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Inspection Report on the Accounts of the Office of the Deputy Director of Health Services, Vellore District for the Period from 02/2017 to 12/2017

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Inspection Report on the Accounts of the Office of the Deputy Director of Health Services, Vellore District for the Period from 02/2017 to 12/2017 1 INSPECTION REPORT ON THE ACCOUNTS OF THE OFFICE OF THE DEPUTY DIRECTOR OF HEALTH SERVICES, VELLORE DISTRICT FOR THE PERIOD FROM 02/2017 TO 12/2017 DATES OF AUDIT: 02.01.2018 TO 23.01.2018 PART-I: INTRODUCTION OVERVIEW Functional/Geographical Jurisdiction : The Deputy Director of Health Services has the jurisdiction of two Health Unit Districts viz. Vellore and Tirupathur and implements Public Health Programme , Technical Guidance and Supervision covering 10 Block Primary Health Centres, 35 Additional Primary Health Centres, 4 Urban Primary Health Centres and 231 Health Sub Centres Relative Significance of the unit in the overall Hierarchy of the Department : The Deputy Director of Health Services, Vellore is functioning under direct administrative control of the Director of Public Health and Preventive Medicine, Chennai Budget/Financial Performance Year Budget Revised Expenditure Estimate Estimate 2014-215 268396875 326570947 332378113 2015-2016 336401760 390055122 364978903 2016-2017 373924232 393392402 377102999 2017-2018 396615561 399034230 328370756 (Up to 12/2017) Regular Activites carried out by the auditee unit : The DDHS,Vellore had implemented the following programme namely Communicable Disease Control Programme, AIDS Control Programme, Maternal and Child Health, Immunization programme, School Health Programme, National Programmes like eradication of 2 Malaria, Leprosy, TB, Blindness control and Iodine Deficiency programme, Special Programme like Pulse Polio Immunization, Dr.Muthulakshmi Reddy Maternity Beneficiary Scheme, Special Medical Camp, Menstrual Hygiene programme, NRHM scheme, Konnoli Kappom Thittam, Amma Arokia Thittam and Amma Baby Care Thittam. Scope of Audit : It is a Low Risk audit and focused on the implementation of Health welfare scheme and budgetary control mechanism. Subject matter selected if any : Nil Complete List of PHCs under the Juridiction of DDHS, Vellore : List Enclosed Audit Sample As per the Headquarters Lr. No.Pr.AG (G&SSA)/SS-I/Civil 1/I/ 2017- 18/Dated: 02/01/2018 Mudur, Punnai, Timiri were selected for test audit. Audit Criteria 1. IPHS guidelines and other Scheme Guidelines issued by the Government 2. Government Orders, Executive instruction and circulars. 3. Budget and Accounting Manual 4. Tamil Nadu Financial Code 5. Tamil Nadu Treasury Code The Previous audit of this office was conducted from 27/02/2017 to 14/03/2017 covering the period from March 2015 to January 2017. During the present audit, taken up from 02nd January 2018 to 23rd January 2018, activities and transaction pertaining to the period from February 2017 to December 2017 were test checked. Part-II : Audit Findings List Enclosed. Part-III – Follow up Findings : Outstanding from Previous Reports : Enclosed Part-IV : Best Practices : Nil 3 Part-V : Acknowledgement : The audit acknowledges the co-operation extended by the Deputy Director of Health Services, Vellore and staff in completing audit successfully The following Persons held the charge of the post of Deputy Director of Health Services, Vellore during the period covered by audit. S.No Name Shri/Smt/Sel. From To 1. Dr. K. S. T. Suresh, MBBS,DCH,DPH,MPH 27.06.2016 Till date The Local audit was conducted by the following officials S.No Name and Designation Shri/Smt/Sel. 1. V. Padmanabham , Audit Officer 2. J. Joab Jaidev Royan, Asst. Audit Officer 3. K. Raja Kumar , Senior Auditor from (02/1/18 to 19/1/18) 4 SUMMARY OF OBJECTIONS PART II B Para No. Gist of objections 1. RKSK-DELAYED/NON IMPLEMENTATION/USAGE OF FUNDS OF CERTAIN SCHEME COMPONENTS 2. NON-RETURN OF BALANCE FUND BY PWD-RS. 6.01 LAKH 3. RETURN OF AMOUNTS CREDITED TO BENEFICIARY ACCOUNTS OF DR. MUTHULAKSHMI REDDY MATERNITY BENEFIT SCHEME- UPHC MUDHUR-RS. 2.08 LAKH, UPHC PUNNAI – RS. 1.56 LAKH 4. NON FULFILLMENT OF INDIAN PUBLIC HEALTH STANDARDS NORMS - COMMUNITY HEALTH CENTRE, PUNNAI, MUDUR, AND THIMIRI 5. NON ESTABLISHEMENT OF TELEMEDICINE CENTRE IN THONGUMALAI HEALTH SUB CENTRE 6. NON FUNCTIONING OF EQUIPMENTS IN GOVERNMENT PUBLIC HEALTH CENTER, PUNNAI - RS. 1,09,175 7.(a) BUILDINGS TO BE DEMOLISHED IN PUNNAI PHC 7.(b) OLD AND DILAPIDATED BUILDINGS TO BE DEMOLISHED- MUDHUR UPHC 8. PROBABLE ENCROACHMENT OF PHC LAND – PUNNAI PHC 9. INTERNAL AUDIT NOT CONDUCTED Part III 1. NON-DISPOSAL OF USED X-RAY FILMS AND WASTE HYPOSOLUTION AT GOVERNMENT PHC, PUNNAI – Rs. 1,320/- 5 Part-IIB 1. RKSK-DELAYED/NON IMPLEMENTATION/USAGE OF FUNDS OF CERTAIN SCHEME COMPONENTS The Rashtriya Kishori Swasthya Karyakram (RKSK) Scheme was launched on 7th of January 2014 to address the health and development needs of the adolescent population which is 21% of India’s population. Administrative sanction to implement the scheme in Tamilnadu was accorded vide GO (Ms) No. 65 Health and Family Welfare (EAPII (1)) Department dt. 05.03.2015. The seven critical components of this strategy are Coverage, Content, Communities, Clinics, Counseling, Communication and Convergence. The six strategic priorities of the Scheme are Nutrition, Sexual and Reproductive Health, Non communicable diseases, Substance misuse, injuries and violence and mental health of the adolescents. In the first phase, the scheme was proposed to be implemented in 9 High priority districts which includes Vellore district. The Mission Director, SHS, is permitted to establish Adolescent Friendly Health Clinics (AFHC) in 185 Health Institutions and to place 370 Adolescent Health Counselors only on contract basis (Outsourcing) at the rate of two Counselors per clinic. In Vellore district inclusive of Tirupattur HUD, AFHCs were established in Govt. Vellore Medical College Hospital, Walajapet Dist. Hqrs hospital, 7 Sub District hospitals and 20 Block Primary Health Centres. Funds to the tune of Rs. 8,01,01,600/- (Rs. 3.23 crore + Rs.4.77 crore) for various activities under RKSK were released to the DDHS of the districts vide Proceedings of the Mission Director, SHS Nos.. 4026/P/SHS/2014 dt. 25.03.2015 and 4026/P/SHS/2014-2 dt. 23.03.2015. Out of this an amount of Rs. 1,46,58,100/- was released to DDHS, Vellore, and credited to the ICICI bank account 614301014854 on 26.03.2015 (8655600+5588900+413600) under various components as shown in the Annexure. It was noticed that the amount of Rs. 1.46 crore received on 26.03.2015 remained unutilized upto end of 2015-16. In 2016-17 funds for the setting up of clinics at DH/MCH/CHC alone were fully utilized. In 2017-18, funds towards provision of training for ANM/LHV for Peer Educator Programme at district and 6 Block level and provision of kits to Peer Educators were partially utilized. However, it was noticed that funds provided for organizing Adolescent Health Day and Sensitization for representatives of PTA were not utilized at all since 2015. The Adolescent Health Day is to be organized every quarter in 2998 villages in Vellore district at the rate of Rs. 2500/- per Health Day. The major amounts fully unspent and partially spent is as below: Sl Component name Amount Amount Closing Remarks No. Sanctioned spent balance (Rs.) (Rs.) (Rs.) 1 Adolescent Health 74,95,000 0 74,95,000 Amount sanctioned in Day 2015. Not utilised at all. 2 Sensitization for 5,12,000 0 5,12,000 Amount sanctioned in representatives of 2015. Not utilised at all. PTA 3 Incentives for Peer 7,85,650 0 7,85,650 Amount sanctioned in Educators 2015. Not utilised at all. 4 Travel expenses by 3,000 0 3,000 Amount sanctioned in APM 2015. Not utilised at all. The amount not spent at all worked out to Rs. 87,92,650/- from 26.03.2015 in respect of 4 components. Components where meager expenditure was incurred is as below: Sl Component name Amount Amount Closing Remarks No Sanctioned spent balance . (Rs.) (Rs.) (Rs.) 1 Kit to Peer Educators 39,28,250 5,87,023 33,41,227 Amount spent in 2017-18 only. 2 Sensitization for PRI, 3,52,000 5,600 3,46,400 Amount spent in NGOs, and PPP at PHC 2017-18 only. level 3 Training for Peer Educator 26,22,700 9,86,260 16,36,440 Amount received in programme at District and 2016-17 and spent in Block level 2017-18 only. 4 Mobility support for 8,000 1,600 6,400 Amount spent in Counsellors 2016-17 only 5 Incentives for mobilising 41,200 1,800 39,400 Amount spent in adolescents form AHD 2017-18 only. 6 Adolescent Health Club 1,81,600 20,000 1,61,000 Amount spent in 2016-17 only 7 Out of a total receipt of Rs. 1,74,54,800/- an amount of Rs. 1,45,57,768/- is available as Closing balance as on date with an expenditure of only Rs. 28,97,032/- which is only16.59% of the sanction for the period from 26.03.2015 till date. This is brought to notice. The department has given an interim reply. 2. NON-RETURN OF BALANCE FUND BY PWD-RS. 6.01 LAKH The approved Civil works for 2013-14 interalia comprised of the upgradation of 60 PHCs into 30 bedded PHCs through NHM. The PHCs were to be upgraded at a cost of Rs. 87 lakh each (GO (Ms) No. 216 Health and Family Welfare (EAPII-2) Department dt. 24.7.15) and 30% of the total cost amounting to Rs. 1566.00 lakh was remitted to SBI, Treasury Branch, Thousand lights, Chennai vide challan No. 1073 dt. 08.01.2015 to get the work executed through the PWD (GO (Ms) No. 116 Health and Family Welfare (EAPII-2) Department dt. 25.03.11). Subsequently, the revised cost of upgradation, due to revision in the Schedule of Rates, and as sanctioned by the Mission Director, SHS, worked out to Rs. 105 lakh. The balance 70% of the cost and the escalation cost of the upgradation worked out to Rs.
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