costing about 12 dollars) has been placed. The Committee therefore strongly feels that an enquiry may be carried out by the Department. Committee may be apprised about the outcome thereof. (Para 18.3)
The Committee understands that the promotion of any general food item does not fall within the domain of Ministry of Health and Family Welfare whose mandate is to regulate the medical sector and not the cause of some other agency. This, the Committee feels is sheer wastage of money. (Para 118.4)
XIX NEW INITIATIVES
The Committee therefore, reiterates its earlier recommendation to give priority to the Diabetes control programme and cardiovascular Disease control Programme.
XX NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL SCIENCES, SHILLONG
Committee can only conclude that chances of this National level Institute primarily meant for the people of N-E Region becoming fully functional seem to be very dim. The Committee observes that status of manpower as on 31.12.05 is even more disturbing. Out of total sanctioned 1520 posts, only 198 posts could be filled up to 31.12.05. This is confirmed by the statement of the Department that all sanctioned posts subject to availability of applicants in super specialty Departments are expected to be filled up during 2006-07. The Committee is of the view that an intensive drive needs to be initiated, if not already done so far. Other wise the situation that will finally emerge will be that at least another Plan period will be required for acquiring the required manpower for the Institute.
XXI PUBLIC PRIVATE PARTNERSHIP
While welcoming the initiative, the Committee has a word of caution for the Govt. The track record of private sector participation in health sector has not been very helpful so far as public at large is concerned. A number of corporate Hospitals have come up on Govt. land acquired at nominal rates. However, the management of such Hospitals has miserably failed to provide free treatment to the poor as agreed to by them at the time of starting such hospitals. The Committee would like to point out that this so-called public-private sector has now penetrated in the State Health Systems also. The Committee is not much convinced by the contention of the Department that this experiment will be confined to the area of public (medical) education only. The Committee would like to be apprised about the full details of this initiative. (Para 21.2)
XXII SERVICES AVAILABLE FOR CRITICAL PATIENTS IN GOVT. HOSPITALS
The Committee is of the firm view that there is a need for having a review of ICU services available in govt. hospitals in the country. A beginning can be made by conducting such an exercise for the two premier hospitals namely Dr. RML Hospital and Safdarjung Hospital located in Delhi. The Committee would appreciate if this exercise is undertaken within a prescribed time schedule so that remedial steps can be initiated at the earliest. (Para 22.2)
XXIII UPGRADATION/STRENGTHENING OF EMERGENCY FACILITIES AT
STATE GOVT. HOSPITALS LOCATED ALONG NATIONAL HIGHWAYS
The Committee, while welcoming the proposed revision of the scheme, would like to point out that the Centre need to play a more pro-active role in the implementation of a scheme meant for welfare of general public. The Committee would also like to be apprised about the status of hospitals opened so far (state-wise) under the scheme of Up-gradation/Strengthening of Emergency Facilities at State govt. hospitals located along with National Highways.
XXIV. NATIONAL RURAL HEALTH MISSION
The Committee observes that analysis of state-wise implementation of key activities during 2005-06 clearly indicates that in a few High Focus States, NRHM is yet to take off. Status of activities in Uttar Pradesh, the most crucial State under the Mission reveals a very discouraging scenario. Neither the Departments of Health and Family Welfare have been merged nor merger of Societies and registration of Rogi Kalyan Samitis have taken place. Even MOU with GOI has not been signed. Status of selection process of ASHA, the most innovative component of the Mission is yet another non-starter in the State. Against 65,000 ASHAS to be selected, only 9548 ASHAs could be selected, with not even a single ASHA getting trained. Position is more or less the same in respect of other components. Jharkhand, Rajasthan and Chattisgarh are the other States where preparatory exercise has barely started. Status of NRHM is equally worrying. Out of total 2,28, 327 ASHAs proposed to be selected, only 1,45,546 ASHAs have been selected as on 21.3.2006 with Rajasthan, Bihar, Orissa and Chattisgarh almost meeting the target and UP and MP remaining way behind their target. In the case of NE States, H.P and J&K, Assam is the only State which is almost touching its target, in respect of other States, selection of ASHAs is not even envisaged. What is more striking is that training of selected ASHAs is simply missing. Out of 1,45,546 selected ASHAs, only 32,000 could be trained and these 32,000 are from one single state of Chattisgarh. In the case of NE states, HP and J&K, nobody seems to have given a thought to the most important aspect of training of ASHA under NRHM. The Committee observes that preparatory activities have taken place in most of seventeen Non High Focus States. However, in Delhi, the capital of the country and nearest to the Department, it seems that the message has not reached so far. (Para 24.4)
The Committee is of the firm opinion that the Department should continue making persistent efforts with all the concerned States so that NRHM takes off in the real sense. The Committee would also like to point out that NRHM is a well-conceived Programme but the fact remains that it is the State Govts. that would be the implementing agencies. Not only the flagship programmes of Family Welfare but also some of the major Disease Control Programmes have been brought under one Umbrella Programme. Experience with regard to implementation of National Health Programmes and Family Welfare Programmes on individual programme basis has varied so far from State to State. Status of various Health Indicators and availability of unspent balances with the implementing agencies clearly indicates lack of effective monitoring mechanism. The Committee is not very convinced especially in view of so many programmes. Another complex dimension of the Mission will be inter-sectoral convergence, with the concerned Ministries. The Committee, therefore, is of the view that a highly dedicated team at the Centre alongwith its counterparts in States can only be effective. (Para 24.5)
25.2 MALARIA
The Committee strongly feels that level of implementation needs strengthening in these vulnerable States. It seems that neither the funds are being released by State Govts to districts nor there is adequate supervision and monitoring being done by them. The Committee also notes that in Assam and Orissa, another handicap noticed is that there is acute shortage of Health Workers responsible for surveillance and detection of malaria in villages. Overall shortage of Health Workers in these few states is very high especially as per the required norms as indicated below.
State Required Sanctioned In position
Assam 5104 638 320
Orissa 5927 628 337
(Para 25.2.2)
The Committee takes a serious view of this development. The Department has chosen not to reply to the specific query about the rent being paid for storage of bed nets in the state warehouse and godowns. The Committee strongly feels that the Department has to be very cautious while entering into any procurement procedure involving such big amount of funds. Non-adherence to procurement procedure has resulted not only in financial losses but also depriving the most vulnerable class of society. Payment of rent to godowns for keeping safe mosquito nets certified and fit for use is a classic case of mismanagement. The Committee, therefore, recommends that the Department should make all conceivable efforts for settlement of case so as to stop incurring of unnecessary expenditures. (Para 25.2.5)
25.3 KALA –AZAR
The Committee is constrained to note that in spite of funds being made available to the states, they are somehow not making an optimum and judicious utilization of allocated funds. Result is that provision of Rs. 58.86 crores in 2005-06 had to be brought down to Rs. 17.62 crore at the RE stage. What is more worrying is that cash assistance could not be released to Bihar, Jharkhand and West Bengal for want of Utilization Certificates for the previous years. The Committee understands that Rs. 20.00 crore have been provided under the programmes for the four endemic states. The Committee hopes that Bihar, Jharkhand and West Bengal must have submitted Utilization Certificates by now. The Committee is of the view that in order to achieve the elimination of Kala-azar by 2010 vigorous efforts needs to be made with special focus on endemic States. (Para 25.3.2)
25.4 JAPANESE ENCEPHALITIS
The Committee is constrained to note that despite continuous efforts made by the Department, number of cases of JE infection is on the rise. Year 2005 was exceptionally bad. Upto December 2005, as many as 6550 cases were already reported with 1645 cases of deaths. In UP, major outbreak of JE was reported with number of cases/deaths being 5978 and 1458 respectively. The Committee observes that UP has been the most endemic state for quite a few years. The Committee is not aware whether any special drive has been launched in UP to contain the spread of disease. The Committee also observes that Haryana seems to be poised for increase in the number of cases reported. (Para 25.4.2)
The Committee’s attention has been drawn by media reports saying that about 3.4 crore children between the age of 1 and 15 need to be vaccinated. The Committee has been informed that vaccine worth Rs. 50.00 crore has been imported from China and a massive immunization programme has been planned. The Committee has been given to understand that an inexpensive vaccine for JE is available which other JE affected countries are currently using to control the disease. The Secretary assured the Committee that appropriate measures have been taken by the Centre to effectively control any epidemic outbreak of JE in any part of the country. The Committee would like be informed about the vaccine that is available in the international market and what has been its success rate in controlling JE in the user countries. The Committee hopes that all preventive measures will continue to be made on a sustained basis so that epidemic of J.E. which occurred in UP in 2005 may not recur. (Para 25.4.3)
25.5 CHICKEN GUINEA
The Committee is however, not inclined to agree with the reported cases of Chicken Guinea disease in Andhra Pradesh. The Committee’s apprehensions are based on first hand information reports being received from the affected districts of Andhra Pradesh as per which the disease has already affected a very large number of people and spreading fast. The Committee is of the firm opinion that required steps need to be initiated by the centre on an urgent basis. (Para 25.5.2)
The Committee would like to point out that along with the assessment of epidemic outbreak, preventive measures were required to be initiated without any further delay. Health education and water management system are the two priority areas which need to be attended to, to prevent the ongoing epidemic as well as such outbreaks in future. The Committee would, therefore, recommend that the Department now take a pro-active approach towards preventive measures in active co-ordination with state and local authorities. Otherwise such outbreaks of epidemic would continue to occur. (Para 25.5.3)
The Committee observes that the National Institute of Communicable Diseases (NICD) is an apex referral organization meant for prevention and control of communicable diseases is the country. Its most important mandate is to evolve an integrated approach for early warning signals and surveillance of diseases of major public health importance. Govt. has also initiated the Integrated Disease Surveillance Programme since 2004-05. The Committee feels that with such an effective mechanism in place, instances like recent out-break of Chicken Guinea in Andhra Pradesh and other adjoining states should not be allowed to reach such a serious dimension. The Committee hopes that all possible measures would be affected promptly. The Committee strongly feels that a suitable amount may be allotted for the total eradication of chicken guinea fever in districts of Chittoor of Andhra Pradesh and Bangalore city. (Para 25.5.5)
XXVI. REVISED NATIONAL T.B. CONTROL PROGRAMME
The Committee observes that assessment of the TB Control Programme during 2005-06 after being brought under NRHM does not show a satisfactory level in respect of few states. Against a percentage of TB suspects examined, out of total new adult out-patients (target to 2%-3%), Andhra Pradesh, Kerala and Tripura have shown only 1% achievement. Similarly, against Annualized total case detection rate of 115 (per 1 lakh population), achievement level remained at 61 in respect of Bihar, J&K and Tripura, 77 and 25 in respect of Kerala and Lakshadweep respectively. (Para 26.2)
The Committee, therefore, strongly feels that more focused attention needs to be given to NE states so as to ensure better performance of all disease control programmes including TB. (Para 26.3)
XXVII. NATIONAL PROGAMME FOR CONTROL OF BLINDNESS
The Committee, therefore, recommends that progress of different targets should be monitored every quarter to ensure better implementation of the programme. (Para 27.3)
The Committee strongly feels that number of eye surgeons trained in IOL surgery is too small for such a big country. This is all the more a cause for concern as at least 62 percent of blindness in the country is attributed to cataract. The Committee, therefore, recommends that the Departments should initiate time bound targeted training programme for eye surgeons with focus on districts suffering from lack of good eye-care. The Committee would also take the opportunity to draw the attention of the Department about the specific suggestion made by the Planning Commission that quality of Intra-Ocular Lenses (IDLSI) produced indigenously needs to be improved in view of very high demand for the same. (Para 27.4)
The Committee observes that as per a survey conducted in 2003, states like Arunachal Pradesh, Assam and Manipur show the blindness prevalence rate to be much higher than the national rate, i.e. 2.28%, 3.05% and 1.38% respectively. The Committee is worried by the low performance level of NE states except Tripura. During the entire Tenth Plan, performance level of cataract operation has been about 50% with Manipur and Sikkim even less then 50%. The Committee finds the utilization of cash grants also equally worrisome. Overall figures show that almost the double of allocated funds have been utilized during the Plan period. However, Assam and Manipur are the two exceptions as they have not succeeded in utilizing the cash grants for reasons unknown to the Committee. Position is the same in the level of utilization of Grants-in-Aid released to District Blindness Control Societies in NE region. The Committee has been highlighting the discouraging status of Blindness Control Programme in NE region. But is seems no visible remedial steps have been initiated so far. The Committee once again urges the Department to concentrate its attention on the remote inaccessible region of the country. (Para 27.5)
XXVIII. INFRASTRUCTURE
The Committee has been observing that inspite of Central funding available for Sub-Centres, States continue to fail miserably on this account. The Committee strongly feels that drastic action is required to be taken at the earliest to improve at least the quantity aspect of Primary health infrastructure. The Committee finds that the position is equally discouraging in respect of PHCs. Against the Tenth Plan target of 1714 PHCs in different states, only 81 PHCs could be set up, that too, by two states, Andhra Pradesh and Chattisgarh. CHCs also continue to fall way behind the required/targeted number. (Para 28.2)
The Committee observes that one of the goals of NRHM is to consider setting up of new CHCs to meet the population norms of Census 2001. This seems to be an ambitious plan in view of the ground realities. This is corroborated by the fact that out of 720 districts of the 18 High Focus States and 426 of 17 Non High Focus States selected for up-gradation to Indian Public Health Standards during 2005-06 under NRHM, facility survey could be done only in 11 and 6 districts respectively. The Committee fails to comprehend the constraints being faced by respective State Govts. to initiate preparatory exercises inspite of Rs. 20 lakhs per CHC duly released by the Centre to all States/UTs. They have also been sent the formats for facility survey. It seems that either the State Govts are not interested or there are too many complexities involved in conducting a facility survey. Whatever may be the situation, the Committee is of the strong opinion that it is time that defaulting States are held accountable. The Committee strongly feels that different key activities under NRHM cannot be carried out in a mission mode in a fixed time frame, if even the preparatory exercises cannot be accomplished timely. (Para 28.3)
The Committee would like to be informed about the major recommendations of this Task Force as and when made. (Para 28.4)
The Committee has also observed that state wise details about ANMs reveals a more disturbing trend with some of the States sanctioning and recruiting more than the required number of ANMs, and in contrast, some States lagging far behind the target of even less than required sanctioned posts. Position is the same in respect of the other key functionaries like Health Assistants (Male) at PHCs. The Committee has been constantly bringing this disturbing trend to the notice of Central Govt. But it seems that the Central Govt. is helpless before the State Govts. The Committee can only conclude that all the planning at Central level, if not implemented by the State Govts in the right spirit as envisaged, will defeat the very objective for which the funds have been provided. It is high time that with the NRHM in its second year, the Central Govt. sits up and persuades the States to strengthen the health care infrastructure in rural areas. Constraints/drawbacks of the existing as well as new programmes need to be eliminated at the earliest. (Para 28.5)
The Committee is happy to learn that number of States like Punjab, Arunachal Pradesh, Tripura, Sikkim, Himachal Pradesh, Tamil Nadu, Orissa and Gujarat have come forward in formulating strategic policies to attract and persuade doctors to serve in rural areas. The Committee hopes that such initiatives will result in marked improvement in quality of Primary Health Care. The Committee finds that Tamil Nadu is the only State which has provided residential accommodation to doctors in most of the PHCs. While making the stay of doctors compulsory, strict action is also reputed to be taken against the erring doctors. The Committee is of the view that similar action needs to be taken by other states also. The Committee would appreciate if the Centre takes a pro-active approach in this regard by taking up with other States to follow the above example. Another initiative that has come to the notice of the Committee is handing over of PHCs to selected NGOs by States like Orissa, Bihar, Uttaranchal, Delhi, Jharkhand and Karnataka. The Committee is of the view that performance of such PHCs needs to be monitored to assess the outcome of such experiments for further improvement and diversification, if necessary. The Committee would like to be apprised about the performance level of such NGOs during the year 2005-06. (Para 28.8)
As per the census of 2001, due to increase of population, proportionate new Primary Health Centres and Sub-centres need to be started all over the country. This needs budget allocation. The Committee therefore recommends that budget allocation should be suitably enhanced.
XXIX. REPRODUCTIVE AND CHILD HEALTH CARE- RCH-II
The Committee, however, understands that a mid-term review of the programme was scheduled in January–February 2006. The Committee would like to be apprised about the outcome thereof. (Para 29.2)
The Committee takes a serious view of this. It seems delay in receipt of NOC from World Bank must have occurred due to want of some required information by the World Bank. If that be so, the department should make efforts so that such instances do not occur in future. (Para 29.3)
Another disturbing trend that has come to the notice of the Committee is availability of unspent balance of Rs. 201.16 crore under the Programme with various States. Out of total release of Rs. 1019.94 crore, expenditure of Rs. 818.83 crore has been incurred so far, thus leaving an unspent balance of Rs. 201.15 crore. Bihar and Orissa are the two States that could utilize only less than half of the allocated funds. (Para 29.4)
The Committee strongly feels that such a position can only be considered to be very alarming. This clearly indicates that in the absence of Utilization Certificates for huge sums, showing a steady increase over the years, quality of services being provided under the various Programme cannot be judged properly. The Committee would like to have full details (State wise) in this regard. (Para 29.5)
The Committee understands that a special dispensation has been sought from the Ministry of Finance keeping in view the complex funds flow involving multi-tier structure and the time taken thereby and the reporting of expenditure from the end-use of funds upto the level of Central Govt. and reporting infrastructures available in the States/UTs. The Committee is not inclined to agree with the contention of the Department. The Committee strongly feels that adherence to GFRs is very much required not only for making accountable all concerned - both Central Govt and implementing agencies, but also for optimum and judicious utilization of allocated funds. The Committee would therefore recommend that the Department instead of asking for such a dispensation should take measures for streamlining the accounting procedure. (Para 29.6)
XXX. ROUTINE IMMUNIZATION PROGRAMME
The Committee strongly feels that this imbalance in performance level of different states needs to be removed without any further delay. (Para 30.2)
The Committee is, however, surprised to note that from 2003-04 onwards upto December 2005, reported immunization coverage as reported by various states shows completely different status. Percentage of coverage for different vaccines has reached the level of 90% and above during this period. The Committee would like to be apprised about the percentage of coverage as per household survey 2002-03 and 2003-04 (state-wise). The Committee has been given to understand that a number of measures have been initiated by the Department to ensure better coverage of Routine Immunizations Programme. The Committee would appreciate if the state figures were verified by an independent survey. (Para 30.3)
The Committee is of the view that the process of replacement of cold chain system already started by Govt. needs to be expedited. (Para 30.4)
The Committee notes that although funds have been duly released to Bihar and UP during 2004-05 and 2005-06 and there has been optimum expenditure thereof, in respect of Bihar for 2005-06, Expenditure Status has not been received. (Para 30.5)
The Committee observes that inspite of unsatisfactory performance level, funds are being duly released to UP. The Committee is of the opinion that remedial action in the light of constraints being faced in Pulse Polio Programme in the two most affected states of UP and Bihar needs to be taken. This is all the more required in view of sporadic cases of polio being reported from UP. This year 17 cases have already been reported from there. The Committee is of the view that sustained efforts need to be made in UP and Bihar otherwise the goal of Eradication of Polio from the country will remain unfulfilled. (Para 30.6)
XXXI. FOREIGN FUNDING
The Committee observes that damage-control exercise has been started by the Department in the matter of World Bank funding for various projects being put on hold. The Committee is of the view that the very fact that instances of corruption and fraud in a number of projects during a prolonged time-frame being noticed by World Bank and its funding being put on hold establishes that there were inherent flaws in the procurement system which went unnoticed for a considerable period of time. Quantum of World Bank funding being too small or Govt. ability to manage in the absence of the same cannot bring back the loss of prestige of the country world over and setback to various projects in Health and Family Welfare sector. The Committee is of the opinion that a thorough assessment of procurement procedure in respect of all projects whether foreign funded or otherwise needs to be made. This task can be entrusted to the Empowered Procurement Committee of the Ministry and some independent experts should also be involved in this exercise. The Committee would also like to reiterate that monitoring mechanism needs to be further strengthened and activated. The Committee would like to be apprised about the final outcome of ongoing CBI investigation in the matter of World Bank funding. (Para 31.5)
XXXII. DECLINING SEX RATIO
The Committee observes that besides the age-old factors responsible for this dismal situation, easy availability of sex determination tests across the country can be considered as a reason behind the declining sex ratio. Coming into force of the Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act in 1996 and subsequent amendments made to remove the inherent inadequacies has so far failed to make any impact in checking this malaise. (Para 32.2)
The Committee would, however, like to point out that there might be equal number of, if not more, unregistered clinics doing their business. Total number of 322 complaints filed in the courts/police stations against the violators of law and sealing and seizure of 33 ultrasound machines during 2005-06 can only be termed as a very small and insignificant attempt to solve a sensitive problem, which indicates a dark future for our country. The Committee appreciates that the Govt has initiated a number of measures, at both state and central level. The Committee, however, feels that these measures can only bring about a change if sustained initiatives are put into effect by all concerned. One should also not forget that social awareness about the implications of this problem has to be built up. The Committee would also like to point out that our medical community is in need of sensitizing the public so that they start playing a pro-active role. The Committee understands that a survey of ultrasound centres was undertaken during 2004-05 in the most vulnerable states and findings of this survey have been sent to the concerned states for taking necessary action on 30.03.2005. The Committee would like to be apprised about full details in this regard. (Para 32.3)
XXXIII MISCELLANEOUS
There is acute shortage of trained nurses in the world. Many nurses from India are going abroad for jobs, with the result that there is shortage of nurses in the country. The Committee understands that there is a certain ratio of bed strength: trainee-nurses, for training these nurses. The present ratio is that for five beds, one nurse can be trained. The Committee understands that suddenly we cannot improve the bed strength in order to overcome the shortages. Hence, the ratio of 5:1 can be relaxed to 3:1 from this academic year itself. (Para 33.1)
The Committee further contends that in our country, there are about 100 Government Medical Colleges and hospitals. The burns wards, trauma wards, children wards in these government medical colleges, can be given a one-time suitable grant by the government for the maintenance of basic amenities inside such wards. Similarly, in Primary Health Centers, many of the refrigerators are not in working condition. Government can add one more refrigerator for storage of vaccines and important medicines that require suitable conditions for shelf life. (Para 33.2)
MINUTES
MINUTES OF THE MEETING OF DEPARTMENT-RELATED PARLIAMENTARY
STANDING COMMITTEE ON HEALTH & FAMILY WELFARE
IX
NINTH MEETING
The Committee met at 11.00 a.m. on Thursday 13th April, 2006 in Room No.63, First Floor, Parliament House, New Delhi.
MEMBERS PRESENT
RAJYA SABHA
1. Shri Amar Singh ¾ Chairman
2. Shrimati Maya Singh
3. Smt. Sukhbuns Kaur
4. Shri Lalhming Liana
5. Shri Digvijay Singh
LOK SABHA
Smt. Sushila Bangaru Laxman
Shri S. Mallikarjuniah
Dr. Babu Rao Mediyam
Dr. Chinta Mohan
Shri Nakul Das Rai
Smt. K. Rani
Shri Kailash Nath Singh Yadav
Dr. Karan Singh Yadav
SECRETARIAT
Smt Vandana Garg, Joint Secretary
Shri H.C.Sethi, Deputy Secretary
Shri Mom Raj Singh, Under Secretary
Shri S.C. Dixit, Committee Officer
Representatives of the Ministry of Health and Family Welfare
1. Shri P.K. Hota Secretary
2. Smt. S. Jalaja Addl. Secretary
3. Shri Deepak Gupta Addl. Secretary
4. Shri Sanjiv Misra Addl. Secretary & FA
5. Smt. Bhavani Thyagarajan Joint Secretary
6. Shri B.P. Sharma Joint Secretary
7. Shri Vineet Chowdhry Joint Secretary
8. Shri S.S. Brar Joint Secretary
9. Prof. P. Vanugopal Dir. (AIIMS)
10. Prof. N.K. Ganguli Dir. General ICMR
11. Dr. R.K. Srivastava D.G.H.S
12. Dr. P.K. Phukan Dir. (CGHS)
13. Ms. Sujata Rao A.S & P. D. (NACO)
2. In the absence of the Chairman, Dr. Karan Singh Yadav, member, Lok Sabha, presided the Pre-lunch session of the meeting.
3. At the outset, Chairman welcomed the Secretary and other officials of the Department of Health and Family Welfare and requested the Secretary to make a brief presentation on the Demand for Grants (2006-07) of the Department. The Secretary made the visual presentation of the activities undertaken during the last year and achievements of the Department. The Secretary briefly explained the budgetary allocations of the different heads of the Department for the year 2006-07. The Members sought clarifications on the activities and achievements of the Ministry and deliberated on the budgetary allocation on different heads of the Department. The Secretary replied to the queries raised by the Members.
4. A verbatim record of the proceedings was kept.
5. The Committee then adjourned at 4.45 p.m.
NEW DELHI
13th April, 2006
MOMRAJ SINGH
UNDER SECRETARY
MINUTES OF THE MEETING OF DEPARTMENT-RELATED PARLIAMENTARY
STANDING COMMITTEE ON HEALTH & FAMILY WELFARE
XI
ELEVENTH MEETING
The Committee met at 9.30 a.m. on Wednesday the 17th May, 2006 in Room 63, First Floor, Parliament House, New Delhi.
MEMBERS PRESENT
RAJYA SABHA
1. Shrimati Maya Singh
2. Shri Digvijay Singh
LOK SABHA
3 Shri D.K. Audikesavulu
4. Dr. Ram Chandra Dome
Smt. Maneka Gandhi ¾ in the Chair
Shri Rajendra Kumar
Smt. Sushila Bangaru Laxman
Dr. Babu Rao Mediyam
Shri D.B. Patil
Smt. V. Rakhika Selvi
Shri Kailash Nath Singh Yadav
Dr. Karan Singh Yadav
SECRETARIAT
Smt Vandana Garg, Joint Secretary
Shri H.C.Sethi, Deputy Secretary
Shri Mom Raj Singh, Under Secretary
Shri S.C. Dixit, Committee Officer
2. In absence of the Chairman, Smt. Maneka Gandhi, member, Lok Sabha, presided over the meeting.
3. At the outset, the Chairperson welcomed the members of the Committee. The Committee then considered the 16th and 17th draft Reports on Demands-for-Grants (2006-07) relating to the Department of Health and Family Welfare and the Department of AYUSH respectively. After some discussion, the Committee adopted both the reports with some minor modifications.
4. The Committee, thereafter, decided that the Reports may be presented to the Rajya Sabha and laid on the table of Lok Sabha on Monday the 22nd of May 2006. The Committee authorized the Chairman of the Committee or in his absence Smt. Maya Singh and in the absence of both, Shri Digvijay Singh to present the reports in Rajya Sabha, and, Dr. R.C. Dome, or in his absence Smt. Sushila Bangaru Laxman and in the absence of both, Dr. Karan Singh Yadav to lay the reports on the table of Lok Sabha.
5. x x x x x x x x x x x x x x x x x X X X X X
6. x x x x x x x x x x x x x x x x x x X X X X
7. The meeting then adjourned at 10.30 a.m.
NEW DELHI
17th May, 2006
(MOMRAJ SINGH)
UNDER SECRETARY
