PARLIAMENT OF INDIA RAJYA SABHA 54

DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE

FIFTY-FOURTH REPORT ON DEMANDS FOR GRANTS 2012-13 (DEMAND NO. 46) OF THE DEPARTMENT OF HEALTH AND FAMILY WELFARE (MINISTRY OF HEALTH AND FAMILY WELFARE)

(PRESENTED TO THE RAJYA SABHA ON 26TH APRIL, 2012) (LAID ON THE TABLE OF THE LOK SABHA ON 25TH APRIL, 2012)

RAJYA SABHA SECRETARIAT NEW DELHI APRIL, 2012/VAISHAKHA, 1934 (SAKA) Website : http://rajyasabha.nic.in E-mail : [email protected] PARLIAMENT OF INDIA RAJYA SABHA

DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE

FIFTY-FOURTH REPORT ON DEMANDS FOR GRANTS 2012-13 (DEMAND NO. 46) OF THE DEPARTMENT OF HEALTH AND FAMILY WELFARE (MINISTRY OF HEALTH AND FAMILY WELFARE)

(PRESENTED TO THE RAJYA SABHA ON 26TH APRIL, 2012) (LAID ON THE TABLE OF THE LOK SABHA ON 25TH APRIL, 2012)

RAJYA SABHA SECRETARIAT NEW DELHI

APRIL, 2012/VAISHAKHA, 1932 (SAKA)

CONTENTS

PAGES

1. COMPOSITION OF THE COMMITTEE ...... (i)-(ii)

2. PREFACE ...... (iii)

Part – A (HEALTH SECTOR)

3. REPORT ...... 1—49

4. OBSERVATIONS/RECOMMENDATIONS — AT A GLANCE (HEALTH SECTOR) ...... 272—89

Part – B (NRHM)

5. REPORT ...... 50—71

6. OBSERVATIONS/RECOMMENDATIONS — AT A GLANCE (NRHM SECTOR) ...... 90—97

7. MINUTES ...... 99—104

8. ANNEXURE ...... 105—108

COMPOSITION OF THE COMMITTEE (2011-12)

RAJYA SABHA 1. Shri Brajesh Pathak — Chairman #2. Shri Janardhan Dwivedi *3. Shrimati Viplove Thakur 4. Dr. Vijaylaxmi Sadho 5. Shri Balbir Punj 6. Dr. Prabhakar Kore 7. Shrimati Vasanthi Stanley @8. Shri Rasheed Masood 9. Shrimati B. Jayashree 10. Shri Derek O’Brien LOK SABHA 11. Shri Ashok Argal 12. Shrimati Harsimrat Kaur Badal 13. Shri Vijay Bahuguna 14. Shrimati Raj Kumari Chauhan 15. Shrimati Bhavana Gawali 16. Dr. Sucharu Ranjan Haldar 17. Dr. Monazir Hassan I8. Dr. Sanjay Jaiswal 19. Shri S. R. Jeyadurai 20. Shri P. Lingam 21. Shri Datta Meghe 22. Dr. Jyoti Mirdha 23. Dr. Chinta Mohan 24. Shri Sidhant Mohapatra 25. Shrimati Jayshreeben Kanubhai Patel 26. Shri M. K. Raghavan 27. Shri J. M. Aaron Rashid 28. Dr. Arvind Kumar Sharma 29. Shri Radhe Mohan Singh 30. Shri Ratan Singh 31. Dr. Kirit Premjibhai Solanki # Ceased to be a Member w.e.f. 27th January, 2012 and re-nominated to the Committee on 2nd February, 2012. * Ceased to be a Member w.e.f. 2nd April, 2012. @ Ceased to be a Member w.e.f. 9th March, 2012.

(i) (ii)

SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R.B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director 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 Fifty-fourth Report of the Committee on the Demand for Grants (Demand No. 46) of the Department of Health and Family Welfare, Ministry of Health and Family Welfare for the year 2012-13.

2. The Committee considered the various documents and relevant papers received from the Department of Health and Family Welfare, Ministry of Health and Family Welfare and also heard the Secretary and other officials of the Department on the said Demand for Grants (2012-13) in its meeting held on 9th April, 2012.

3. The Committee considered the Draft Report and adopted the same in its meeting held on 23rd April, 2012.

BRAJESH PATHAK NEW DELHI; Chairman, 23rd April, 2012 Department-related Parliamentary Vaishakha 3, 1934 (Saka) Standing Committee on Health and Family Welfare.

(iii)

1

PART-A

HEALTH SECTOR

I. BUDGETARY ALLOCATION 1.1 The Department has informed that the expenditure status of the allocated funds under Plan heads for the Eleventh Plan was as follows: (Rs. in crore) Year BE RE Actual Expdt. 2007-08 2985.00 2331.39 2183.83 2008-09 3650.00 3650.00 3008.40 2009-10 4450.00 3825.25 3261.90 2010-11 5560.00 5139.55 4666.04 2011-12 5720.00 4450.00 4101.41 Total – XI Plan 22365.00 19396.19 17221.58

1.2 From a scrutiny of the above Table, the Committee is constrained to observe that there was substantial and persistent under-utilization of the budgeted funds during the Eleventh Plan. That the savings occurred under the Plan head underlines the fact that the development activities have been curtailed. Though the Committee is supportive of the Department’s demand for higher allocation of funds, it deprecates the Department for failing to optimally utilize its Plan Allocations over the last five years. The Committee observes that the underutilization of budgeted funds is indicative of slack monitoring on the part of the Department as well as formulation of the Budget Estimates in a ritualistic manner without application of proper financial yardsticks. The Committee, accordingly, impresses upon the Department to pay focused attention to streamlining its monitoring mechanism and ensure optimal and more efficient deployment and utilization of its financial resources for smooth execution of its Plan programmes. 1.3 The Committee has been informed that the Department of Health & Family Welfare has proposed an outlay of Rs.45,532.18 crore, consisting of Rs.28439.65 crore for NRHM and Rs.17092.53 crore for Health Sector Schemes for Annual Plan 2012-13. As against the proposed plan outlay of Rs.45532.18 crore, approved plan outlay for the Department of Health and Family Welfare for 2012-13 is Rs.27127 crore, which is only 15% hike over the Budget Estimates of 2011-12. Out of this the NRHM component is 76% at Rs.20542 crore and the outlay for various other health schemes is Rs. 6585 crore against the proposed outlay of Rs.17092.53 crore. 1.4 The Committee has also been informed that the Planning Commission in their document- “Faster, Sustainable and More Inclusive Growth: An Approach to the Twelfth Five Year Plan”, has aimed at raising the total public health expenditure to 2.5% of GDP by the end of the Twelfth Plan. 1.5 The Committee has been further apprised that Government of India in partnership with the States has been involved in formulating health policies from time to time to provide better health to the population. Presently States and Union Territories together account for about two-thirds of total public health outlay. 2

1.6 The Committee observes that a shortfall in allocation of funds to the tune of Rs.10507.53 crore vis-a-vis the proposed outlay for 2012-13 that too at a time when the Government has committed itself to raising its expenditure on health from roughly 1% of the GDP to 2.5% of the GDP by the end of Twelfth Plan is baffling, to say the least. The public expenditure on health in the country is one of the lowest in the world and total plan expenditure would need to rise substantially and consistently before the target expenditure level of 2.5% of GDP is achieved. The Committee, therefore, desires to know the reasons behind the substantially reduced allocation for 2012-13. The Committee also desires to know the rate at which the total Plan expenditure would need to grow annually, in order to meet the expenditure level of 2.5% of GDP by the end of the Twelfth Plan and what would be the share of the Centre and the States therein. The Committee, therefore, recommends that the Department should make all out efforts to convince the Planning Commission and the Department of Expenditure for enhancing the annual Plan allocation for the remaining four years of the Twelfth Plan and also at RE 2012-13 in such a way that the target of meeting expenditure level of 2.5% of GDP could be achieved. 1.7 Giving a break-up of the funds allocated vis-a-vis financial outlay proposed for 2012-13, the Secretary during his deposition before the Committee on 9/4/2012 inter-alia furnished the following information: Major ongoing schemes under Health (Centrally Sponsored Schemes) (Rs. in crore) S1. Name of the Schemes/ 2012-13 2012-13 No. Institutions (proposed) (approved) 1 National Programme for Prevention and 1024.95 300 Control of Cancer, Diabetes, CVD and Stroke 2 National Mental Health Programme 704.00 130 3 Trauma Care 656.42 100 4 National Programme for Health Care for the Elderly 200.00 150 5 Human Resources for Health 800.00 505 6 District Hospitals 400.00 350

New Activities proposed under Health (Centrally Sponsored Schemes) (Rs. in crore) Sl. Name of the scheme 2012-12 2012-13 No. (proposed) (approved) 1 Strengthening Govt medical colleges and central 270.00 2.00 govt. health institutions 2 Establishing new Medical colleges 30.00 2.00 3 Setting up of state paramedical institutions/colleges 100.00 2.00 4 Setting up of college of pharmacy in govt. 75.00 2.00 medical colleges 5 Strengthening state drug regulatory system 100.00 2.00 6 Strengthening state food regulatory system 70.00 2.00 7 Innovation based schemes 100.00 50.00 3

Major Activities under Health (Central Sector) (Rs. in crore) Name of the Schemes/ 201213 2012-13 Institutions (proposed) (approved) Strengthening of Hospitals and dispensaries 556.65 393.36 Strengthening of institutions of Medical education, training 1009.18 418.21 and research PMSSY 2022.79 1544.21 National Centre for Disease Control 100.00 52.25 Redevelopment of Hospitals/lnstitutions including AIIMS, 2230.01 1418.85 Safdarjung Hospital, Dr. RML Hospital

1.8 The Committee has been apprised that no provision could be made for the scheme ‘National Urban Health Mission’ and some of the new schemes like ‘Strengthening of District Hospitals, to provide advanced level secondary care, supply of generic medicines and public health facilities etc. 1.9 From the information made available, the Committee gathers that some of the major programmes/heads which are likely to be affected due to substantially less allocation of funds include PMSSY, Financial Assistance for Strengthening and Upgradation of Medical Colleges, Establishment of New Medical Colleges in underserved States, Strengthening of tertiary care institutions like AIIMS, JIPMER, PGIMER, NIMHANS, Safdarjung Hospital and VMMC, RML Hospital, NPCDSC, Capacity Building for establishing Trauma Care Facilities in Government Hospitals on National Highways and the proposed National Urban Health Mission. The Committee is of the firm opinion that the above trend of allocation of funds would adversely impact the public health sector’s ability to cater to the healthcare needs of the people at large. The Committee is also aware that the absorption capacity of the States has witnessed improvement and their spending capacity is expected to pick up during the Twelfth Plan. Besides, presently more than 9 crore people of the country have been categorized as urban poor, mostly residing in urban slums. The level of availability of health care facilities to these poor people is worse than that available to the rural poor. Their health indicators are also worse than those of the rural poor. The Committee, accordingly, opines that non-rolling of National Urban Health Mission on account of no provision of funds would further impact the health indicators of poor people residing in urban slums. 1.10 Taking all the above factors into consideration, the Committee recommends that the Department should once again assess its fund requirements realistically and thereafter move the Planning Commission for augmentation of financial resources for health sector for 2012-13 at RE stage. The Committee would like to be apprised of the follow-up action taken in this regard. 1.11 The Committee is aware that the central vision of the Eleventh Plan as per the Plan document was to trigger a development process, ensuring a broad based improvement in the quality of life of the people. To achieve these objectives in the Eleventh Five Year plan the emphasis was given to areas like mirroring of Centers of Excellence like AIIMS, redevelopment of Hospitals, strengthening of medical, paramedical, education and nursing areas and greater focus to hitherto neglected areas like taking care of older populations, reversing the trend of occurrence of major diseases like Cancer, diabetes etc. 4

1.12 As per the information furnished by the Department the allocation made vis-a-vis actual expenditure incurred in respect of some of the major Institutions/projects/initiatives of Department for the last three financial years is as follows: (Rs. in crore)

Sl. Scheme 2009-10 2010-11 20l1-12 No. BE RE AE BE RE AE BE RE AE 1 CGHS 51.00 66.64 58.02 68.65 80.81 57.21 84.00 86.23 55.34 2 CIP, Ranchi 15.00 21.64 20.88 27.25 26.60 13.94 40.90 38.97 16.18 3 Cancer 95.00 35.00 28.25 180.00 55.00 31.97 200.00 112.00 76.80 Research 4 LHMC & 60.00 70.50 43.64 79.00 72.00 50.90 80.00 68.00 50.52 S.K. Hospital 5 PMSSY 1447.92 683.58 474.48 750.00 747.00 653.84 1616.57 918.91 714.31 6 Tobacco 30.00 17.00 16.40 45.00 30.00 29.28 50.00 32.00 11.31 Control Programme 7 Development 18.00 2.00 17.55 21.00 26.00 25.47 40.00 27.00 10.25 of Nursing Services 8 Total/Medical 2279.52 1659.03 1338.39 1982.51 1967.55 1749.94 3135.92 2257.18 1780.18 Education, Training and Research

1.13 From a perusal of the utilization trend of the allocation as given in the Table above, the Committee infers that the Department has failed to meet broad committed objectives of the Eleventh Five Year plan. The Committee feels that the Department needs to introspect the reasons for underutilization of funds practically in all of its major initiatives targeted to be achieved during the Eleventh Plan period and take appropriate corrective actions accordingly. In addition to dedicated approach, advance action plans may also be drawn for completion of all the projects in hand within the targeted timelines.

1.14 The Committee’s attention has been drawn to faulty planning of the National Programme for Prevention and Control Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The Committee was informed that NPCDCS was launched in 2010 in 100 districts across 21 States. Under Cancer component of NPCDCS, various activities like early diagnosis of Cancer, Chemotherapy facilities etc were envisaged. However, non- availability of adequate manpower, non-signing of MOUs with State Governments, non-opening of Bank Accounts in States etc. led to reduction of BE of Rs.200.00 crore for 2011-12 to Rs.112.00 crore at RE stage and the actual expenditure was pegged even less at Rs. 99.79 crore, which clearly reflects that the Department did not complete preparatory activities on time. From the information furnished the Committee gathers that Non Communicable Diseases (NCDs) are emerging as a leading cause of death in the country accounting for 42% of al1 deaths and that NCDs cause significant morbidity and mortality in popUlation with considerable loss in potentially productive years of life. The Committee 5 would, therefore, expect the Department to urgently initiate appropriate corrective measures to arrest shortfall in utilization of the budgeted amount for NPCDCS in future.

1.15 The Committee’s attention is also drawn towards large number of pending Utilization Certificate in respect of both Centrally Sponsored and Central Sector Schemes and huge amount involved therein. The Committee was informed that outstanding U.Cs for Centrally Sponsored Schemes in respect of Department of Health and Family Welfare as on 29.2.2012 is as below: No. of UCs Amount (in crores of rupees) 1130 2166.02 1.16 The Central Sector Plan Schemes are financed directly by the Central Government and implementation is overseen and monitored by them directly. Central Plan Schemes are implemented by Autonomous Bodies/Agencies/Institutions under the administrative control of the Ministry. 1.17 The details of outstanding utilization certificates for Central Plan Schemes in respect Department of Health & Family Welfare as on 29.02.2012 is as below: No. of UCs Amount (In crores of rupees) 2336 2246.85 1.18 The Committee recalls the following recommendations it has made in its 39th Report:– “The Committee takes note of the fact that the Department has taken measures like for non-recurring grants, no fresh releases are being authorized unless audited Utilization Certificate for grant released in the year prior to the last year (i.e. with a ‘grace period’ of one year) has been received, subject to the condition that the sanction for the earlier grant does not permit a longer period of utilization. Further, the provisions of the General Financial Rules, which require that in case of recurring grants, funds for same purpose beyond 75% of the next year’s provision will not be released unless audited Utilization Certificate for the grants released in the previous year is received, are being strictly implemented. Impact of such measures does not seem to be very effective as number of pending UCs continues to remain very high. Not only this, such a trend also indicates that schemes are not being implemented as envisaged.” “The Committee notes that as a further effort to maximize liquidation of UCs, a communication has been sent by the Secretary (Health) to the Principal Health Secretaries of all the States. If need be, this exercise needs to be pursued further with higher authorities.” 1.19 The Committee is deeply disturbed that no heed has been paid to the Committee’s above observations/recommendations, and a large no. of UCs are still pending under both the Centrally Sponsored and Central Sector Schemes. The additional measure taken by the Department by sending a communication from the Secretary (Health) to the Principal Health Secretaries of all the States has also been proved to be futile. The Committee, accordingly, recommends that the Department needs to have a serious introspection of the reasons for pendency of such a large no. of Utilization Certificates and come out with clear and innovative action plans for liquidation thereof. 1.20 As regards the action taken on the deficiencies as pointed out in the audit paras for the last 5 years the following information has been provided:– 6

Sl. Report Para Subject of Para Status of the para No. No. No. 12 3 4 5 I CA I of 8.1 Unfruitful expenditure on construction of Audit has vetted the ATN 2008 sub-standard Laboratories (CRl) Kasauli. on 12.12.2011 with certain observations. Final ATN is being processed for sub- mission to Monitoring Cell (Ministry of Finance) 2 CA 14 of 5.2 Failure to recover CGHS charges from ATN sent to audit on 6th 2008-09 BSNL and Postal Department March, 2012 3 PA 30 of Entire National Institute of Biological (NIB) Revised ATN sent to audit 2008-09 Report on 5th Sept. 2011. 4 23 of 3.2 Non recovery of cess (AIIMS) ATN is under preparation 2009-10 Audit pointed out that failure on the part of AIIMS to deduct cess and pay the same to the designated authority resulted in non-compliance with the mandatory provision of an Act, No responsibility had been fixed by AIIMS. 5 3 of Chapter Reimbursement of medical claims to ATN sent to audit on 2010-11 II pensioners under CGHS 14.7.2011 (PA) 6 9 of 7.1 Non-implementation of computerized ATN sent to audit on 2010-11 Management Information System for 16.2.2012 Food Control Organization 7 9 of 7.3 Delayed supply of equipment (NICD) ATN sent on audit on 2010-11 15.2.2012 8 9 of 7.5 Supply of medicines on unlimited credit ATN sent to audit on 2010-11 period (MSO) 12.10.2011 9 20 of Chapter Medical Council of India 63% medical ATN sent to audit on 2010-11 1 colleges are in 6 states indicates skewed 19.01.2012 distribution of medical colleges across the country. Permissions for 4 medical colleges were granted without ensuring fulfillment of prescribed medical standards. 59 medical colleges were found admitting 326 students in excess of their intake capacity in 126 post graduate courses. 10 38 of 3.1 Avoidable payment of interest – AIIMS ATN sent to audit on 2010-11 Audit observed that after 1993, AIIMS 19.3.2012 did not pay the ground rent. Consequently, the LDO raised (12/2001) a demand of Rs.50.72 lakh for seven 7

12 3 4 5 years and the same was paid by AIIMS. Thereafter, AIIMS again defaulted in making the payment of ground rent on time. Consequently, the LDO raised (10/2002) and June 2009 demands for interest also for belated payment of ground rent. 11 16 of 8.1 Unfruitful Expenditure – Safdarjung ATN is under preparation 2011-12 Hospital & VMCC 12 16 of 8.2 Avoidable payment – CGHS ATN is under preparation 2011-12

1.21 The Committee is constrained to note that to a pointed query to the Department in this regard, the Department has either merely stated that the ATN has been submitted to the Audit or the ATN is under preparation. The Committee rather desires that details of the Action Taken by the Department on the Audit paras should have been made available to the Committee. The Committee also takes note of the fact that action on audit paras dating as far back to years 2008, 2009 are still under preparation stage. The Committee calls for a speedy action on the observations as contained in audit paras. The Committee would like to be apprised of the action taken in this regard.

1.22 On being asked about the total projected allocation for the Twelfth Plan and justification for the same, the Department in a written reply has submitted that the Twelfth Plan outlay proposed by Department of Health and Family Welfare is Rs.404490.96 crore, comprising Rs.219702.45 crore for NRHM and Rs.184788.24 crore for Health. The outlay proposed by this Department for 2012-13 was Rs.45532.18 crore. The outlay approved by the Planning commission for 2012-13 is Rs.27127 crore for Department of Health and Family Welfare comprising of Rs.6585 crore under Health and Rs.20542 crore under NRHM. The outlay for 2012-13 approved by Planning Commission is only 59.58 per cent of the proposed outlay for 2012-13. Accordingly, the activities envisaged under the schemes would need to be adjusted within the contours of the approved outlay. It is hoped that the shortfall in 2012-13 outlay would be made good during 2013-14 and the outlay proposed by the Department for the Twelfth Plan would be approved. Therefore, no plan holiday has been considered. Insofar as Zero Based Budgeting is concerned, it may be stated that the allocation made by the Planning Commission for an Annual Plan is significantly less than the requirement projected. Accordingly, that allocation is distributed judiciously amongst the respective Schemes based on need, priorities assigned, etc. It may also be added that for continuation of all the ongoing Schemes from Eleventh Plan to Twelfth Plan, there is a requirement of their appraisal and approval and this will be done at the appropriate stage. 1.23 The Committee notes that the Eleventh Plan has concluded; however, the Twelfth Plan outlay of the Department is yet to be approved. The Committee feels that the delay in approval of the Twelfth Plan outlay is sure to impinge on the process of EFC/CCEA approvals which entails further delay in finalization and implementation of the Schemes/ Programmes of the Department for the Twelfth Plan. The Committee, therefore, recommends to the Government to hasten the approval of Twelfth Plan outlay and related proposals so that the Department is not hamstrung by lack of necessary approvals and the consequent delay in finalization and implementation of various schemes/ programmes in the Twelfth Plan period. The Committee desires to be apprised of the reasons for delay in approval of the Twelfth Plan outlay of the Department. 8

II. CENTRAL GOVERNMENT HEALTH SCHEME 2.1 CGHS is a scheme for providing health care to serving Central Government Employees/ pensioners and their dependent family membens and certain other categories like MPs, Freedom fighters, employees of some selected autonomous bodies and also PIB accredited journalists. Initially started in Delhi in the year 1954, it covers 25 cities at present. As on 24th March, 2012, CGHS has 9.351akh card holders with a beneficiary base of 31,81,719. 2.2 Status of allocation of Plan funds and utilization thereof during the Eleventh Plan is as under: (Rs. in crore) Year BE RE AE 2007-08 40.00 40.00 35.20 2008-09 50.00 59.37 45.45 2009-10 51.00 66.64 58.02 2010-11 68.65 80.81 57.21 2011-12 78.00 78.00 61.67

2.3 The Committee is disappointed to note the continuous trend of under-utilization of Plan Funds during the last five years i.e. Eleventh Plan, more so when the Department has sought enhanced funds at RE stage during 2008-09, 2010-11 and 2011-12. The actual expenditure figures also indicate that the Department could not even utilize the funds allocated at BE stage except during 2009-10. The Committee, therefore, strongly recommends that the Department should devise strategies to utilize the allocated funds optimally before proposing the revised estimate so that the funds are not unnecessarily blocked and remain unspent. 2.4 Despite continuous under utilization of funds during the Eleventh Five Year Plan, there is enhanced allocation in Plan funds from Rs.78.00 crore in 2011-12 to Rs.82.81 crore for 2012-13. The Committee is given to understand that these enhanced funds are meant for meeting the expenditure on account of salary and wages, purchase of medicines and all other administrative expenses incurred by some CGHS cities for which budget is allocated under plan Head only i.e. Chandigarh, Bhopal, Bhubaneswar, Guwahati, Shillong, Dehradun, Jabalpur, Ranchi and Thiruvananthapuram. Further, construction of own CGHS building where plots are already allotted and opening of already sanctioned dispensaries in Delhi and NCR are also proposed during 2012-13. The Committee observes that the Department has to undertake lot of ground work in CGHS and is of the view that for this purpose the targets need to be set, resources to be placed at the disposal in time and implementing agencies need to be made accountable for accomplishing the set targets from the very outset. 2.5 The Committee notes that the earmarked funds for 2012-13 under the scheme are not in tune the projected demand of the Department. From the figures made available to the Committee it is evident that Rs.600.00 crore have been allocated against projected demand of Rs.759.08 crore under non plan Head and Rs.82.81 crore against the projection of Rs.92.17 crore under Plan head. The Committee is given to understand that this deficit in allocation may adversely affect procurement of medicines. The Committee, therefore, recommends that the Department should try its best to convince the Planning Commission and Ministry of Finance, for enhancement of allocation at RE stage for procurement of medicines. 9

2.6 On a query regarding the settlement of reimbursement claims of CGHS beneficiaries, the Committee has been apprised of a number of steps taken by the Department to expedite the process and as a result thereof the pendency has been brought out significantly to 3075 bills all over the country. The Committee lauds the efforts made by the Department to bring about a significant reduction in pendency of reimbursement claims and hopes that the Department would strive to bring this figure further down with its sincere efforts. The Committee likes the Department to issue a circular intimating the simplified procedures and for dispelling any misgivings among the beneficiaries. 2.7 The Department has stated that in order to mitigate the problems faced by the CGHS beneficiaries in getting their bills reimbursed, there is no need of verification of bills by the treating doctor and submission of essentiality certificate. Also, specific guidelines for examination of requests for full reimbursement of claims have also been issued. In addition to this, the beneficiaries now have the option of submitting the original bills under any health insurance scheme that they may be subscribing and claim the balance amount from CGHS/Department that shall be as per CGHS rates and regulations. The Committee observes a lot of ambiguity in process of reimbursement of bills and the facts that are brought to the notice of the Committee are at variance. The Committee, therefore, recommends to the Department to issue a fresh circular in this regard addressing all the misgivings currently prevailing among beneficiaries. 2.8 The Committee has been informed that the system of UTI-TSL as Bill Clearing Agency is functioning satisfactorily and bills amounting to Rs.346.00 crore have so far been processed by it. The Committee notes the initiatives taken by the Department to simplify the bill reimbursement process under which the empanelled hospitals & diagnostic centers are required to submit their bills after discharge of the patient which will pay them the applicable amount as per the package rates for the treatment within 10 days. However, on the basis of feedback received from various witnesses, the Committee is dismayed on the poor outcome of the above mentioned scheme. The Committee is of the view that assessment of the scheme should be done to gauge its performance as also to take corrective steps for its smooth functioning. 2.9 Despite Department’s declaration that financial powers for settlement of reimbursement claims and hospital bills, ADs,/JDs of CGHS and Director CGHS, Financial powers of Additional Secretary & Director General (CGHS) to approve reimbursement cases have been enhanced, the Committee notices the hardships the beneficiaries have to face in getting their bills reimbursed. The Committee would like to suggest that the Department should continuously monitor the claim reimbursement mechanism and also ensure the claim adalats meant for settling pending claims are regularly held. The Committee understands that third Thursday of every month is designated as claims settlement day for interaction with the beneficiaries to sort out pending reimbursement claims. The Committee impresses that the Department may try to settle more & more pending claims on this day. 2.10 The Committee is happy to note that 4,332 beneficiaries have opted for the Preventive Health Check Up Scheme (PHCU) till 19th March 2012 since its introduction. 30 beneficiaries per day are registered in advance-online and undergo a list of identified investigation. Keeping in view the success of the scheme, the Committee feels that these facilities should be made available at all the Wellness Centers across the country so that more and more CGHS beneficiaries can avail these facilities. Secondly, the Committee also suggests the Department to have a monitoring mechanism to gauge the performance of Preventive Health Checkup Scheme at regular basis so as to maintain the quality standards of diagnostics and treatment procedures. While appreciating Departments efforts to spread 10 awareness about this scheme, the Committee would like to suggest that Department should publicize it through audio-video aids; newspapers in regional languages, etc. in order to expand the scheme to a wide range. Also the Department should make efforts to ensure that CGHS beneficiaries should understand the importance of Preventive Health Checkup Scheme and opt for it. 2.11 Regarding computerization, the Committee has been informed that the process of computerization of CGHS has been completed in all dispensaries in collaboration with the National Informatics Centre (NIC). Now computerization of AYUSH Wellness Centers/Units/Medical Store in Delhi & NCR is in progress. The Committee appreciates the Department’s effort to enable the provision of online connectivity of all CGHS Wellness Centers in the country which will enable CGHS beneficiaries to avail the healthcare services from any Wellness Centers across the country. The Committee observes that this is one of the revolutionary benefits accrued as a result of computerization and the Department deserves Committee’s appreciation in this regard. 2.12 In context of Health Insurance Scheme, the Committee is given to understand that as per the directions of the Committee of Secretaries (CoS), a proposal for inclusion of the Health Insurance Scheme in the Twelfth Five Year Plan has been sent for consideration of the Steering Committee of the Planning Commission. This Scheme will require a plan outlay of approx Rs. 2,600.00 crore over the plan period of five years. After obtaining a go ahead from the Planning Commission, the proposal would be placed before the Expenditure Finance Committee (EFC) and finally before the Cabinet for its approval of the Health Insurance Scheme. Request For Proposal (RFP) for the Scheme will be issued after getting all the requisite approvals. The Committee was informed that the proposed scheme is mainly for non-CGHS areas and is not a substitute of CGHS. The Committee appreciates that the above scheme is primarily for non-CGHS areas and is of the firm view that if at all it is implemented, it should be over and above of CGHS facility instead of replacing it. 2.13 During the meeting of the Committee held on 09/04/12, the Secretary admitted that although CGHS has expanded to 25 cities across the country, the coverage is limited to 35% of the employees both serving and retired under CGHS including nearly 9 lakh cardholders and about 32 lakh beneficiaries. The Committee was informed that as of now, the expansion of CGHS has not been done on the grounds of financial/manpower/logistics issues, hence to cover up CGHS beneficiaries in non-CGHS areas, Health Insurance Scheme is envisaged. Speaking about the recent initiatives made under CGHS, he apprised that computerization of allopathic Wellness Centers in all cities; easy availability of medicines; provision of getting treatment from any CGHS wellness center in any city without any special permission; IVF facility for childless CGHS beneficiaries, inclusion of minor children of dependent widowed/separated daughter as dependant family member for CGHS; revision of rates for coronary stents and hearing aids; and extension of preventive health check up scheme to 8 wellness centers have been achieved and the total expenditure on CGHS during 2011-12 was Rs.1528.00 crore. Further, he threw some light on future plans to be undertaken in CGHS which includes setting up of Delhi type HIND Lab facilities in Mumbai and Bangalore; review of empanelment process and package rates; preparation of CGHS manual; and introduction of Health Insurance Scheme for Central Government employees and pensioners. 2.14 The Committee has been informed that the double shifts have been introduced from August 2011 in CGHS Wellness centers at Noida, Gurgaon and Faridabad but the response received has not been encouraging. The Committee feels that the purpose behind starting the double shifts in CGHS Wellness Centers was that the beneficiaries need not have to take leave from their offices to see the doctor in the morning shift and further, patients’ load will also get distributed. Moreover, the Committee is of the view that double shift system needs an 11 extended run along with wide publicity through local and print media. The viability of using same staff on rotation basis can also be looked into. In addition to this, the Department should be flexible and open to understand the reasons for low turnout and implement corrective action plan based on its assessment. The Committee, accordingly, impresses upon the Department to see the viability of implementing double shift system in other wellness centers also particularly those located at prominent places and catering to a considerably large number of beneficiaries. 2.15 The Committee has been informed that Central Government has sanctioned 8 new Wellness Centers to be opened in Delhi to cater to the demands of CGHS beneficiaries. Also, efforts are on to start the other dispensaries in rented locations at the earliest. Three dispensaries are being opened in Gurgaon, Faridabad and Greater Noida by relocation of approved dispensaries. In addition, CoS has also given an in-principle approval for opening 3 more dispensaries at Vasant Vihar, Patparganj and M.B. Road Sector-7 where CGHS has plots of land available with it for construction of its own buildings. The matter has been taken up with the Department of Expenditure for sanction of these dispensaries including creation of posts. The Committee appreciates the efforts made by the Department to expand the coverage of CGHS by increasing the number of Wellness Centers. The Committee is of the opinion that setting up of Wellness Centers at given location should be put on fast track with emphasis on time bound completion of the projects. Further, the Department should not limit the scope of CGHS healthcare facilities to Delhi/NCR but across the length and breadth of the country alongwith assessment of workload vis-a-vis capacity of Wellness Centers and taking necessary remedial measures accordingly. 2.16 The Committee was apprised that the sanctioned staff strength and vacancy position of doctors and staff under CGHS is as follows:

Sanctioned In position Vacancy Group A Allopathy Specialists 227 155 72 GDMOs 1425 1141 284 AYUSH Ayurveda 79 50 29 Homeopathy 69 46 23 Unani 20 15 5 Sidha 3 3 Nil Group B 19 4 15 Group C 1137 986 151

2.17 The Committee noted that there is shortage of doctors and staff in CGHS dispensaries. Various complaints from CGHS beneficiaries have been brought to Committee’s notice that patients have to return home unattended. Besides, the expenses of transportation for multiple visits burden their pockets over their personal ill-health. Also, unavailability of specialist doctors leaves patient with no choice but to go to either government or private hospitals. The specialist doctors at the Wellness Centers, where specialty services have been made available, visits once weekly with no leave reserves. 12

2.18 The Committee has been informed that for filling up of the vacancies of GDMOs and Specialists, requisitions have been sent to Upsc. As a short term measure, appointment of retired GDMOs is made from time to time on contract basis. For filling up of vacancies of pharmacists, applications were called for and further action to select the candidates is under process. For other vacancies in Group ‘C’, action has been initiated as required under the Recruitment Rules. 2.19 Despite the Department’s claim that the contractual appointments of retired doctors is being made to fill up the vacancies, Committee is constrained to observe on the basis of the feedback received from various stakeholders that there is still a huge gap between the doctors in position and the sanctioned strength. If all the vacancies had been filled up by contractual appointment as claimed by the Department, the vacancies would have ceased to exist. The Committee, therefore, observes that the Department should reassess the strategies adopted to fill up the vacancies and come up with realistic measures so that the shortage of doctors and paramedical staff in CGHS dispensaries can be overcome. 2.20 The Committee was informed that around 485 hospitals and 138 Diagnostic centers are empanelled under the scheme. As far as rates are concerned, the Committee was informed that only L1 rates are notified and all those hospitals who agree for the notified rates get CGHS approval. The Committee is constrained to note that the reluctance of the private hospitals and diagnostic centers for empanelment is because of the low rates quoted by the CGHS for the specialized treatment and diagnostic procedures due to which the CGHS beneficiaries are deprived of highly specialized medical care and diagnostic facilities. The Committee hopes that the Department would rationalize the new package rates as committed in the meeting. 2.21 One must not forget that the main objective of CGHS is to provide quality heaIthcare at economical rates to the targeted beneficiaries. The Committee, therefore, is of the view that the rates should be rationalized so that the beneficiaries should be able to avail high quality diagnostics, laboratories, specialized medical and surgical treatment in various private super specialty hospitals. The Committee, accordingly, recommends framing of a policy for revision of rates after every two years to realistically fix the rates of treatment as stated in 39th Report of the Committee on Demand for Grants 2010-11 and would like to be updated about the action taken by the Department in this regard. 2.22 The Committee also noted the corrective measures initiated by the Department to check fraud and corruption in disbursement of prescribed drugs to the beneficiaries and procurement thereof which includes availability of details of issue of drugs. On previous visits and further drugs are prescribed and issued to beneficiaries after verifying such details. It is now possible to monitor the demand, supply and consumption pattern of drugs in CGHS Wellness Centers. Indents are placed online. Any unusual change in such patterns is closely monitored and scrutinized at the level of CMOs in charge and also at Medical Store Depot. To curb malpractices in supply of and pilferage of drugs, a copy of the prescription is kept with the bill where the cost of drugs exceeds Rs.l,000/- and the issue of costly drugs is done from MSD, after the CMO in charge of the Wellness Centre verifies the prescription of the Specialist and utilization certificate of drugs issued earlier. A copy each of the prescription and utilization certificate along with a photocopy of CGHS Token Card are kept in record each time drugs are issued. 2.23 The Committee is happy to note that the computerization of various facilities of CGHS has brought about transparency and accountability in administration of CGHS and has proved instrumental in identifying the malpractices and negligence in drug procurement procedure. The Committee is of the opinion that the punishment in these cases should act as strict deterrence for all functionaries of CGHS. The surprise visits by the concerned authorities to check the records and verify the details of demand, supply and consumption pattern of drugs in CGHS Wellness Centers can be also considered for regulating the 13 functioning at CGHS. The Committee, therefore, recommends that the Department should devise some checks and balances to ensure that incidence of fraud and corruption reported recently in media should not recur in future.

III. SAFDARJUNG HOSPITAL, NEW DELHI 3.1 Safdarjung Hospital (SJH) is a Central Government Hospital with total bed strength of 1531 providing medical care to millions of citizens from Delhi and the neighboring States. It also extends free Ayurvedic OPD, Homoeopathic OPD within its premises. 3.2 The Plan allocation during the year 2010-11 at BE was Rs.118.60 crore which was raised to Rs.149.58 crore at RE, but by the end of the year, the actual expenditure was Rs.139.55 crore leaving funds unutilized. In contrast, during 2011-12, the provisional expenditure incurred by the Hospital was Rs.169.72 crore against an allocation of Rs.163.88 crore at RE stage. 3.3 During the course of presentation by the Secretary of the Department of Health & Family Welfare, in the meeting held on 9th April 2012, it was informed that 164 rooms (100 single and 64 double rooms) were added to accommodate additional 228 students at the Doctors Hostel at SJH and the Sports Injury Center which is a state-of-art Center with high end equipments providing surgical and physiotherapy facilities of a very high order has been constructed and is in operation since September, 2010. It has also been informed that the Detailed Project Reports (DPR) for the construction of Super Specialty block and ICU/Nursing facility and CRBN Medical Management System at SJH are under preparation. 3.4 The allocations made during 2012-13 for SJH and VMMC are Rs.261.05 crore against the projected outlay of Rs.364.05 crore. The Department has informed that Rs.150.00 crore under Capital head is proposed for the Twelfth Five Year Plan (2012-17) project of construction of 360 bedded ICU Super Specialty Wing in Safdarjung Hospital. 3.5 The Committee observes that in the financial year 2011-12 against an allocation of Rs.163.88 crore at RE stage, the Department had incurred a provisional expenditure of Rs.169.72 crore, which is more than the outlay at RE stage. However, against the projected outlay of Rs.364.05 crore for 2012-13, the Department has been allocated only Rs.261.05 crore for the hospital. The Committee is of the opinion that in view the various expansion activities proposed to be undertaken by the Hospital during the Twelfth Plan, there is a need for increased allocation for the Hospital. The Committee, therefore, recommends that if need be, the Department may approach the Planning Commission and Department of Expenditure to increase allocation at RE stage 2012-13 and also seek enhanced funds for subsequent financial years of the Twelfth Plan as per the requirements. 3.6 The status of the sanctioned strength, actual strength, strength actually required and vacancy position of doctors as well as para-medical staff at the Hospital as furnished by Department is as under: Status of Sanctioned Posts, In-Position Posts and Vacant Posts as on 31.12.2010 & 31.12.2011 Name of Posts as on 31.12.2010 Posts as on 31.12.2011 Post/Cadre Sanctioned In-Position Vacant Sanction In- Vacant Position 1234567 Group-A 382 324 58 382 321 61 (Medical & Non- Medical) 14

1234567 Group-A - 95 94 1 95 94 1 Nursing Total – Group-A 477 418 59 477 415 62 Group-B - Medical 56 28 28 56 28 28 - Non-Medical 91 58 33 77 57 20 - Nursing 1227 1102 125 1227 1145 82 Total- Group-B 1374 1188 186 1360 1230 130 Group-C - General 868 750 118 837 774 63 - RR Cell 126 85 41 126 107 19 - Nursing 10 10 0 10 9 1 Total- Group-C 1004 845 159 973 890 83 Group-D 1246 1068 178 1246 1034 212 Grand Total 4101 3519 582 4056 3569 487

3.7 The Committee is very much concerned with the persisting vacant position in different categories of posts at the Hospital and VMMC. As per the information provided by the Department, the Committee finds that there is no noticeable change in the situation since 2010. As on 31.12.2010, out of total sanctioned strength of 4101 posts in different categories, as many as 582 posts were vacant and as on 31.12.2011, out of total sanctioned strength of 4056 posts, 487 are vacant in different categories. What is more worrisome is the shortfall in Group B: medical posts have not changed since 2010. As many as 28 medical personnel are still required to be in place out of total strength of 56. The status of vacant posts presents a sorry state of affairs. The Committee is not aware about the status of filling up of Group A posts initiated by the Department. But from its past experience, the Committee can only conclude that it would be a long drawn affair. Looking at the ever- increasing attendance of patients in the Hospital which was 23,22,152 in the year 2011, the Committee concludes that to cater to the healthcare needs of such a high load of patients, the actual requirement of the medical, paramedical and Group D staff at the Hospital is higher than the sanctioned strength. The Committee is of the opinion that vacancies, irrespective of its category, directly or indirectly have an adverse impact on the quality and quantity of services being rendered by the Hospital in addition to the overstressing of the existing manpower. It seems that the Department has not given due attention to the status of vacancy positions in different cadres at SJH. The Committee, therefore, would like to impress upon the Department to review the manpower requirements of the Hospital considering the patient load and put all the efforts together to not only fill up the existing vacancies at the earliest, but also put up its case for increase in staff strength. 3.8 As regards the steps taken by the Department as per the Committee’s recommendation to review the manpower vis-a-vis the sanctioned strength of the Safdarjung Hospital and Vardhman Mahavir College as well as to take pre-emptive action in case of vacancies of Resident Doctors, 15 the Committee was informed that for filling up vacancies of the Resident Doctors, walk-in interviews are held twice a year – in January and July by open advertisement. In case of intervening vacancies, the Head of the Department concerned is allowed to recommend ad-hoc appointment for 89 days after constituting an interview panel of 3 senior doctors. A statement indicating the posts sanctioned and posts filled in this year 2010-2011 is below:–

Sl. Name of Total Year Vacancy Post Filled Total Post No. Post Sanctioned Arise Year-wise Filled Posts Year-wise Year-wise 1 JR 332 2010 332 332 332 2 SR 431 131 131 431 2011 1 JR 397 355 355 397 2 SR 477 229 229 477

3.9 The following posts of JR, SR were created. The detail is as under:– Post created in 2010 Sr. Residents Anaesthesia 10 Sports Injury 12 Rehad 01 Nuclear Med. 02 Jr. Residents Sports injury (Ortho) 12 Sports Injury (Anaes) 08 SIC (Rehad) 03 Post created in Aug 2011 due to OBC Reservation: SI. Resident 21 Jr. Residents 42

3.10 The Committee is happy to note that Department has acted positively to the Committee’s earlier recommendation and had taken steps to not only fill up the vacant posts of Resident doctors but also after review of manpower vis-a-vis sanctioned strength had created more posts in different cadres. The Committee is of the opinion that the Department should take measures for reviewing the manpower strength year-wise at a regular basis to ensure that the process of filling-up of the vacancies is initiated well in advance so that the duration of vacancy to any post is minimized to the lowest level and the ever increasing patient load in the hospitals is aptly tackled. 3.11 As regards to the Nursing category, the Committee has noticed that vacant posts in Nursing cadre has reduced from 125 in the year 2010 to 82 by the end of 2011. Although the vacancies 16 have reduced, the Committee’s concern is the availability of good accommodation for the nursing staff which was cited as the main factor responsible for the fall in number of nursing staff. As it was previously reported, that the capacity of existing staff quarters at Srinivaspuri is inadequate for which the project to construct staff quarters for nursing at Dwarka had been planned. The Committee, therefore, would like to reiterate its earlier recommendation made in its DFG Report (2010-11) that the provision of the required accommodation facilities for nursing staff should be taken on priority basis and if feasible, it should be considered under the Re- Development Plan of the Hospital. In addition to this, the Committee is also of the opinion that the provision of transport facility from the hospital to staff quarter at Dwarka should be provided considering the distance of the hospital from Dwarka and the night duties of the nursing staff. The Committee should be updated in this regard. 3.12 The Committee is dismayed to note that the original Re-development plan approved during Eleventh Plan consisting of dismantling the existing hospital in III phase and rebuilding the hospital in 9 towers in time period of 6 years has been shelved. This has not come as a surprise to the Committee considering the pace with which things were moving in respect of Re-development plan of the hospital in previous years. Now, the Twelfth five year plan, has proposed to build a super specialty hospital with 650 beds including 200 beds nursing home, CBRN Medical management center and 400 bed emergency wards for which Rs.257.55 crore have been allocated. Also, the Committee is given to understand that the expansion of VMMC building to accommodate 27% increase in OBC quota seats, Lecture Theatre, Auditorium and increase in Hostel Accommodation is in progress. Keeping in mind the achievement of the Re-development plan of SJH during Eleventh plan, the Committee recommends that the Department needs to have a serious introspection of the reasons for shelving the re-development Plan of SJH during Eleventh Plan. Further, the Department should take realistic measures and make all conceivable efforts so that the whole new re-development project gets completed within the given time period. For this to happen, from the very outset, targets need to be set, resources to be put to use judiciously and implementing agencies to be made accountable to accomplish the set targets. 3.13 The Committee is given to understand that all requirements for starting of New Renal Transplantation (RT) Unit have been met except recruitment of DM Nephrologist, without which the said unit cannot be started. The Committee fails to comprehend the reasons for the delay in recruitment of DM Nephrologist. Nonetheless, the Committee is surprised that no action has been taken in this regard so far and is dismayed that having invested so many funds in renovation of space, procuring equipments & training of staff for Renal Transplantation Unit, the project is yet to see the light of the day. The Committee feels that Department has failed to prioritize their activities before acting upon the projects. The Committee, therefore, is of the opinion that inspite of all good works done by the Department, the delay in filling up the post of DM Nephrology has superseded its effort in kick-starting the RT unit. 3.14 In context of setting up of IVF Unit, the Committee is given to understand that equipments for IVF procedures are under process of procurement and due to lack of competition or single tender response, re-tendering has been done in majority of items. Also, the Committee is given to note that there is space constraint which is hampering the start of IVF facilities. The Committee expresses its displeasure at unjustifiable delay in setting up of IVF Unit in SJH arising out of conflicting statements provided by the Department in this regard. The Committee feels that the development work has been carried out at snail pace and has failed miserably. The Committee would like to draw the attention towards Department’s statement as mentioned in 39th Report on DFG 2010-11 wherein it has been stated that second floor of old Cardiology Wing had been selected as site for setting up of IVF Unit and inspection was also 17 carried out in August, 2009 along with the go-ahead for carrying out necessary renovation work. Now, the Committee has been informed that space constraint is hampering operationalization of IVF Unit. This clearly shows lack of accountability on part of Department and improper planning and mismanagement of resources. The Committee, therefore, recommends that Department should channelize its efforts in doing realistic assessment to remove all the bottlenecks in setting up of IVF Unit and chalk out a time bound action plan with regard to funds allocated for the purpose.

IV. VARDHMAN MAHAVEER MEDICAL COLLEGE, NEW DELHI 4.1 The utilization status of Plan funds allocated in 2011-12 to VMMC, New Delhi shows substantial reduction at RE stage and that too remaining unutilized at the end of financial year 2011-12.The Committee fails to comprehend reasons for the same and would like to be apprised of the physical targets achieved during 2011-12. 4.2 The Committee also noted that two projects namely construction of Lecture Theatre for the capacity of 150 MBBS Students, and construction of theatre with capacity of 1,000 MBBS students are underway. The Committee would like to know the timeline set for the completion of these projects. 4.3 On the query regarding the current capacity of the Institute, the Department has furnished that at present, the intake capacity is 150 seats of UG Students; 168 posts including teaching faculty, Registrar etc. has been created and the process of filling these posts is underway. It has also been informed that on completion of construction of lecture theaters, filling up of manpower, the VMMC will become functional in full strength. The Committee just hopes that the college could adhere to the timelines set in this regard.

V. DR. RAM MANOHAR LOHIA HOSPITAL 5.1 Dr. R.M.L. Hospital has been Centre of Excellence in the health care under Government Sector hospitals for over 75 years. The hospital annually provides healthcare services in 25 specialties to approximately 14.5 lakhs outdoor patients and admits around 60,000 indoor patients. About 1.99 lakhs patients are attended in the Emergency and Casualty Department annually. The hospital has well established round the clock Emergency services. The Hospital has well laid Disaster Management Unit to attend serious patients with desired care. During 2011, Renal Transplantatation has been successfully started in the hospital. It is now 1065 bedded hospital providing services in almost all major specialities and super specialities. 5.2 The Plan funds allocation in respect of Dr. R M L Hospital in 2011-12 was Rs.155.00 crore which was decreased to Rs.140.85 crore due to non-filling up of vacant posts, non-purchase of ambulances, slow progress in the construction work of Dharamshala because of non-allotment of land by L&DO and slow progress of the construction work of New Emergency Care Building including procurement of its equipments and machineries as furnished by the Department. 5.3 The Committee is given to understand that funds doled out to the Hospital for 2012-13 are as per the projected demand and are planned to be utilized for construction of New Emergency Care Block, upgradation of critical ongoing facilities, construction of Dharamshala, construction of New Super-Speciality Building at G-point, purchase of new equipments, committed liabilities of salary including newly created posts in various departments and other expenditures. 5.4 The Committee is not happy with the slow pace of construction work and recommends that the Department needs to make serious introspection of the reasons for delay in execution of various projects envisaged during 2011-12 and take all measures to see 18 that the same reasons do not crop up again and hinder the progress of various projects/ programmes envisaged in current financial year. A realistic assessment of targets and dedicated timelines for their achievements would be a right step in this direction.

5.5 The Committee was apprised that the New Emergency building is a state-of-art centrally air- conditioned building and will provide 250 Emergency beds which will cater to medical emergency, surgical emergency and pediatric emergency and will have 60 ICU beds with facility for X-ray and ultrasound. The Committee is given to understand that M/s Hosmac Limited was entrusted the work of construction of Emergency Care Building (ECB) and renovation of VIP rooms in May, 2010. The project outlay for ECB is Rs.26.10 crore and renovation Rs.1.39 crore. IIT, Delhi reviewed the strength of the steel structure of the building and suggested some rectification to the structure and the rectification work delayed the project. All these works are being carried out under the supervision of DTTDC, the Project Management Consultant. The project is expected to be completed by August, 2012.

5.6 The Committee was earlier informed that the Hospital proposes to construct New Casualty Building, a multi-storey super speciality block after likely possession of land in the G point near Trauma Care Centre. Now, as informed, the land at ‘G point’ has been physically handed over to the hospital on 22.11.2010 by L&DO. The Committee would like to be apprised of the action plan for the construction of New Casualty Building, the physical and financial targets set therefor and the resources to be deployed w.r.t. the new projects. The Committee feels that the Department should strive to adhere to the timelines set for completion of various projects.

5.7 In response to the query regarding the sanctioned strength vis-a-vis the in-position status of posts in the Hospital and PGIMER as in year 2011, the Department has furnished the following status:

Group of the Posts Sanctioned Filled Vacant Group ‘A’ CHS 228 200 28

Group ‘A’ Non CHS 37 16 21

Group ‘B’ (Gazetted) 43 23 20

JR & SR 636 614 22*

Group ‘B’ (Non-Gazetted) 47 29 18

Group ‘C’-Clerical 181 125 56+

Group ‘C’-Nursing 1192 1075 117**

Group ‘C’-Technical 542 373 169+

Group ‘C’ (erstwhile Group ‘D’) 966 690 276

GRAND TOTAL 3872 3048 824

* Newly created SR Posts + Most of these are newly created posts and process for filling up the posts is at various stages. ** Newly created posts 19

5.8 The Committee is disappointed on the continuance of a large number of vacancies in different categories of post. Although new posts have been created in the category Senior Residents (SR) and Group ‘C’ Nursing, the process of filling up of these posts has not been started yet. The Committee is unable to comprehend as to why there has been always a substantial number of vacancies at any given point in time. At least, in case of Resident Doctors (RD), the Department can pro-actively step in to place the next batch of RDs well in advance. Since the hospital is catering the health needs of ever increasing patients, the Committee can easily visualize the amount of burden on the existing manpower. In such scenario, it is really a matter of concern that such a large number of vacancies is allowed to persist. The Committee, therefore, keeping in mind the OPD, IPD attendance of the Dr. R M L Hospital, would like to suggest that Department should consider necessary steps to expedite the process of filling up of newly created posts of senior residents and nursing category which are integral part of healthcare services to ensure smooth functioning of the Hospital on priority basis.

VI. CENTRAL INSTITUTE OF PSYCHIATRY (CIP), RANCHI

6.1 The Central Institute of Psychiatry, Ranchi is a pioneer Government of India, Institute in the field of psychiatry established in pre-independence era in 1918. The current bed capacity is 643. Apart from catering to adult, child and adolescent psychiatric patients, the Institute runs number of special clinics including De-addiction clinic, headache clinic, epilepsy clinic etc, where management of illness range from pharmacological to non-pharmacological therapies. The Institute also holds the honor of having Centre of Excellence for Cognitive Neuroscience Research in the country. The Institute is running M.Phil (M&SP) and Ph.D in Clinical Psychology courses with 18 and 4 seats respectively.

6.2 The utilization status of funds both Plan and Non-Plan in crore allocated in 2011-12 is as follows:– (Rs. in crore)

Year BE RE AE

2009-10 15 21.64 20.88

2010-11 27.25 26.60 13.94

2011-12 40 38.97 26.12 (upto 20.03.12)

6.3 The Committee notes that the expenditure during 2010-11 showed marked under-utilization of funds allocated. The Committee fails to understand the reasons thereof. During 2011-12, Rs.38.97 crore were allocated and expenditure figure shows the same trend of under-utilization of funds although by the end of year the Institute managed to have enhanced capacity for training of Manpower, enhanced utilization of patient care services and quality in the field of mental health as stated by the Department.

6.4 The Department has been allocated Rs. 45.74 crore under Plan Head in BE 2012-13. The enhanced Plan allocation for 2012-13 is proposed to be utilized for procurement of equipments, construction of OPD, family ward, Neuroscience Block etc. along with completion of 210 bedded hostel and resident flats. The Committee is hopeful that the funds earmarked for the projects would be utilized judiciously and optimally so that the envisaged projects are accomplished as per the time lines set in this regard. 20

VII. KALAWATI SARAN CHILDREN HOSPITAL, NEW DELHI 7.1 As per the information furnished by the Department, the utilization status of funds, both Plan and Non-Plan allocated in 2011-12 is as under: (Rs. in crore) Budget Head Allocation Expenditure (Provisional) Plan 28.22 23.87 Non-Plan 28.00 27.65

7.2 The Committee is given to note that there is no on-going project and the funds allocated for 2012-13 are sufficient to meet the requirement of the Hospital as per present situation. 7.3 On the issue of Hospital staff in place as per the sanctioned strength in various categories, the following information has been furnished:

Sl. No. Group Sanctioned Post Filled Post Vacancy 1. A 44 30 14 2. B 150 137 13 3. C 589 426 163 4. D 170 157 13

TOTAL 953 750 203

7.4 From the plain reading of the above information, it can be found that a large number of posts are lying vacant in all the service categories (Group A, B, C and D). The Committee, therefore, recommends that Department should take urgent steps to fill up the vacancies at the earliest so as to fulfil the objective of providing better quality of patient care to all patients.

VIII. LADY HARDING MEDICAL COLLEGE 8.1 The utilization of funds allocated under plan head for Lady Harding Medical College and Smt. Sucheta Kriplani Hospital, New Delhi along with expenditure incurred is as under:– (Rs. in crores) Year BE RE AE 2009-10 60 70.50 43.64 2010-11 79 72 50.90 2011-12 80 68 50.52 (as on Feb., 2012)

8.2 The Committee observes consistent under-utilization of funds during last 3 years of Eleventh Five Year Plan. As regard to the activities undertaken by the Hospital, the Committee notes that modular Eye and ENT operation theaters were renovated; new central AC plant for auditorium and central library has been installed and the construction of new hospital and residential buildings/ 21 facilities have started at a great pace after getting approval from competent authorities. In light of the activities undertaken by the Hospital; the Committee understands that underutilization of funds reflect that the Hospital has failed to accomplish the targeted activities during the Eleventh Plan. The Committee, accordingly, recommends that the Hospital should draw out definite action plan for realization of its targets and monitor construction of new hospital and other related buildings scrupulously. 8.3 The Committee makes a note of the fact that the enhanced allocation of Rs.92.00 crore for 2012-13 is proposed to be utilized for recruitment of 121 contractual faculties; procurement of Machinery and Equipment to the tune of Rs.6.00 crore; expenditure on major works; and for augmentation of security and sanitation services through outsourcing. 8.4 The Committees’ attention was drawn to the current shortage of staff in different cadres in the Institute. As per the information furnished by the Department, at present 121 vacancies exist for which the interview for selecting contractual staff (till UPSC provides regular staff) is underway. For the augmented bed strength proposed to be made available under the Comprehensive Redevelopment Plan (CRP), 810 posts in cadres (other than the teaching cadre) have been sanctioned which would be filled-up on availability of additional facilities under CRP. Further, on completion of the construction and availability of extra facilities a review would be needed for assessing the staff requirement. 8.5 The Committee impresses upon the Department to take up the matter with the UPSC for expediting recruitment of regular staff to fill up a large number of vacancies existing in the Hospital. The Committee would like to be apprised about the preparatory steps taken so far to fill up the additional sanctioned 810 posts, which would be filled-up on availability of additional facilities under CRP.

IX. ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS) 9.1 All India Institute of Medical Sciences was established in 1956 by an Act of Parliament as an institution of national importance. During 2011-12, the Institute trained many WHO sponsored candidates to fulfil its international obligations. As reported, a total of 8,34,992 patients attended the general OPD and speciality clinics of main hospital and other centres of AIIMS till 30.09.2011. 9.2 An amount of Rs.1461.00 crore was earmarked for the Institute under Eleventh Five Year Plan Period. 9.3 The year-wise allocation vis-a-vis actual expenditure under Plan head is as follows: (Rs. in crore) Year Budget Rised Actual Actual Estimate Estimate release (Expenditure) 2007-08 200.00 160.00 160.00 163.84 2008-09 162.00 218.00 218.00 223.77 2009-10 177.00 320.51 250.51 261.04 2010-11 400.00 400.00 380.00 381.62 2011-12 412.35 412.35 412.35 Expenditure under compilation 22

9.4 The Committee was informed that wherever there is revision in the requirement of funds at RE stage the same is because of re-assessment of activities to be carried out and non-finalization of Expenditure Finance Committee (EFC). 9.5 On the query as regards the utilization status of funds, both Plan and Non-Plan allocated in 2011-12 along with the status of the physical targets set and achieved during 2011-12, the Committee was apprised that Rs.650.00 crore and Rs.412.35 crore were allocated under Non-Plan and Plan respectively for the year 2011-12. The allocation under Non-Plan was utilized fully. The Department has informed that allocation under Plan would be fully utilized by the end of current financial year. 9.6 The Committee observes that out of 21 projects envisaged to be completed during Eleventh Plan, only a few projects namely installation of additional lifts, minor work including renovation of hospital, wards, Phase I of refurbishment of OPD and entrance and Phase I covering of Nallah flowing on east side of Ansari Nagar Campus could be completed. However, the status of other projects indicate that work is at preliminary levels for most of the projects. A statement indicating targets for the various projects for the year 2011-12 and achievement made in respect thereto is at Annexure-I. 9.7 The Department informed that an amount of Rs.741.00 crore was projected under Plan head for financial year 2012-13 against which Rs.474.00 crore has been allocated. After assessment of funds requirement of various departments, centres and engineering division by the Assessment Committee of the Institute, Planning Commission would be approached for further release of funds. 9.8 The Committee notes the fact that in spite of lot of developmental work being undertaken, most of projects have gone beyond the targeted time-line. The Committee has been informed that the delay in execution of various infrastructure development project is attributed to delay in approval of Master Plan of AIIMS which is pending due to clearance from various agencies like MCD, NDMC, CPWD etc. The Committee feels that time overruns are certain to result in cost overruns. The Committee, therefore, recommends that the Department should chalk out a time bound Action Plan for the projects which are yet to be executed and also for the projects underway. Further, the Committee would like to be apprised of the current status of various approvals and also the extent of cost overruns likely to be caused due to the delay in completion of projects. The Committee would like to be apprised about the targeted timelines for all the underway projects planned in AIIMS. 9.9 The Committee had sought to know whether the Department had made any assessment of the patient load in the Burns Unit at the Safdarjung Hospital with a view to take decision regarding setting up of a Burns Unit at AIIMS. From the reply furnished by the Department the Committee notes that no assessment of the patient load in the Burns Unit at Safdurjang Hospital has been made and instead the Committee has been informed that Ministry of Health and Family Welfare had launched a pilot project for creating burn injury facilities in salient districts in the country and accordingly, the need for a parallel burns unit at AIIMS has not been felt. The Committee is not convinced that opening of Burns injury facilities in salient districts in the country would in any case reduce the requirement of an additional burns unit at AIIMS since Safdarjung Burns Ward in already burdened with patients. The Committee, accordingly, recommends that the Department should reassess the requirement of Burns Unit at AIIMS. 9.10 The Committee notes that AIIMS is facing acute shortage of manpower at present.The Faculty position at AIIMS as informed by the Department is as under: 23

Faculty Position as on 16.03.2012 Sl. No. Name of the post Sanctioned In Position Vacant Strength 1. Director 001 001 – 2. Medical Supdt. 002 002 – 3. Professor 119 05(Moily) 174 47 4. Addl. Professor 047 01(Moily) 128 09 5. Assoc. Professor 129 102 16 6. Asstt. Professor 321 144 21 303 (Moily) 34 (New Creation) 7. Principal College of 001 001 – Nursing 8. Lecturer in Nursing 009 10 (Moily) 006 13 9. ‘A’ 551 423 128 (Non-Faculty) 10. ‘B’ 4668 4322 346 11. ‘C’ 2708 1796 912 12. ‘D’ 1889 2195 -306

GRAND TOTAL 10639 9207 1468

9.11 The Committee is extremely disappointed with the vacancy position in different categories of posts in AIIMS. Out of total sanctioned strength of 10639, 1468 posts are lying vacant in various categories. The Committee is perturbed to note that 303 posts of Assistant Professors are lying vacant in such a premier institute and feels that this would bound to adversely affect the quality of healthcare services rendered by the premier Institute of the country. Besides, this would also adversely impact the quality of medical education being imparted at AIIMS. 9.12 As regards the steps being taken to fill up the vacancies the Committee was apprised that on finalization of reservation roster, advertisement for filling up of 115 faculty posts was issued by the Institute and the selection process for some posts has been completed. Candidates who have cleared first two phases of interviews have started joining. However, interview for remaining advertised posts is underway and the posts will be filled up soon. 9.13 The Committee was also informed that under Moily Committee, 160 faculty posts have been created in addition to 34 new posts duly approved by the Academic Committee, Standing Finance Committee and Governing Body on 29th February, 2012. The Committee was further informed that these 194 vacancies would be advertised after finalization of roster. The Committee was also apprised that backlog reserved vacancies for the posts of Assistant Professor have also been advertised in March, 2012. The Committee observes that with a large number of posts lying vacant at Faculty level it would be practically difficult for the Institute to maintain the high standards of patient care and teaching for which it has been known for decades. The efforts made by Department to fill up the backlog vacancies came as sign of relief to the 24

Committee. While appreciating the Department’s efforts, the Committee would, however, recommend to the Department to make all out efforts to fill up all the vacant posts existing in faculty, non-faculty and other categories in a time bound manner. 9.14 In respect of Non-Faculty posts, the Committee notes that recruitment is initiated as and when any vacancy arises/anticipated. Further, Departmental Promotional Committees are held at regular intervals for vacancies under promotion mode and in the current financial year for most of the posts, recruitment action is under progress. The Committee was apprised that since the recruitment rules of all the posts at the Institute are being revised/rationalized as per Government of India directions, the recruitment actions to fill up the remaining vacant posts would be initiated, after finalization of the same. 9.15 The Committee was further informed that there is a huge mismatch in doctors-patients ratio in OPD; even if the vacant posts are filled up in the near future the mismatch would remain there. The Committee cannot remain a mute spectator to the appalling circumstances prevailing in such a reputed Institute like AIIMS which is a role model for all medical institutes across the country and implore upon the Department to take proactive steps not only to fill up the vacant posts on a war-footing but also to initiate a blueprint to ensure a decent doctor-patient ratio, which would help the Institute to achieve the overall aim of the Institute to provide tertiary care and path breaking research. The Committee feels that the above objectives can only be possible when there is adequate number of doctors who could besides delivering quality healthcare to the patients also devote quality time for research activities. Hence, a realistic assessment of available manpower vis-a-vis sanctioned strength of the Institute is urgently required. 9.16 On a suggestion to the Department for evolving a mechanism to utilize the services of students passing out from the Institute, the Committee was informed that the number of students passing out from the Institute far exceed the job opportunities available at AIIMS. The Institute would not be in a position to offer a job to every student passing out from the Institute. Hence, no bond of serving in the Institute is obtained from the students. The Committee is not convinced with the reply furnished by the Department. The Committee has merely opined that probability of utilizing the services of the students passing out from AIIMS may be explored in view of the huge vacancy position at AIIMS. However, it is surprising to note that an Institute like AIIMS has expressed its inability to retain students passing out of the Institute after graduation. The Committee, therefore, expresses its displeasure that its earlier recommendations made in 27th and 39th Reports have not been given adequate weight and lack of seriousness required on the part of the Institute to implement the recommendation made by a Parliamentary Committee. The Committee implores upon the Department to explore the possibility of implementing its suggestion without any further delay.

X. NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES (NIMHANS), BENGALURU 10.1 National Institute of Mental Health and Neuro Sciences, is a multidisciplinary frontier institution for service delivery, human resource development, basic and applied research and policy and programme development for the nation in the areas of mental health and neurological sciences. It is an apex tertiary care hospital in the field of psychiatry, neurology and neurosurgery for impatient and out-patient care along with psychiatric and neuro-rehabilitation. 10.2 The Institute was allocated Rs.95.00 crore and Rs.78.23 crore under Plan and Non-Plan heads respectively, during the year 2011-12. As regards to the utilization status of funds (both Plan and Non-Plan) allocated, the physical targets set and achieved during the year, the Committee has noted the optimal utilization of funds by the Institute. 25

10.3 The Committee, in regard to the ongoing initiatives/activities undertaken by the Institute, was informed that various activities under patient care, academic development and research have been carried on as per schedule and all targets set have been achieved. The Committee appreciates the stellar role played by the Department by undertaking new activities under the headings: Clinical Services initiatives, Academic Initiatives and infrastructure facilities created during the year 2011-12.

10.4 The Plan allocation of Rs.109.00 crore was made against the projected demand of Rs.225.61 crore projected for the first year of the Twelfth Five Year. The reasons cited for seeking enhanced allocation targets for the year 2012-13 were to make the Institute move towards achieving the proposals laid down for the year 2012-13 especially to meet expenditure on salary for newly created posts as well as meeting the cost of equipments and infrastructure needed for implementing the new initiatives. The Committee finds although the Plan allocation is lesser than what was projected by the Institute, it should be utilized effectively by prioritizing the activities/ expenditure without having significant impact on the performance of the Institute. Prioritization would enable phasing out lesser priority areas to the subsequent years of the plan period. However, if the Department finds itself hamstrung midway, the Committee recommends the Department to approach the Planning Commission and the Department of Expenditure seeking for more funds at RE stage, as per its requirements.

XI. THE POST-GRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH (PGIMER), CHANDIGARH

11.1 The Post-Graduate Institute of Medical Education and Research, Chandigarh, is a premier national centre of medical education, research, post-graduate medical education and is also a specialized hospital. The Committee notes that during the year 2010-11, the Institute continued to excel in quality research and the clinicians and basic scientists produced 771 papers during the year, 82 scientists were awarded fellowships, orations and other national and international awards during the year. The Nehru Hospital attached to PGIMER, Chandigarh provides tertiary care in all the medical and surgical specialities to the patients. The total bed strength of PGI has increased to 1740 beds with OPD Attendance of 16,63,110 and in-patients 64969 during 2010-11.

11.2 Though the funds earmarked for individual financial years of the Eleventh Plan period were optimally utilized, the Committee notes that there was substantial reduction in Plan funds allocation from Rs.140.00 crore at BE stage to Rs.92.00 crore at RE stage during the year 2011-12 which as informed, was due to delay in process for starting various capital works which were pending for approval of Union Territory administration. From the perusal of status of different projects envisaged during the Eleventh Plan period, the Committee notes that in many areas no or negligible achievements have been made as against the targets set. The Committee observes that this state of affairs clearly reflect that Institute has not drawn out its action plans for achieving the goals set in right perspective and targets could not be achieved despite availability of adequate funds. The Committee, therefore, strongly recommends the Department to make a checklist of all approvals required before the execution of works and approach the concerned agencies for getting this same. The Institute should draw definite action plans and time lines for completion of all the projected works to avoid cost overruns.

11.3 For the financial year of 2012-13, the Institute has demanded Rs.229.00 crore against which it has been allocated Rs.161.00 crore, keeping in view the present position of on-going works as well as the proposed augmentation of various Departments. The Committee was informed that the reduced allocation is likely to impact the major projects which were pending for approval of UT Administration. The Committee is of the opinion that lack of funds should not hamper the progress of the projects and recommends that this could be achieved by proper monitoring and judicious utilization of the available funds. The Department should if 26 required take up with the Planning Commission and Department of Expenditure for revision of funds at RE stage. 11.4 The Committee has been informed that out of the sanctioned strength of 7785 posts in different categories, 1414 posts are lying vacant. Out of 78 vacant posts in Faculty category, 48 posts of backlog vacancies of faculty (6 posts of Professors and 42 posts of Assistant Professors) have been advertised and remaining 30 posts of Faculty will be advertised in due course. 80 vacancies in Resident category are due to be filled up in June session. The Committee takes note of the measures taken by the Hospital to fill up the vacancies in different categories. The Committee would appreciate if these posts get filled up as scheduled.

XII. NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL SCIENCES (NEIGRIHMS), SHILLONG 12.1 North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences has been established in Shillong on the lines of AIIMS, New Delhi and PGIMER, Chandigarh, with the objective of providing advanced specialized healthcare to the people of North-Eastern region. The projection under Twelfth Plan for this Institute is Rs.2049.73 crore. 12.2 The Committee was informed that the components of further development plan of the Institute include (i) Establishment of UG College in the Institute at an estimated cost of Rs.198.55 crore for which EFC note is under finalization in consultation with other appraising agencies; (ii) Expansion of existing Nursing College from capacity of 50 to 100 B.Sc. Nursing students at an estimated cost of Rs.51.28 crore which is also under way; and (iii) Establishment of Regional Cancer Centre at an estimated cost of Rs.123.31 crore which is still under consideration in the Ministry. 12.3 The Committee is happy to note that the Department has chalked out a defined development plan of the Institute but has not been set any timelines/deadlines for the proposed initiatives. Since all the projects are under planning stage, the Committee would like the Institute should frame a time bound Action Plan for execution of all projects emphasizing on judicious utilization of resources at the outset. The Committee, therefore, recommends to the Department to monitor execution of all the proposed new initiatives from the outset so that these are accomplished as targeted. 12.4 The Committee has been keeping a close watch on the availability of the manpower for the Institute. The Committee notes that out of sanctioned strength of 1524 posts in different categories, as many as 517 are lying vacant. Though the position has improved since 2010-11, still the number of vacant posts cannot be ignored as indicated below cannot be ignored:– Post Filled up Filled up Contract/ Total Vacancy sanctioned Regular Ad hoc/Outsourced position Faculty 141 42 6 48 93 Group A 63 15 5 20 43 Group B 608 467 10 477 131 Group C 352 158 4 162 190 Group D 171 53 118 171 0 SRD 105 54 0 54 51 JRD 84 75 0 75 9

TOTAL 1524 870 137 1007 517 27

12.5 The Committee was also informed that stay order of Central Administration Tribunal (CAT) has been vacated and the process of recruitment of faculty has been initiated in compliance to the High Court’s Order and the institute has appointed 19 Faculty and 4 Lecturer (Nursing) candidates. Further, it is also given to note that to attract more manpower, the modified Recruitment Rules for the faculty posts have been approved by Governing Council and Standing Selection Committee has been asked to conduct interviews more frequently both at Shillong and New Delhi to attract more manpower. 12.6 In addition to this, the Committee was given to understand that faculty is given pay scale at par with pay scales of faculty in AIIMS, Delhi along with furnished accommodation upto a limit of 1,00,000/- with Special Duty Allowances. Also, 2 MBBS seats have also reserved for their wards. Further, Assessment Promotion Scheme (APS) on the liens of AIIMS has also been approved for faculty of the Institute. With due regards for the measures taken by Institute for filling up the vacancies in faculty posts, the Committee is hopeful that 93 vacant posts of faculty will be filled soon to cater to the healthcare needs of patients from deprived region of North-East. 12.7 The Committee notes that no further efforts have been made to fill up Group ‘B’ and ‘C’ Technical Posts which is evident from huge number of posts numbering 131 (Group B) and 190 (Group C) out of sanctioned strength of 608 and 352 lying vacant respectively. The Committee is unable to comprehend as to how the Institute is working effectively with such a large number of vacancies. The Committee opines that the manpower and infrastructure are two foremost requirements for smooth functioning of any Institute. The Committee, accordingly, recommends the Department to put relentless efforts to attract technical manpower by special incentives and special recruitment drives to facilitate early filling up of the vacancies. The Committee would like to be updated on the issue.

XIII. PRADHAN MANTRI SWASTHYA SURAKSHA YOTANA (PMSSY) 13.1 It is an ambitious scheme launched by Government of India on 15th July, 2003 with the objective of reducing the gaps in the availability of tertiary heaIthcare across States by developing AIIMS like institutions in the States to cater to specialized tertiary healthcare and also to augment facilities for quality medical education in the country. 13.2 As per the details furnished by the Department the expenditure incurred under the scheme is as follows:– (Rs. in crore) 2009-10 2010-11 2011-12 BE 1447.92 750 616.57 RE 683.58 747 918.91 AE 474.48 653.84 863.83

13.3 The Committee observes that there is a trend of substantial reduction of funds at RE Stage during the last 3 years of Eleventh Five Year Plan particularly during 2009-10 and 2011-12. Also, the actual expenditure shows consistent under-utilization during these years. As regards under- utilization of funds in 2011-12, the Department has informed that this was either due to delay in awarding works or delay in start of projects for various reasons. 13.4 However, the funds allocated for 2012-13 are Rs.1544.21 crore against the projected demand of Rs. 2022.00 crore. The Committee was informed that the allocated funds would not be sufficient as the Department was proposing to make AIIMS like Institutions functional; from Academic session August 2012-13. Further, work of Hospitals and remaining packages was also 28 proposed to be completed. The Committee was further informed that the additional requirement of funds would be requisitioned at RE Stage, if required for the projects under the scheme. 13.5 The Phase I of PMSSY included construction of 6 AIIMS like institutions at Bhopal, Bhubaneshwar, Jodhpur, Patna, Raipur and Rishikesh and upgradation of 13 existing medical college institutions. From the information furnished by the Department, the current status of Phase I of PMSSY (Hospital Component) is as follows:- (i) Residential Complex: The construction of works for two places at Jodhpur and Raipur has been completed and out of the rest 4 places, three will be ready by June, 2012 and AIIMS-Bhubaneshwar will be ready by March, 2013. (ii) Package I: (Medical Colllege/Hostel/Trauma): At Bhopal 68%, Bhubaneshwar 57%, Jodhpur 76%, Patna 66%, Raipur 45% and Rishikesh 57% of the progress have been made till date and is expected to be made functional for Academic Session of August, 2012. (iii) Package II : Hospital Complex: The hospitals are likely to be completed and made functional in 2013 and the progress of work so far is reported as per schedule. (iv) Package III : Electrical Services: The work under package III is reported to be running as per schedule at all the 6 places. (v) Package IV: Estate Services: The work is likely to be awarded by April, 2012. (vi) Package V: Furniture: The work will be awarded by May, 2012. (vii) Package VI: Modular OTs: The preparation of tender document is being carried out by HLL which will be finalized by July, 2012. 13.6 The Committee observes that although the ground work under the all packages more or less has been started, the completion has spilled over to 2012-13. It is self revealing situation to comprehend the correlation between pendency of work under the scheme and under-utilization of funds. The Committee is perturbed to note the slow pace of implementation of Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) scheme, one of the key initiatives of the Department launched with the objective of correcting regional imbalances in the affordable tertiary healthcare services as well as to augment facilities for quality medical education in the country. Almost all the projects proposed under the programme are running beyond schedule. The Committee observes that the delay in operationalization of this ambitious project would certainly lead to the cost overruns. The Committee, therefore, recommends to the Department to streamline monitoring of the progress of the project and strive to meet the new targets set under PMSSY. 13.7 The reasons for overall delay in implementation of the Project are stated to be the delay in selection of Project Consultant and architectural design which was done in 2007 and preparation or finalization of Detailed Project Report for Medical Colleges/Hospitals which were finalized only in February, 2009 following which the revised cost estimates were approved by Cabinet on 19th March, 2010. The work of Package I was awarded in April, 2010 at all the six sites, but due to local problems at Bhubaneshwar site, change in basic design of the building due to site condition at Rishikesh, modification in design at foundation level at Patna and Raipur sites, an ambitious and tight completion schedule could not be adnered to. 13.8 The Committee recommends that the Department needs to have a serious introspection of the reasons which led to not only in delay in completion of targeted projects but also resulted in underutilization of funds and cost overruns as the Department has to seek approval for the revised estimates for the project. The Committee expects that the 29

Department would meet its deadline to start AIIMS like Institutes functional from this academic session 2012-13 i.e. August, 2012. 13.9 In the second phase of PMSSY, it is proposed to set up two more AIlMS-like Institutions in Uttar Pradesh and West Bengal and to upgrade 6 medical college institutions namely (i) Government Medical College, Amritsar, Punjab; (ii) Government Medical College, Tanda, Himachal Pradesh; (iii) Government Medical College, Madurai, Tamil Nadu; (iv) Government Medical College, Nagpur, Maharashtra and (v) Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh (UP); and (vi) Pandit B.D. Sharma Postgraduate Institute of Medical Sciences, Rohtak at an estimate cost of Rs 823.00 crore for each AIIMS like institution. For upgradation of medical college institution, Central Government will contribute Rs.125 crore each. 13.10 As regards to the Phase 2 : setting up of 2 AIIMS like institutions, the Committee was apprised of the fact that finalization and availability of land for AIIMS like institutions both in West Bengal and UP are under correspondence with concerned State Governments. 13.11 The Committee impresses upon the Department to learn from the hurdles being faced in the rolling out of Phase I of the project and make a serious effort to plug all the possible loopholes to ensure timely completion of the targeted projects. 13.12 Details of Targets set and achieved including reasons for delay for upgradation of Medical Colleges-Phase-I

1 Srinagar Medical CPWD 100% 66% Initially work was delayed due to internal College agitation and disturbances in the valley and (Trauma Centre) non-availability of labour on account of same, delay in handing over of site of the Carpet Factory earlier due to litigation due to which certain external development works could not be undertaken. 2. IMS, BHU, Varanasi CPWD 100% 82% Construction site was low-lying area with (Trauma Centre storm water and sewerage flowing in from BHU. and Nursing College) Earthen bunds had to be constructed all around the Construction area. Flooding during rains affected the progress. 3. RIMS, Ranchi CPWD 100% 89% Initial delay was due to delay in selection of (SS, Oncology contractor for civil work which has taken more Blocks,) time due to re-tendering. Shifting of overhead electric lines and poles by the State Government also resulted in delay. 4. SVIMS, Tirupati HLL 100% 80% The process of procurement will be completed (Procurement of by May/June, 2012. equipment only) 5. B.J. Medical College, HLL 100% 87% The process of procurement will be completed Ahmadabad (Nursing by May/June, 2012. school and college and Proc. of equipment) 6. Grants Medical HLL 100% 84% The process of procurement will be completed College, Mumbai. by May/June, 2012. (Procurement of equipment only) 30

Details of Targets set and achieved including reasons for delay for upgradation of Medical Colleges- Phase II Sl. Agency Name of Physical Targets Physical Targets Remarks/ Reasons for No. College/Institute set during 2011-12 achieved during delay 2011-12 1 HSCC Government Medical Award and start of Work started in Civil work started in January, College, Amritsar work January, 2012 2012 and is scheduled to be (Diagnostic Block) completed in June, 2013. 2 HSCC Government Medical Award and start of Work started in Civil work started in November, College, Tanda work November, 2011 2011 and is scheduled to be (Super Specialty Block) completed by May, 2013. 3 HLL J.N. Medical College of Award and start of Work started in The civil work started in Aligarh Muslim work November, 2011 November, 2011 and is University, Aligarh scheduled to be completed in (Trauma centre i/c 21 months. OPD and Extension of OBG Block.) 4 HLL Government Medical Award and start of Work coule not HLL Life care Ltd., Project College, Madurai work be awarded and Consultant has received (Super Specialty started due to tenders for civil work. Block) change of site by However, in the meantime State Government State Government has sought change in location of site adjacent to existing medical college at Madurai and the feasibility of same is being examined in the Ministry. 5 State Government Medical The work mainly Rs. 40 Cr. has been Upgradation of the institution Govt. College, Nagpur-(OT involves released to the mainly involves procurement and Procurement of procurement of State Government of equipment only. Equipment) equipment by Rs.40 Cr. has been released State Government to the State Government. 6. HLL Pandit B.D. Sharma Award and start of Not yet started Tender process for civil work Postgraduate Institute work initiated. of Medical Sciences, Earlier delay was due to Rohtak revision of earlier proposal by Institute for construction

of Institute of Ophthalmology with new proposal by providing tertiary healthcare facilities covered under PMSSY scheme.

13.13 From the perusal of the Details of Targets set and achieved, the Committee notes that percentage of work completed in respect of upgradation of State Government Medical colleges, is well below the targeted deadline. The Committee only hopes that the Department ensures to meet the new deadlines set in this regard. 13.14 On the query with respect to Department’s exercise of manpower planning for these AIIMS-like institutions, the Committee was informed that a 12 member Technical Committee 31 constituted under the chairmanship of Director, PGIMER, Chandigarh worked out manpower requirement for medical college, hospital complex and nursing college for the AIIMS-like institutions and recruitment planning in a phased manner. This was further examined by premier medical institutions in the country, e.g. AIIMS, PGIMER, JIPMER, Tata Memorial Hospital etc. The proposal for creation of 4047 posts for each of the six AIIMS-like institutions required to be filled up in three phases was sent to Ministry of finance for approval out of which creation of 1145 posts required to be filled up in first phase of recruitment for each of the institution. In addition, a Project Cell at each of six sites has been established. Superintending Engineers for all sites, Financial Advisers for 3 sites, Administrative Officers for all sites, Deputy Director (Admn.) for 1 site were appointed. Orders are under issue for appointment of other Deputy Directors and Executive Engineers. Further, Directors for Bhopal and Patna were appointed and has assumed charge. The process for selection of Directors for remaining 4 AIIMS and other posts at Project Cell and recruitment of faculty for all the six AIIMS-like institutions has already been initiated. The Director, AIIMS, Patna is the nodal officer for faculty recruitment. It has also been informed that the Recruitment Rules for the posts being filled out of sanctioned have been framed and the functions and duties of the posts will be the same as those existing in AIIMS, New Delhi. 13.15 In context with the equipment procurement, the Department has furnished that Project Management Committee (PMC) headed by Secretary (Health and Family Welfare) decided to engage M/s HLL Lifecare Ltd. for procurement of medical equipments for all the six institutions. M/s HLL has been directed to prepare the list of equipments in consultation with Director, AIIMS, Bhopal and initiate the process for procurement of equipments required for pre-clinical and other departments which are to be established for start of Medical College in the Academic session 2012-13. 13.16 The Committee appreciates the Department for taking timely suitable action to meet the faculty and equipments needs of the six AIIMS like Institutes. The Committee hopes that all the exercises would be completed well within the dedicated timelines and all the Institutes would be made functional from the current Academic session 2012-13.

XIV. DEVELOPMENT OF NURSING SERVICES 14.1 Nursing Personnel are the largest workforce in Hospital setup and play important role in healthcare delivery system. The activities under the programme include in-service training of nurses to update their knowledge and skills; strengthening of Nursing schools and colleges to improve quality of education being imparted to students and National florence Nightingale Award for nursing personnel. 14.2 During the year 2011-12 the allocations made for the programme were Rs.34.00 crore which were reduced to Rs. 25.00 crores at RE stage and the said amount was utilized to meet the following targets:

Scheme Target Achievement Training of Nurses 121 courses to train 36300 76 courses to train 2280 Strengthening 20 47 Upgradation 7 3 Nurses Award – –

14.3 From the perusal of the physical targets set vis-a-vis achievements made, it can be seen that in one area the Department has crossed the physical targets set but in other 32 areas, the Department has missed the targets by almost 50%. The Committee would like to suggest that a better planning model should be put in place enabling the Department to achieve all targets, instead of over-achieving one facet of the plan, and missing on other fronts. The Committee would like to be apprised the reasons for reduction in allocation from Rs.34.00 crore (BE) to Rs.25.00 crore at RE stage. Whether the reduction in allocation indicates that the targets originally conceived were either shelved or could not executed? 14.4 On analysis of grant-in-aid released during the Eleventh Plan under the scheme, the Committee noted the following points:– 1. With Rs.4.80 crore sanctioned for the training of Nurses, the Department was able to introduce 372 short term courses to train 11,160 nurses. 2. With Rs.24.71 crore sanctioned for strengthening of institutes (maximum limit of Rs.25 lakh per Institute) the Department was able to strengthen 94 institutes. 3. With Rs.42.52 crore sanctioned for upgradation of Nursing schools into Nursing Colleges, the Department was able to upgrade:- a. 17 new Institutions. b. 7 Institutions which were upgraded during the Tenth plan period. The grant- in-aid for this effort was given as per the revised pattern of assistance. 14.5 The Committee also enquired from the Department the status of action taken on its recommendations as contained in its 39th Report asking the Department to draw out a strategy whereby institutions getting grants from the Department are brought under some kind of regular training quality assessment schedule, to which the Department had agreed in its Action Taken Note. The Committee would like to have a status note on implementation of the same. To this, the Committee was apprised that the Indian Nursing Council has prepared a manual for training of ANM school teachers for six weeks duration to strengthen Midwifery skills of faculty of ANM Training institutions. The training is being provided through the selected nodal centers. The INC has started the training program in one Nodal center and so far 15 faculties from the State of Bihar and Jharkhand have been trained. 14.6 The Committee is happy that the Department has acted on its advice, but it feels that yet a lot is to be achieved in this regard as the number of faculty trained till date is miniscule as compared to the grants in aid given to the States. The Committee, accordingly, impresses upon the Department to take its recommendations in right perspective and act on it with vigour and urgency it calls for. 14.7 The Plan funds allocated for the programme for 2012-13 are Rs.22.50 crore against the projected outlay of Rs.55.00 crore. Given the fact that the provisional expenditure exceeded the allocated funds during 2011-12, the Committee is surprised to find a huge gap of Rs.32.50 crore between the projected and budgeted funds for 2012-13. The Committee was also apprised of many on-going programmes and new schemes proposed under development of nursing services. Further, upgradation of RAK College of Nursing into Centre of Excellence is also under process. The Committee, therefore, recommends that additional funds be allocated at RE Stage so that lack of funds does not hamper the developmental activities undertaken by the Department. 14.8 The Committee has been continuously voicing its concern and pursuing the matter regarding upgradation of RAK College of Nursing into Centre of Excellence for years now. The current statistics show a meager development in the form of getting ownership of land which has been till date hampering the further development of the project. The Committee has been informed that now the final drawings and concept plan has been submitted to MCD again for approval and the 33 draft SFC for Revised cost estimates based on the final estimates of tender process is under process of finalization. 14.9 The Committee is not happy with the slow pace of upgradation of RAK College on account of one reason or the other. The Committee feels that the Department should have acted in an earnest manner to get all the approvals in right time. The Committee had desired to be apprised of the timelines originally set for the project and the new proposed timelines but the Department has chosen to remain silent and non-committal in this regard. The Committee would like to be updated about the status of this project regularly. 14.10 The Committee is concerned at the continuance of large number of vacancies to the posts of Nurses in Hospitals/Institutions under the Department which is bound to impact in meeting the health needs of the patients. The Committee notes that the current status of availability vis-a-vis sanctioned strength of nurses as follows:–

Name of CNO NS DNS ANS Nursing Sister Staff Nurse the Institution S P V S P V S P V S P V S P V S P V LHMC, 1 – 1 1 – 1 5 4. 1 36 23 13 162 149 13 379 343 36 Delhi KSCH 1 – 1 1 1 – 5 4 1 24 23 1 96 96 – 267 204 63 Dr. RML 1 0 1 1 1 0 10 10 0 68 68 0 283 283 0 817 692 125 Hospital Safdarjung 1 1 0 1 0 1 10 10 0 72 72 0 322 322 0 897 809 88 Hospital

TOTAL : 4 1 3 4 2 2 30 28 2 200 186 14 863 850 13 2360 2048 312 CNO - Chief Nursing Officer; NS-Nursing Superintendent; DNS-Deputy Nursing Superintendent ANS - Asstt. Nursing Superintendent; S-Sanction Strength; P-In position; V-Vacant; LHMC - Lady Hardinge Medical coIIege; KSCH-Kalawati Saran children’s Hospital Dr. RMLH - Dr. Ram Manohar Lohia Hospital.

14.11 The Committee was apprised that Indian Nursing Council has taken a number of measures to meet the shortage of nurses which include relaxation of norms and conditions applicable in nursing education both for students and teachers as well as Institutions. The Committee expected that these initiatives clubbed with improvement in the pay scales of nurses subsequent to the sixth pay commission’s recommendations and creation of more dwelling units for nurses would have mitigated the problem of shortage of nurses. The Committee, however, feels that still much is to be achieved in this regard. The Committee, accordingly, recommends that concerted efforts need to be made by the Department to fill up the vacancies at the earliest. 14.12 The Committee reiterates its earlier stand on the matter of availability of accommodation for nurses. The Committee is now worried in the light of the fact the nothing significant has happened till now and it seems not enough attention has been paid to its recommendation as contained in its 39th Report on DFG (2010-11). The Department in its Action Taken Note on Committee’s 39th Report has informed that the demand and availability of residential accommodation for nurses is being assessed in consultation with the concerned hospitals. The Committee would like to be apprised of the outcome of the said exercise, and also the follow-up action taken thereon. The Committee is of the opinion 34 that if the Department does not pay proper attention to seriousness of the matter it would fail to get desired and significant results in the Twelfth Five Year Plan also.

14.13 Another area of concern for the Committee had been maintenance of record of nursing personnel in the country. The Committee has been informed that the States of West Bengal, Gujarat, Delhi, Tamil Nadu, Karnataka and Maharashtra are undertaking the process of renewal of license. Further, Indian Nursing Council has taken various decisions with regard to live register such as requirement of nursing professionals who are working in the respective State be registered in the respective State every 5 years as renewal; details of re-registration be widely publicized by mode of Public notices, audio video media and on the respective State Nursing Council website; State Nurses Registration Council should develop the required infrastructure for the same; and INC shall develop a software wherein certificates wil1 be generated and other reports, so that a uniform database will be maintained in each Council. Each State Nursing Council will be given the username and password to update their data. A smart card will also be generated accordingly (biometric) to solve the reciprocal registration. A Unique Identification Card for nurses will be issued. Uniformity of registration will be maintained. Data variables required for registration have been identified. INC is in process of inviting Expression of Interest for procurement of hardware, development of software, training of personnel, issue of license etc. with all State nursing councils for the above said measures.

14.14 The Committee is happy to note that this issue has been given due weightage by the Department as the steps taken by INC regarding maintenance of live registers of Nurses seems to be encouraging. The Committee, therefore, recommends that the Department should made adequate efforts to materialize the proposed initiatives during the Twelfth Plan and see that these are not bogged down by beaurocratic delays. The Committee would like to be updated on the progress made in this regard.

XV. NATIONAL MENTAL HEALTH PROGRAMME

15.1 To address the huge burden of mental disorders, the Department is implementing NMHP since 1982 which was re-strategized during Tenth Five Year Plan to ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to most vulnerable sections of the population, to encourage mental health knowledge and to promote community participation in mental health service development. Under the Eleventh Five Year Plan, the NMHP was restructured to include manpower development scheme, District Mental Health Programme, upgradation of Psychiatric wings of Government Medical Colleges and modernization of Government Mental Hospitals.

15.2 As regards the progress of the NMHP, the Committee was informed that the proposal for NMHP during the Eleventh Five Year Plan with an outlay of Rs.1000.00 crore was considered by the EFC in July, 2008. Based on EFC recommendations, CCEA approval for following components of the Programme with outlay of Rs.473.445 crore has been obtained:–

• Manpower Development in Mental Health

• Spill over activities of the Tenth Plan (upgradation of psychiatric wings of Government Medical Colleges/General Hospitals, and Modernization of Government Mental Hospitals), as per existing norms.

• Continuation of existing DMHPs under implementation on existing norms.

15.3 The allocation of funds and utilization status under NMHP as furnished by the Department is as under: 35

(Rs. in crores) 2009-10 2010-11 2011-12 BE 70 120 130 RE 55 101 75 AE 51.59 90.76 58.28 (upto Feb.2012)

15.4 There is a reduction in allocated funds every financial year at RE stage during the years 2009-10, 2010-11 and 2011-12 and also under-utilization of the allocated funds as shown in actual expenditure figures. The details of targets set and achieved during 2011-12 are as follows: Sl. No. Targets set Targets Achieved 1 Support to 25 Districts under the District Support to 11 Districts under District Mental Health Programme Mental Health Programme (DMHP) on old funding pattern. Support to 10 Districts under DMHP on both old and new funding pattern. Central Assistance completed for 2 DMHPs initiated in the Ninth Five Year Plan and 4 DMHPs initiated in the Tenth Five Year Plan. 2 Establishment of 1 Centre of Excellence 1 new Centre of Excellence established at and continuation of support to 10 already Maharashtra Institute of Mental Health, established Centres of Excellence Pune. Continued financial support provided to 5 already established Centres of Excellence. 3 Establishment of 15 PG Departments 4 New PG Departments in Mental Health under Mental Health Specialties and Specialties established Shortfall in achieve- continuation of support to 23 already ment was mainly due to lack of sufficient established PG Departments number of recommended proposals for establishment of PG Departments. 4 Support to 33 State Mental Health Support to 31 State Mental Health Authorities. Authorities 5 IEC Activities Continuation of media campaign at National and Regional level in 12 languages with new Audio Video Spots.

15.5 It is evident that the Department has not achieved the set targets during 2011-12. The Committee is of the view that unless the targets are met with the required pace, these backlogs are bound to happen and the spillover of components of programme to the next year is unavoidable. The Committee recommends that the Department needs to take proactive approach and try to bring all the States on board for effective implementation of the programme besides having regular interactions with them. It is high time that the problem areas hampering implementation of the programme are identified and suitable and timely action is taken accordingly. 15.6 The shortage of manpower under NMHP, as brought to notice of the Committee indicating, the details of availability vis-a-vis requirement of professionals in the field of Mental Health are as follows: 36

Sl. No Personnel Existing No. Additional Requirement 1. Psychiatrist 3800 7700 2. Clinical Psychologist 898 16352 3. Psychiatric Social Worker 850 22150 4. Psychiatric Nurses 1500 1500

15.7 The Committee is shocked to see the mismatch between requirement of manpower under NMHP and the personnel actually available. The Department has also stated that there is shortage of the qualified mental health manpower in the country. The Committee is unable to accept the Department’s statement when so many efforts are being invested in strengthening and upgradation of the institutions, training of personnel and research activities. Further, the Committee also notes that the last National survey of Mental Health Resources was carried out a decade back in 2002, which clearly indicates casual attitude on part of Department in this matter. The Committee would like to be apprised of whether the Department is taking any steps to conduct the next National Mental Health survey and parameters on the basis of which such surveys are carried out by the Department. 15.8 To address the problem of shortage of manpower in the field of mental health, the Manpower Development Schemes under NMHP were approved by the Government with a total budget outlay of Rs.408.01 crore for the Eleventh Five Year Plan under which upgradation and strengthening of identified existing mental health hospital/ institutes into Centres of Excellence in the field of Mental Health and starting of PC courses or increasing the intake capacity for PG training in Mental Health were proposed. The funds have been released for establishment of 11 Centres of Excellence in Mental Health and starting 27 PG Department in Mental Health Specialties. The additional manpower that will be generated through these two schemes over the next 5 years in a phased manner is as follows:–

Scheme - A Scheme - B Seats to be Seats Seats to be Seats to be Seats already No. of Seats created already created created created created till through 11 created through through through date Centres of through 11 Supporting Supporting Supporting 27 Excellence Centres of 120 PG 27 PG PG training Excellence training training departments departments departments A B C D E B+E Psychiatrist 44 3 60 14 11 14 Clinical 176 28 240 56 16 44 psychologist PSW 176 12 240 42 17 29 Psychiatric 220 14 600 140 13 36 nurses 123* * Creation of seats is dependent on creation of teaching posts at various Institutes based on approval of concerned regulatory bodies like Medical Council of India, Rehabilitation Council of India, Nursing Council of India etc. 37

15.9 The Committee notes that till date only 123 seats have been created under the scheme which is very small considering the actual requirement. The unsatisfactory level of performance of the overall programme and gaps in physical targets and achievements and above all the giant gap in in-position strength vis-a-vis the actual requirement of manpower further strengthens the point that the Department should take up the matter on priority basis and identify the loopholes in the action plan in the implementation of the schemes under the programme and should take necessary steps to expedite all the developmental projects in the field of Mental Health. 15.10 The District Mental Health Programme (DMHP) was initiated under NMHP in 1996 to provide community based mental health services in the country in tune with National Health Policy 2002 and to integrate with general health services. The Committee observes that there has been no change in the Department’s stance in regard to expansion of DMHP to all the districts across the country and the figure has remained static at 123 districts. It has been informed that future expansion of DMHP to all districts of the country has been restricted due to non-availability of trained manpower and fund constraints and this matter will be taken up during Twelfth Plan subject to the approval of the competent authorities. The Committee expresses its displeasure to note that although the Department has proposed to expand DMHP in all the districts across the country, final approval is yet to be given by bureaucratic authorities. With this fate of affairs, the Committee can visualize as to what would be the ultimate results. The Committee, therefore, directs the Department to take urgent and remedial measures to rectify the existing deficiencies and, if need be, approach the Planning Commission as and when it proposes to expand the Mental Health Programme. 15.11 Majority of districts in the country have not still been covered under DMHP, which was initiated way back in 1996. Almost 16 years have passed but the scenario seems to be at standstill. With about 500 districts still remaining outside the reach of this vital aspect of the programme, the Committee can only hope that the matter regarding extension of District Mental Health Programme to all the district of India would be taken up earnestly during the Twelfth Five Year Plan and the failure of the Department to extend the District MHP in the Tenth and Eleventh Plan would not be repeated. The Committee, therefore, recommends that the Department should make all out efforts to accomplish all the set targets within the set time line. The Committee would like to be apprised of breakthrough made in the programme.

XVI. CENTRAL DRUGS STANDARD CONTROL ORGANISATION (CDSCO) 16.1 Central Drugs Standard Control Organisation headed by the Drugs Controller General (India) regulates the quality of drugs, cosmetics and medical devices in the country and administers various provisions of the Drugs and Cosmetics Acts and rules framed thereunder through various technical and statutory bodies. 16.2 The following allocations have been made under drugs quality control for the financial year 2012-13 as compared to RE 2011-12: (Rs. in crore) Drugs Quality Control RE 2011-12 BE 2012-13 CDSCO (Revenue) 24.56 37.50 CDSCO (Capital) 0.02 20.00 Indian Pharmacopoeia Commission (IPC) 13.00 15.00 National Pharmacovigilance Programme 0.06 0.10 38

16.3 The Committee has been informed that under the Revenue Section of CDSCO, an expenditure of Rs.12.00 crore is expected to be on the salaries of the CDSCO. Headquarters and various Zonal and Sub-Zonal Offices as well as the 5 existing Central Drugs Testing Laboratories (CDTL) including provision for the expected increase in the staff strength of CDSCO during the year as 100 more Drug Inspectors are likely to join; an expenditure of Rs.6.00 crore is expected to be on Professional Expenses, including payment to 234 contractual staff and an expenditure of Rs.8.00 crore is expected on Office Expenses, which will include strengthening and upgradation of CDSCO offices and CDTLs, setting up of e-governance system etc. In addition to this, rest of the allocation under the Revenue Section of CDSCO will be on various petty items of running expenses of CDSCO/CDTLs, travel expenses, etc. Further, under the Capital Section of CDSCO, funds are planned to be utilized to purchase sophisticated equipments for the CDTLs and other existing labs which are deficient in critical equipments. Out of the allocations made for the Indian Pharmacopoeia Commission (IPC), about Rs.2.00 crare is expected on payment of wages, including 20 additional Pharmacopoeial Associates and 25 Technical Data Associates which the Commission is to induct this year on contractual basis; about Rs.1.00 crore is expected to be on office expenses; and expenditure of around Rs.I0.00 crore is expected to be incurred on construction of new lab building and purchase of equipments. The allocation of Rs.10.00 lakh is for National Pharmacovigilance Programme. The Committee would like to be apprised of the status of the recruitment of 100 Drug Inspectors as envisaged. 16.4 The Committee was further informed that no financial assistance was provided for strengthening of Drug Testing Labs (States/UTs-wise) during 2011-12 as no such scheme was in operation so far. As regards to the details of the drug samples tested and follow-up action taken, the Department furnished the following information:

Year Sample Sub- Spurious/ Prosecution Cases Arrest Tested Standard adulterated Launched decided 2000-10 39248 1942 117 138 6 147 2010-11 49682 2372 95 167 9 72 2011-12 26856 1420 37 32 6 73 (till Oct, 2011)

16.5 The Committee feels that the Department should strive to act more vigorously in the area of sample checking to prevent the menace of availability of spurious and sub-standard drugs in the market.

Generic Medicines 16.6 The Committee was apprised that in order to make healthcare affordable, it is important to make generic medicines available in the market. To meet this goal, the DCGI (India) while approving a proposal for manufacture and sale of drugs does not consider patent linkage of such drugs. This means that even though, certain drugs may be under patent, if a generic manufacturer applies to the DCG(I) for approval after following the due process, his application would be considered on the merits of its quality, safety and efficacy alone. In this regard, DCG(I) also does not consider the “data submitted by the originator company as exclusive” for examining the proposal for manufacture of its generic version. 16.7 The Committee lauds the efforts made by the Department for promoting availability of generic medicines in the country which is a giant leap for ensuring affordable healthcare 39 for every citizen of the country. But the Committee also observes that still much is to be done and achieved in this direction. The Committee impresses upon the Department to make dedicated efforts for opening of more Jan Aushadi Stores as envisaged. The Committee would like to be apprised about the status of its proposed initiative for supply of generic medicines for all in public health facilities in the country during the Twelfth Plan. The Committee would also like to be informed as to whether the Department is making any effort to ensure prescription of generic only drugs by the doctors.

XVII. Vaccine Manufacturing Units 17.1 Utilization status of funds (both plan and non-plan) allocated in 2011-12 under this head is as under: (Rs. in lakh) Institute FE (2011-12) Utilization Plan Non-Plan Plan Non-Plan BCG VL, Guindy 481.48 451.69 480.36 426.57 PII, Coonoor 2100 * 1535∧ * * PIl, Coonoor receives Grant-in-Aid under Plan scheme only. ∧ A further sum of Rs.5.00 Crore is proposed to be utilized during 2011-12.

17.2 On the query regarding the updated status of progress made towards making the three vaccine manufacturing PSUs GMP compliant, the Committee has been informed that the work for revival of CRI, Kasauli and making it cGMP compliant has almost been completed at the cost of Rs.48.90 crore.The up gradation of BCG vaccine manufacturing facility as per cGMP norms at BCG VL, Guindy has also been approved at an estimated cost of Rs.58.52 crore and of DPT group of vaccine manufacturing facilities at PII, Coonoor has also been approved with an estimated cost of Rs.137.02 crore and would be completed by the year 2014. 17.3 The Committee is concerned about the huge dependency of the country on Private Sector to meet its requirement of vaccines under the Universal Immunization Programme and hopes that the revival of these three PSUs is ensured in targeted timelines, since a lot of time has already elapsed since their closure. As informed, the upgradation of BCGVL, Guindy, and PII, Coonoor is likely to be completed by the middle of 2014 and end of 2014 respectively. Suspension of vaccine manufacturing licenses of these units was revoked in 2010, since then period of more than 2 years has already elapsed and the Department could only get approval of the upgradation plans of these two units. The Committee expresses its serious concern on the slow pace of upgradation process of these units and recommends that its high time the Department should buckle up its shoes to complete upgradation projects in letter and spirit so that requirement of vaccines could be met indigenously. The Committee would like to be apprised periodically about the progress made at BCGVL, Guindy and PII, Coonoor in achieving cGMP compliance. 17.4 As per the updated status of production of vaccines and sera by the three PSUs under reference, the Committee has been informed from PII, Coonoor, about 15.00 lakh doses have been sent to CDL, Kasauli for testing and after the due validation and certification for the release of vaccine, the first batch of DPT will be supplied in June/July, 2012. The Institute proposes to supply 39.5 million doses of DPT Vaccine from June-July, 2012 to June-July, 2013. The production of vaccine has restarted in the existing manufacturing facilities at BCGVL Guindy. 49.87 lakh doses of BCG Vaccine have been produced and samples sent to CDI, Kasauli for clearance and at CRI, 40

Kasauli, during 2011-12, a total of 23 batches (138 lakh doses) of TT vaccine and 15 batches (90 lakh doses) of DTP vaccine were produced in the old facility. 17.5 The Committee has been constantly monitoring the progress of upgradation of these three vaccines producing PSU’s and is equally perturbed with the dependence on private players on account of closure of these units. Hence, the Committee is delighted that production of vaccines has again started in these units. The Committee, however, hopes that soon the no. of doses of DPT and TT Vacines produced at CRI, Kasauli, meet the national demand. Similar aspirations are there for BCGVL, Guindy and PII, Coonoor. The Committee, accordingly, would like to be updated on the measures that would be taken to increase the production of vaccines in these units to meet the national requirements simultaneously working upon fulfilling of cGMP norms. 17.6 On the issue of efforts being made by the Department to regulate the cost of vaccines, the Committee was informed that vaccines are being procured at competitive prices through tender systems. Further, the suspension of manufacturing licenses of the three vaccine manufacturing units namely the Central Research Institute at Kasauli, the Pasteur Institute of India at Coonoor and BCG Vaccine Laboratory at Chennai has been revoked. The process for their upgradation for compliance with the Good Manufacturing Practices(GMP) as provided under Schedule M of Drugs and Cosmetic Rules, 1945 is underway and would be completed soon which would further help in regulating the cost of vaccines. The Committee is not convinced with the evasive reply given by the Department. The efforts or step taken by the Department to regulate the cost of vaccine finds no mention in the reply furnished by it. The Committee, therefore, impresses upon the Department to furnish realistic efforts being made by it to regulate the costs of vaccines. 17.7 Utilization of funds by CRI, Kasauli upto 28th March, 2012 which is as under:– (Rs. in lakh) Utilization RE (2011-12) FE (2011-12) Utilization Plan Non-Plan Plan Non-Plan Plan Non-Plan CRI, Kasauli 740.00 2868.00 550.15 2409.48 468.32 2290.73

17.8 The Committee observes under-utilisation of funds in both Plan and Non-Plan funds, though Department has claimed vast number of activities undertaken at CRI, Kasauli including production of vaccines, antisera and diagnostic reagents; during the year. 17.9 The Committee fails to understand as to how the funds of the Department remain under-utilized even after undertaking so many activities in CRI, Kasauli. The underutilization of funds reflect mis-match between the targets set and achieved. The Committee feels that in order to step up production of vaccines at the Institute to meet the national requirements optimum utilization of funds is required; which can only be achieved by chalking out foolproof action plans and dedicated timelines for all the activities envisaged in the Institute. The Committee hopes that the Institutes would make good use of the enhanced allocations. 17.10 The Department has further informed that for the financial year of 2012-13, Plan allocations has been substantially increased to Rs.1806.70 lakh as compared to Rs.550.15 lakh in 2011-12. The Committee is constrained to note that it has sought to know as to how the enhanced Plan allocation to the tune of Rs.35.00 crore for 2012-13 is proposed to be utilized. The Department reply is casual and evasive since it has stated that the proposed increase in BE 2012-13 to the tune of Rs.1806.70 lakh as compared to RE 2011-12 i.e. (Rs.739.88 lakh) is due to increased targets of vaccine production specially DPT group of vaccines; for rain water harvesting project proposed to be executed by Irrigation and Public Health 41

Department of Himachal Pradesh; and upgradation of existing facilities like Animal House, Yellow Fever, Anti Sera, etc. The Committee is unable to comprehend as to why the Department has chosen to give restricted reply and directs the Department to give complete and coherent reply to the information sought by the Committee. XVIII.HEALTH SECTOR DISASTER PREPAREDNESS AND MANAGEMENT INCLUDING EMERGENCY MEDICAL RELIEF 18.1 The Emergency Medical Relief division of DGHS, Ministry of Health and Family Welfare, is mandated for prevention, preparedness, mitigation and response for health sector disaster management activities and coordinates health activities in terms of manpower and material logistic support to the States. 18.2 As regards to the utilization status of allocated Plan funds and physical targets set and achieved during 2011-12 under Programme, the Plan allocation at RE stage was reduced to Rs.2.00 crore from Rs 80.50 crore at BE stage. Further, the actual expenditure was even lesser to the tune of Rs.0.02 crore. The reasons behind the reduction of funds at RE Stage were due to a few sporadic outbreaks in Avian and Pandemic Influenza which could be managed by drugs, personal protective equipments etc. available in the stock. No fresh procurement was anticipated and no large scale visual or print media publicity required also, in context to the Health Sector Disaster Preparedness, as the specifications finalization took time, it was anticipated that the allocated budget under this head would not be utilized. In addition to this, there has been no major disaster that requiring health sector intervention during the year 2011-12. However, the Committee is not convinced with the reasons cited for not procuring one mobile Hospital due to the delay in refraining specification by Technical Sub-Committee which truly reflect no-preparedness on the part of the Department. The Committee, therefore, recommends the Department should even in the absence of any major disaster, acquire all necessary equipments and create the required infrastructure in order to get it fully equipped to face any disaster instead of waiting for the disaster to happen and then move forward for getting prepared to face the same. Almost cent-percent under utilisation of allocated funds indicates lack of seriousness and lacklustre approach on the part of the Department for any eventuality. 18.3 As per the information furnished by the Department, the initiatives/activities proposed under the said programme for the Twelfth Plan include Capacity development for management of medical aspects of Chemical, Biological, Radiological and Nuclear (CBRN) disasters and Capacity development for disaster preparedness and response and; Emergency Medical Services. For the financial year 2012-13, under the Health Sector Disaster Preparedness and Response, the activities proposed are setting up of strategic health operation centre; procurement of mobile hospital; and Short term training courses for disaster preparedness and response. Under the Avian Influenza and Pandemic Influenza since the risk from Pandemic Influenza A H1N1 has substantially receded, therefore, less budgetary allocation has been sought in BE 2012-13. The Department informed that although the fresh waves of pandemic as witnessed now in Pune, Hyderabad etc or a fresh outbreak of Avian influenza cannot be ruled out due to its propensity to mutate and create a worst case scenario, additional funds may be required for IEC, procurement, training etc. in such situations. 18.4 The Committee welcomes and appreciates the aforesaid initiatives proposed to be taken by the Department during the Twelfth Plan. The Committee infers that these measures would certainly help in building a taskforce to strengthen the facilities to be utilized at the time of emergency during disaster subject to the condition that these are implemented in letter and spirit. The proposals of capacity development for medical intervention in various types of disasters and developing Emergency Medical Services if rightly designed result in saving human life. The Committee would recommend the Department to take all necessary steps for initiation of these projects without any 42 procedural delays and to keep a close watch on the progress of new initiatives from the outset so that these are accomplished as targeted. The Committee would like to be informed of the progress made with respect to the new initiatives on quarterly basis.

XIX. ASSISTANCE FOR CAPACITY BUILDING 19.1 The scheme “Assistance for Capacity Building” is implemented under the project for ‘Upgradation & Strengthening of Emergency Trauma Care Facility in State Government Hospitals located on National Highways’ with a view to provide immediate treatment to victims of Road Traffic Injury. 19.2 The Plan allocation of Rs.98.32 crore made in BE 2011-12 had to be drastically reduced to Rs.48.32 crore at the RE stage. The reasons stated for reduction of funds at RE were non-utilization of funds and non-submission of audited utilization certificates timely by the grantee institutions in respect of the already sanctioned grant. The provisional expenditure during 2011-12 was Rs.79.66 crore. For the year 2012-13, the enhanced alIocation to the tune of Rs.102.00 crore has been made for 68 Government Hospitals (22 already selected during Eleventh Plan) and 46 [L-I(6), L-II(20), L-III(20)] out of 160 Government Hospitals proposed in Twelfth Plan yet to be identified for release of funds including the escalation factor. 19.3 The activity-wise Physical Targets for Assistance for Capacity Building for Trauma Care in Selected Government Hospitals located on National Highways for 2012-13 are as under: Activity - ‘in-principle approval’ for 160 institutions and signing MOUs with State Govts. i. Survey, identification & signing MOU of 46 new institutions. ii. Sensitization of personnel of 113 trauma centers sanctioned in Eleventh Plans in injury surveillance. iii. Release of funds for 46 Trauma Centre for construction and equipment and spill over cases of Eleventh plan. iv. *Release of funds for Rehab components 50 Trauma centre. v. To initiate process for construction for establishment of injury surveillance centre at GMCH, Chandigarh vi. To initiate identification of State resource trauma centre. vii. Formulation of SOP’s for injuries surveillance, trauma registries and Data Capture format viii. To process for development of Software for the registry ix. Identification, MOU, initiation of Construction of Apex Rehab Centre x. Quarterly review meeting with experts/Regional Directors/State Health Secretaries depending upon the requirement for monitoring the status of progress in States and to discuss the technical & administrative issues. PHYSICAL & FINANCIAL TARGETS FOR SPILL OVER OF TRAUMA CENTRES DURING 2012-13 (Rs. in crore) PHYSICAL Funds for Equipments, Communication, Manpower, Legal Service CM, MP, LS, T L-II 7 48.636 L-IlI 15 44.01

TOTAL 22 92.646 ** The funds for C+ E+M (manpower is granted for 1 year) as per new scale of funding i.e. 20% added to previous scale. 43

PHYSICAL & FINANCIAL TARGETS FOR 46 NEW TRAUMA CENTRES-2012-2013 (Rs. in crore)

PHYSICAL Funds for construction and Equipments L-I 6 82.800 L-II 20 139.200 L-III 20 63.600

TOTAL 46 285.600 Component:- C-construction, E-Equipment, CM-Communication, MP-Man Power, LS-Legal Service, T-Training * Physical Target.

19.4 The Committee has been informed that there are no new initiative/projects proposed for 2012-13. It is basically the continuation and expansion of the existing Scheme. 19.5 To another query relating to the number of States/UTs which were provided financial assistance for upgradation/strengthening of emergency facilities at State Hospitals located in towns/ cities along the National Highways and the details of States yet to be covered under this Programme, the Department has informed that 140 trauma care centres along the Golden Quadrilateral covering 5,846 Kms. connecting Delhi-Kolkata-Chennai-Mumbai-Delhi, North-South & East-West Corridors covering 7,716 Kms. connecting Kashmir to Kanyakumari and Silchar to Porbandhar respectively of the National Highways has been identified during the Eleventh five year plan period. Out of 140 selected Government Hospitals, so far 114 trauma care centres in 16 States have been provided financial assistance, in phases, which are at various stages of progress. Out of these, 30 trauma care facilities are operational. Further, there would be 160 new Government Hospitals to be identified for trauma care facility which is under active consideration during Twelfth Five Year Plan. 19.6 The Committee is constrained to note that during 2012-13, 46 out of 160 Government hospitals are yet to be identified to provide financial assistance for capacity building. This clearly indicates lackadaisical attitude of the Department which ultimately results in delay in achieving the set targets. The Committee, accordingly, persuades the Department to play a proactive role in implementation of the scheme so the capacity building target in all 68 Government Hospitals including 46 new hospitals could be achieved well in time. 19.7 Regarding the monitoring mechanism under this scheme the Committee informed that the implementation and progress of the Scheme is closely monitored by visit of the State-wise designated nodal Officer including the Regional Directors of Ministry of Health and Family Welfare. The Committee is happy that the Department has put in place a mechanism for monitoring the scheme. The Committee impresses upon the Department that corrective measures, wherever required, be taken to check any element of delay.

XX. RASHTRIYA AROGYA NIDHI (RAN) 20.1 The Department has created Rashtriya Arogya Nidhi (RAN) in 1997 to provide financial assistance to the patients, living at below poverty line (BPL) who are suffering from major life threatening diseases, to receive medical treatment in Government Hospitals. The financial assistance to such patients is released in the form of “one time grant” to the Medical Superintendent of the hospital in which treatment is being received. In a bid to speed up the assistance to the needy patients, the scheme has been modified in January, 1998 and an advance of Rs.l0.00 to 40.00 lakh 44 has been kept with the (i) Medical Supdts. of the AIIMS, New Delhi, (ii) Dr. RML Hospital, (iii) Safdarjung Hospital, (iv) LHMC & Smt. S.K. Hospital, New Delhi, (v) PGIMER, Chandigarh, (vi) JIPMER, Puducherry, (vii) NIMHANS, Bangalore, (viii) SGPGIMS, Lucknow, (ix) Gandhi Memorial & Associated Hospitals (KGMC) Lucknow, (x) RIMS, Imphal and (xi) NEIGRIHMS Shillong to enable sanction of an amount up to Rs.1.00 lakh in each deserving case reporting for treatment in the respective Hospitals/Institute. The advance amount replenished as and when the reports of its utilization are received from the Hospital/Institutes. The two funds under RAN scheme are Health Minister’s Cancer Patient Fund and State Illness Assistance Fund. 20.2 As regards to the utilization status of funds allocated in 2010-11 & 2011-12, the Department has furnished the details as under: (Rs. in lakh) Allocated Fund Expenditure/Utilization Year 2010-11 1500.00 1500.00 Year 2011-12 2050.00 2050.00

20.3 During the year 2010-11, financial assistance totaling Rs 791.06 lakh was given directly to 254 patients under Rashtriya Arogya Nidhi (Central fund) and further, the revolving fund of amount Rs.305.00 lakh has also being given to the above mentioned Hospitals. 20.4 As regards to the eligibility criteria for the beneficiaries to be covered under RAN scheme, the Department has informed that only persons below the poverty line suffering from specified life threatening disease are eligible for this aid. The diseases of common nature and disease for which treatment is available free of cost under other health programmes/schemes do not cover for grant. The Financial Assistance is admissible for treatment in Government Hospital only and no Central Government/State Government/PSU employees are eligible for RAN scheme. Patient taking treatment in his State has to avail assistance from State Illness Fund (where such fund has been set up) provided medical estimate does not exceed Rs.l.50 lakh. The cases of estimates above Rs.l.50 lakh are referred by States for assistance from Rashtriya Arogya Nidhi (Central Fund) of the Ministry of Health and Family Welfare. In addition to this, re-imbursement of medical expenditure already incurred is not permissible. However, in exceptional cases, reimbursement could be allowed on a case to case basis with due approval of the Management Committee, provided the eligible patient has already applied for financial assistance before taking medical treatment/operation under emergency situation only and paid the dues to the concerned hospital/Institute. 20.5 From time-to-time review is undertaken and the related information has been provided in the website of this Ministry. All the States/UTs/Hospitals/Institutes are also requested from time-to-time to take action regarding awareness of RAN scheme by displaying the posters/pamphlets, etc. in their respective hospital/institute campus. The Committee is happy to note full utilization of funds during 2010-11 and 2011-12. The Committee would like to be apprised as to whether any record of number of beneficiaries utilizing funds under RAN has been kept. The Committee is of the opinion that since this service is meant for poor people, the publicity of these scheme should be done in a wider scale in vernacular languages so that the really needy and deserving poor people may avail benefits of the scheme.

XXI. NATIONAL TOBACCO CONTROL PROGRAMME 21.1 The National Tobacco Control Programme was launched in the Eleventh Five Year Plan to facilitate implementation of the Tobacco control laws to bring about greater awareness about the harmful effects of Tobacco and to fulfill the obligation (s) under WHO-FCTC. It was started in 45

18 districts concerning 9 States in 2007-08 and at present it is under implementation in 42 Districts in 21 States in the country. 21.2 The expenditure under NTCP at nation~llevel by Ministry of Health and Family Welfare including grants to States is as follow:–

Financial Year Budget Estimate Revised Expenditure Percentage Estimate utilization of RE 2007-08 Rs. 40.00 Cr. Rs. 29.00 Cr. Rs. 13.98 Cr. 48.2% 2008-09 Rs. 30.00 Cr. Rs. 39.00 Cr Rs. 33.86 Cr. 86.82% 2009-10 Rs. 30.00 Cr. Rs. 17.00 Cr. Rs. 16.67 Cr. 98.05% 2010-11 Rs. 45.00 Cr. Rs, 30.00 Cr Rs. 29.32 Cr. 97.73% 2011-12 Rs. 50.00 Cr Rs. 32.00 Cr Rs. 29.61 Cr. 92.53%

21.3 The Committee notes with regret that the allocations made at BE stage was reduced drastically at RE stage during the entire Eleventh Plan period except the year 2008-09. The Committee fails to comprehend the reasons for same. However, the Department could optimally utilize nearly complete reduced allocations made at RE stage. The Committee also feels that a lot more needs to be done to eliminate the scourge of Tobacco related diseases and Department should make all out efforts to utilize entire allocations made at BE stage for the year 2012-13. 21.4 The Committee had commented in its previous reports on the issue of the setting up of National Tobacco Regulatory Authority and Tobacco Testing Labs. As per the information supplied by the Department, the former is still at discussion stage while there has been some progress made regarding the latter. The Committee, while appreciating the efforts made by the Department on the issue of setting up of Tobacco Testing Laboratories, expresses its displeasure as the laggard approach taken by Department on the matter of setting up of National Tobacco Regulatory Authority (NTRA). The Committee, therefore, recommends that the Department should prepare a blueprint by the time the said authority would be set up and keep the Committee regularly updated of the progress made in this regard.

XXII. TELEMEDICINE 22.1 Telemedicine or E-Health can expand the reach, range and quality of Primary Health Care services available in Public Health System to seamlessly synergize with the overall health sector rejuvenation being undertaken under NRHM. The telemedicine centre at SGPGI, Lucknow is the National Resource Centre and network hub. During the year 2011-12, Rs.20.00 crore was allocated for e-Health (Telemedicine). Out of this Rs.l.00 crore was released to Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, the National Resource Centre identified under the scheme of National Medical College Network (NMCN) and balance amount of Rs.19.00 crore is being surrendered. The Committee was apprised that subsequent to approval of NMCN Scheme, the Standardization group recommended to entrust the work to Telecommunications Consultants India Ltd. (TCIL), a PSU which has furnished a proposal involving Rs.151.00 crore which is under examination in consultation with Department of Information Technology and Department of Telecommunications. The Committee was informed that keeping in view the time being taken in finalization of the agency for executing the work, the plan allocation was reduced at RE stage. After technical examination of the TCIL’s proposal, and financial concurrence, it is anticipated that substantial amount of funds would be required for undertaking the strengthening and upgradation 46 of the National Resource Centre (NRC) and five Regional Resource Centers (RRCs) identified under NMCN scheme as well as for establishing the network and infrastructure for providing tele- education facilities to medical colleges to be linked to RRCs. 22.2 The Committee was further informed that the National Resource Centre and Regional Resource Centres under National Medical College Network would undertake a capacity building exercise in consultation with the partner medical colleges so as to optimally utilize the network/ infrastructure. After technical and financial approval in respect of the executing agency for establishing the network, the work will be entrusted and to begin with at least a total of 13 sites, viz. NRC, 6 RRCs and at least 6 medical colleges will be considered for establishing tele-education network. For this purpose, the required material/equipments will be procured, installed, tested, commissioned and coordinated and maintained by the TCIL at the various sites. 22.3 The Committee appreciates this new initiative of the Department aiming at extending the outreach of health services to a vast population but is apprehensive that the casual approach of the Department has resulted in surrendering of Rs.19.00 crore out of Rs.20.00 crore allocated for E-health during 2011-12. The Committee is skeptical of the success of the programme since the programme is yet in planning stage and large milestones have to be travelled till some visible impact is seen of the programme. The Committee, accordingly, impresses upon the Department to draw up clear action plans and dedicated timelines for implementation of the programme. The Committee would like to be apprise of the progress of the programme on quarterly basis.

XXIII.THE NATIONAL PROGRAMME FOR HEALTH CARE OF THE ELDERLY (NPHCE) 23.1 The National Programme for Health Care of the Elderly (NPHCE) was initiated in 2010-11 to be implemented in 21 States during 2011-12 with the objective to provide comprehensive health care to elderly by preventive, curative and rehabilitative services; training of health professionals in geriatrics; strengthening of preventive & promotive rehabilitative services; and developing scientific solutions to specific health problems of elderly by research in Geriatrics and Gerontology. The major component of the NPHCE during 2010-12 was to establish 30 bedded Department of Geriatric in 8 identified Regional Medical Institutions (Regional Geriatric Centres) in different regions of the country and to provide dedicated health care facilities in District Hospitals, CHCs, PHCs and Sub Centres level in 100 identified districts of the 21 States. Funds would be released to the State Health Society (NCD) into the separate account opened for the purpose. State Health Society will retain funds for State level activity and release grant in aid to the District Health Societies. NPHCE would operate through NCD cells under the programme constituted at State and District levels and also maintain separate bank accounts at each level. 23.2 During the course of presentation, the Secretary highlighted the achievements made under NPHCE till date that includes (i) establishment of 8 Regional Geriatric Centres at All India Institute of Medical Sciences, New Delhi; Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh; Govt. Medical College, Trivandrum; Guwahati Medical College, Guwahati, Assam; SN Med. College, Jodhpur; Madras Medical College, Chennai; Grants Medical College & JJ Hospital, Mumbai Grants; Shere-I-Kashmir Institute of Medical Sciences, Srinagar that are funded for setting up of 30 bedded geriatric ward & OPD; academic & research wing; video conferencing unit; and procurement of machinery and equipments in addition to the provision of two seats in MD(Geriatric Medicine);(ii) funding for 91 out of 100 districts identified in 21 States for establishing 10 bedded Geriatric unit, Rehabilitation units at Community Health centers, weekly Geriatric clinic at primary health centers and procurement of supportive devices/equipments at sub- centers. He also discussed annual plan proposed for 2012-13 wherein addition of another 100 districts,4 new regional geriatric centers, establishments of two NIAs, coordination with old age homes and IEC activities including workshops, surveys, etc. at Centre and State level. 47

23.3 The Committee also notes that Rs.150.00 crore only has been allocated for BE 2012-13 against the projected outlay of Rs.200.00 crore. The Committee further notes that due to considerably increased life expectancy the number of elderly people particularly, women has been increasing day by day out of total population of the country and a majority of these elderly people would be women; particularly widows. This trend of increasing population of elders will continue and the Department will have to make all necessary arrangement for providing proper and adequate healthcare facilities to these people. The Committee is happy to note the activities undertaken under NPHCE and plans for the year 2012-13. The Committee feels that the inadequacy of funds available for elderly population of the country might create hurdles in implementation of planned activities. The Committee, therefore, is of the firm opinion that the paucity of funds should not block the progress of the proposed projects and Department should seek more funds, if required, for the timely completion of the projected endeavors at RE stage.

XXIV. DISTRICT HOSPITALS

24.1 Under the scheme for strengthening and upgradation of State Government medical college for starting new Post Graduate (PG) disciplines and increasing PG seats by central funding during Eleventh Plan, the Committee has been given to understand that during the financial year 2011-12, a total of Rs.260.00 crore (General: Rs.21.19 crore + Capital: Rs.238.81) was allocated at RE stage. In addition, an amount of Rs.20.00 crore was also allocated for North Eastern Region. The Committee was informed that Rs.260.00 crore has been utilized and the first instalment has been released to 26 medical colleges. Besides, two more medical colleges were granted partial second instalment due to paucity of funds during that current financial year. Further, the first instalment provided to the North Eastern Region (NER) could not be exhausted fully resulting non-receipt of utilization certificate.

24.2 The Department has also informed that under the present scheme, the financial assistance extended by the Department to the government medical colleges is for the purpose of development of infrastructure, purchase of equipments and creation of faculty and staff with a target to increase approximately 4500 postgraduate seats over and above the existing capacity for which during the last three years, the Department has released first instalment to 72 medical colleges and partial second instalment to two medical colleges.

24.3 With regard to physical targets achieved by the medical colleges, it is stated that the beneficiary medical colleges have been utilizing the money but the college authorities have to complete certain formalities like creation of posts, inviting tenders for civil work and inviting tenders for purchase of equipment. It is beyond doubt that all these formalities take some time and approval of the competent authorities in State Governments. These facilities would ultimately be created only after receiving the total central and state share. After creation of facilities, the medical colleges would apply to the Medical Council of India for increasing of postgraduate seats. However, many of the college have utilized the funds granted as first instalment and have furnished the physical progress report indicating the proportionate development of infrastructure and installation of equipments. In this regard, the Department has been receiving physical progress report on monthly basis from different medical colleges funded under the scheme. 24.4 The Committee, on the basis of physical targets achieved till date, is not convinced with the steps taken for monitoring utilization of allocated funds by various colleges. It seems as if the monitoring is being done on the basis of exchange of words only. The Committee, therefore, would like the Department to take some stringent measures to put a mechanism in place for checks and balances to ensure proper communication and coordination among the concerned authorities at Centre, State and college levels. Further, in view of the fact conceded by the Department that the formalities to be completed by 48 college authorities would be time consuming, the Committee opines that measure to expedite the process of getting approvals from the authorities at various levels to accomplish the objectives of the scheme as envisaged should also be looked into. The Committee would also like to be apprised of the measures taken by the Department for encouraging utilization of allocations by the two colleges in the North Eastern Region who had received funds under this scheme. The mechanism put in place for active monitoring of progress made by the colleges receiving funds under the scheme may also be communicated to the Committee.

XXV. HUMAN RESOURCES FOR HEALTH 25.1 The different components of the programme and the financial/physical targets set and achieved under the programme are as follows:–

Scheme Target Achievement Opening of ANM/GNM schools 50 43 Faculty Development programme 25 candidates for undergoing M.Sc.(N) 15 candidates

25.2 The utilization status of Plan funds allocated in 2011-12 shows reduction of Rs.100.00 crore at RE stage and even lesser actual expenditure by the year end. The reasons cited for this under-utilization of funds were non-receipt of proposals and MOUs from the State of UP, change in some districts proposed by the States. In view of consistently huge shortage of manpower in heath sector, the Committee is not convinced with the progress of programme carried under development of human resources for health. It seems that Department’s approach is ‘Nursing-centric’ as can be seen from the Department’s strategies, as furnished to the Committee, about the proposed utilization of funds earmarked for 2012-13. The Committee is well aware of the looming shortage of manpower in Nursing category, but finds it strange that majority of expenditure is being allocated for Nursing profession when the availability of medical/paramedical professionals is also not satisfactory. Accordingly, the Committee, recommends that Department should strike a balance while allocating the scarce financial resources of the country. 25.3 The Committee has been informed that there exist an unequal distribution of medical colleges-44% in South and 21% in West; irrational deployment of doctors and other health workers; shortage of faculty and need for strengthening of cadre of Paramedics. It has also been informed about the steps taken for in building human resource for health, wherein 46 new medical colleges were set up during 2009-12, taking the total number of medical colleges to 335; more than 8100 & 9100 seats were added taking the total training capacity at UG level to about 42000 & at PG level to about 22000 respectively; annual training capacity in 5700 nursing schools/colleges has been augmented to 2.20 lakh. Further, around 4000 additional PG seats are likely to be created at various medical colleges during 2012 under centrally sponsored scheme for strengthening/ upgradation of Medical colleges. The Department also furnished the physical targets set to be accomplished in Twelfth Five year Plan which includes training capacity of 80,000 MBBS doctors & 45,000 specialists per annum by 2020 and bringing down the doctor: population ratio from 1:2000 to 1:1000. 25.4 The Committee appreciates the steps, the Department proposes to take during the Twelfth Five year plan for building Human Resources. However, the Committee is at loss to understand how the Department would be able to achieve the huge and ambitious targets set, by 2020. The Committee, therefore, would like to be apprised of the detailed and 49 comprehensive action plan the Department proposes to adopt from the year 2012 to 2020. The Committee is also apprehensive of how the Department would be able to retain the additional doctors so as to improve the doctor: population ratio to 1: 1000 from current 1: 2000 by 2020 when there is no mechanism to prevent migration of doctors to foreign pastures after completing their studies in home country. The Committee, therefore, recommends that in addition to preparation of detailed & comprehensive plan to increase human resources for health, the Department should also devise a mechanism for retaining such doctors who have been trained at subsidized and valuable financial resources of the country. 50

PART-B

NRHM

INTRODUCTION National Rural Health Mission (NRHM), the flagship programme of the Ministry was launched in 2005, with a view to improve availability and accessibility to quality healthcare for the people, especially those residing in rural areas, with focus on the poor and marginalised, women and children. The Mission also seeks to bridge gaps in healthcare, facilitate decentralized planning in the health sector, ensure population stabilization, gender balance and bring about inter-sectoral convergence. The NRHM also provides an overarching umbrella to the existing programme of Health and Family Welfare including Reproductive and Child Health (RCH-II) and various disease control programmes. The Mission has its special focus on 18 States, which have weak health infrastructure and health indicators. The Mission (2005-2012) has completed in March, 2012. The Ministry has informed the Committee that since the health goals envisaged to be achieved during 2005-12 could not be accomplished in their entirety, it has been extended till 2017.

II. BUDGETARY PROVISIONS 2.1 Approved outlay for NRHM for the Eleventh plan was Rs.90558.00 crore. The Committee however, learnt that substantial plan allocation could not be released during the Plan period. Out of the total approved outlay of Rs. 90558.00 crore for NRHM, total allocation made during the Eleventh Plan period amounted to Rs.70,030.00 crore with a balance of Rs.20528.00 crore remaining and not being allocated during the Plan period. The following table gives an idea of the approved outlay vis-a-vis their utilization:– (Rs. in crore) 2009-10 2010-11 2011-12 Approved Expenditure Approved Expenditure Approved Expenditure outlay outlay outlay 13930.00 13305.76 15440.00 14696.71 17840.00 16490.14

The Committee is constrained to observe that shortfall has been reported every year in the utilization of the allocated funds. Utilization has failed to keep pace with the allocation as indicated above. The Committee feels that such worrisome trends in the utilization of funds allocated does not augur well for a flagship scheme like NRHM which was designed to complement state efforts on the health front. The Committee observes that such a huge and persistent under-utilization of the budgeted funds is certain to have a bearing on the achievements of National Health Goals and calls for streamlining the existing monitoring of expenditure. The Committee, therefore, strongly recommends that the Ministry needs to take some innovative yet practical measures to streamline the monitoring mechanism of utilization of funds and ensure that the utilization of funds allocated is carried out in an optimal and judicious manner in the Twelfth Plan (2012-17) so that the Goal of the Mission, i.e., to provide effective and quality primary healthcare to the rural population throughout the country with special focus on 18 States with weak health indicators and weak infrastructure could be fulfilled.

50 51

2.2 The Committee has been informed that against the projected demand for Rs.28439.65 crore for NRHM, the Planning Commission has approved an outlay of Rs.20542.00 crore for 2012-13. The lower approved outlay as compared to proposed outlay is likely to affect the implementation of a number of ongoing schemes under NRHM like Mission Flexible Pool, RCH Flexible Pool, National Vector Borne Disease Control Programme, Revised National TB Programme and Routine Immunization. The Committee notes out that under all such programmes which are going to be adversely affected due to non-allocation of required funds, funds allocated so far have remained underutilized during 2011-12, as indicated below:– (Rs. in crore) 2011-12 Schemes Allocation Expenditure (upto February, 2012) Vector borne Disease Control 520.00 383.23 Programme National T.B. Control 400.00 264.62 Programme RCH Flexible Pool 9890.00 7703.97 Mission Flexible Pool 4300.00 3623.77 Routine Immunization 541.00 289.21

2.3 The Committee views with serious concern the trend of allocation of funds and utilization thereof in the year 2011-12 in some other crucial programmes such as National Programme for Control of Blindness(B.E.-Rs.261 crore, A.E.-Rs.221.37 crore), Iodine Deficiency Disorder Control Programme (B.E.-Rs.47.00 crore, A.E.-Rs.23.04 crore) and National T.B Control Programme (B.E.-Rs. 400.00 crore, A.E.-Rs.264.62 crore) are some of the other programmes under which financial performance level during the Eleventh Plan so far has also been far from satisfactory. The Committee has been repeatedly cautioning the Department year after year to take remedial measures to ensure optimum utilization of funds but the situation has not improved. The Committee, therefore, recommends even at the cost of repetition that the Department should take appropriate measures to ensure proper utilization of funds allocated under the above heads and obviate large variations in approved allocation and actual expenditure. The Committee desires to be apprised of the steps taken in this direction and the success achieved in ensuring optimal utilization of the budgeted funds. 2.4 The Committee, at the same time, observes that the above programmes are too vital to be allowed to be plagued with under-funding which can have very serious implications for the access to quality healthcare for those who are residing in rural areas. The Committee, therefore, recommends that the fund-crunch should not be allowed to come in the way of effective implementation of the above programmes and quantum of funding be enhanced for them. 2.5 The Committee takes note of the fact that the Department intends to carry forward the NRHM programme into the Twelfth Plan (2012-17). The Committee has been given to understand that a Cabinet note on continuation of NRHM under the Twelfth Plan has been sent to the Cabinet Secretariat for approval. The Committee hopes that in the second phase the programme would bring more fruitful results. The Committee would, however, recommend that in the meanwhile the Department should undertake a review of NRHM and 52 take concrete and concerted efforts to plug the gaps and bottlenecks in the implementation of the programme that existed in the first phase, so that the result in the second phase would be far better than the performance in the first phase. 2.6 On the issue of adequacy of plan allocation for different components under NRHM for 2012-13 and the Schemes/Progammes which would be affected as a result thereof, the Department has informed that the plan allocation for different components of NRHM for 2012-13 is not as per projected requirements. Against a projected requirement of Rs.28439.65 crore, allocation is only Rs.20542 crore. As a result schemes such as strengthening of district hospitals, supply of free generic medicines in public health facilities and provision of 2nd health worker in Sub-Centres would be affected. 2.7 The Committee feels that insufficient allocation of funds would needlessly affect schemes as mentioned above as these schemes are the bedrock for effective and efficient delivery of healthcare services to the rural population under the NRHM. The Committee, therefore, recommends favourably that the Ministry of Finance and Planning Commission should relook at the cutting down of plan allocations so drastically so as to ensure that these life line schemes of ensuring success of NRHM programmes remain on track. The Committee observes that enhancement of allocation under the on-going schemes of NRHM is also important from the point of view of raising public spending on health from the current 1% (roughly) of the GDP to 2.5% of GDP by the end of the 12th Plan. The Committee would like the Department to bring the above observation to the notice of the concerned authorities of Planning Commission and also acquaint it with their response in the matter. The Committee also recommends that the Department should strive towards deploying the available resources more efficiently so that the allocated funds are spent fully to justify higher allocation. 2.8 The problem of pending Utilization Certificate (UCs) under various programmes/components of NRHM have been engaging the attention of the Committee since long. The Committee finds that the year 2011-12 was also no different. The Committee was informed that as on 29th February, 2012, there were 3861 UCs amounting to Rs.5171.06 crore outstanding in respect of releases made upto 2009-10. This pendency must have increased manifold by the end of March, 2012. 2.9 The Committee observes that 3861 number of pending UCs amounting to Rs.5171.06 crore (as on 29.02.2012) is too large to be comfortable with. The Committee had earlier recommended that the monitoring of pending UCs needed to be strengthened further. However; pending UCs do not show any improvement. The Committee feels that the Ministry of Health and Family Welfare should co-ordinate with the State Governments to appoint a senior officer in the various Health Departments of the respective State Governments to ensure timely submission of utilization certificates immediately on utilization of funds allocated, which would go a long way in ensuring fiscal prudence. 2.10 On the issue of pending UCs, the Department has furnished State-wise details of UCs pending under RCH and Mission Flexible Pool. As per details furnished, it has been found that both under RCH and Mission Flexible Pool, though the number of UCs pending has shown a considerable improvement, the amount that is pending is too high to be comfortable with. The Committee would like the Department to resolve the issue of pending utilization certificates in both the programmes as their pendency has a direct impact on the release of funds to be made to the States. 2.11 The Department further stated that the 5th Common Review Mission conducted from 8th-15th November, 2011 highlighted problems faced in the implementation of various components under NRHM, which include certain gaps in infrastructure including lack of residential 53 accommodation in ensuring 24x7 service availability, shortage of human resources including specialists, doctors and staff nurses, high out-of-pocket expenses on drugs, diagnostics and transportation costs across the States, increase in the utilization of untied funds but need for increasing their effectiveness and involvement in addressing social determinants of health etc. The Committee feels that these problems could have been addressed appropriately by now. At least in the second phase of the scheme, Government should concentrate on all these problems so that the Mission can be implemented with a meaningful results. 2.12 The Department has further informed that the Twelfth Plan proposal of the Deptt. has been forwarded to the Planning Commission. The Twelfth Plan outlay proposed by Deptt. of Health and Family Welfare is Rs.404490.96crore, comprising Rs.219702.45 crore for NRHM and Rs.184788.24 crore for Health. The outlay proposed by this Deptt. for 2012-13 was Rs.45532.18 crore. The outlay approved by the Planning commission for 2012-13 is Rs.27127 crore for Deptt. of Health and FW comprising of Rs.6585 crores under Health and Rs.20542 crores under NRHM. The outlay for 2012-13 approved by Planning Commission is only 59.58 per cent of the proposed outlay for 2012-13. Accordingly, the activities envisaged under the schemes would need to be adjusted within the contours of the approved outlay. It is hoped that the shortfall in 2012-13 outlay would be made good during 2013-14 and the outlay proposed by the Deptt. for the Twelfth Plan would be approved. Therefore, no plan holiday has been considered. Insofar as Zero Based Budgeting is concerned, it may be stated that the allocation made by the Planning Commission for an Annual Plan is significantly less than the requirement projected. Accordingly, that allocation is distributed judiciously amongst the respective Schemes based on need, priorities assigned, etc. It may also be added that for continuation of all the ongoing Schemes from Eleventh Plan to Twelfth Plan, there is a requirement of their appraisal and approval and this will be done at the appropriate stage. 2.13 The Committee is not pleased with the stand taken by the Ministry that for continuation of all ongoing schemes from Eleventh Plan to Twelfth Plan, their appraisal and approval will be done at the appropriate stage. The Committee feels that the Department should set up realistic and time bound schedules for appraisal and approval of these schemes from Eleventh to Twelfth plan so as to ensure smooth functioning of the schemes set to be launched in the Twelfth Plan. The Committee, therefore, recommends that the deadlines be fixed for appraisal and approval so as to ensure that the Twelfth Plan Schemes do not suffer from teething problems.

III. INFRASTUCTURE STRENGTHENING Healthcare Units 3.1 NRHM aims at strengthening of Primary Health Infrastructure and improving effective service delivery across the country. Sub-centers (SCs), Primary Healthcare Centres (PHCs) and Community Health Centres (CHCs) are the three cornerstones on which rural infrastructure is built upon. The Committee was informed that as per Rural Health Statistics, 2010, the number of Sub- Centres, PHCs and CHCs required, sanctioned and functional is as under:–

Health facility Required Sanctioned Shortfall SC 1,58,792 1,47,069 19,590 PHC 26,022 23,673 4,252 CHC 6,491 4535 2115

Further, for strengthening of infrastructure in existing SCs/PHCs and CHCs and for new equipments, provision has been made under NRHM to provide financial assistance upto 33% of 54 the annual plan in High focus States and 25% for Non-high focus States. Further, since 2005, 18151 Sub-Centres, 1582 PHCs, 451 CHCs and 61 DHs have been taken up for new construction and 13299 SCs, 3438 PHCs, 1660 CHCs and 486 DHs have been taken up for Renovation/ upgradation under NRHM upto 31st December, 2011. The Committee, however, cannot feel complacent with the situation. Out of the total shortfall in the SCs, CHCs and PHCs, Bihar with a shortfall of 5263 Sub-Centres, 626 PHCs and 552 CHCs and Uttar Pradesh with a shortfall of 5823 SCs, 698 PHCs and 582 CHCs continue to be an eyesore and may lead to fallback of targets set in the NRHM to provide Universal Health Coverage for all. The Committee, therefore, impresses upon the Department to undertake special efforts in these States to ensure that the shortfall in setting up of SCs, PHCs and CHCs are taken on a warfooting with dead lines fixed for completion of the same and penalties for non- completion of the deadlines set. 3.2 The Committee also notes with disdain that in the 129 District Hospitals sanctioned for renovation and upgradation in Uttar Pradesh, not even one has been completed as on 31st December, 2011. The Committee, therefore, impresses upon the Department to look into the reasons for the same and also depute a senior officer of the Department to personally take up the task of completion of the renovation/upgradation of these district hospitals with the State authorities within a designated time-line. The Committee should also be kept posted of the developments taking place in this regard on a regular basis. Furthermore, the Committee would also like to be kept apprised of the progress made towards the completion of all SCs, PHCs, CHCs and District Hospitals in all States on a six- monthly basis so as to ensure continuity in completion of such infrastructure which is the most important aspect of provision of uniform healthcare for all under the aegis of NRHM. 3.3 The Department has informed that as per Rural Health Survey (RHS) 2009 there is 7.3% overall shortfall in the posts of ANMs, 16.2% in the post of doctors at PHCs and 68% shortfall of specialists at CHCs. To address the problem highlighted in RHS 2009, the following steps have been taken by the Department:– (a) States have been encouraged to appoint health functionaries on contractual basis under NRHM. Under NRHM 8722 Doctors, 14529 Paramedics, 2914 Specialists, 10995 AYUSH Doctors, 33413 Staff Nurses, 69662 ANMs and 3894 AYUSH Paramedics were appointed by States on contract basis since 2005. (b) Norms for establishment of Medical Colleges have been simplified and streamlined to increase their admission capacity. (c) Number of PG seats has been increased by rationalizing the teacher student ratio to increase availability of Specialists. (d) Monetary and non-monetary incentives are provided to staff working in difficult and hard to reach areas. (e) States have undertaken reforms in Recruitment, Transfer and Promotion policies and articulated policies on these issues. Some States have taken out recruitment from the purview of the State Public Service Commission to expedite recruitment. (f) Regulatory measures: States have introduced compulsory rural postings, bond for medical students for working in rural areas. (g) For strengthening of infrastructure in SCs/PHCs/CHCs provision has been made under NRHM to provide financial assistance upto 33% of the annual plan in High Focus States and upto 25% for Non high Focus States. 55

(h) Since 2005, 1815 Sub-Centres, 1582 PHCs, 457 CHCs and 61 DHs have been taken up for new construction and 13299 SCs, 3438 PHCs, 1660 CHCs and 486 DHs for Renovation/Upgradation under NRHM up to 31st December, 2011. 3.4 The Committee on the basis of the above statistics given by the Department finds that inspite of Committee’s recommendation and its concern shown on contractual appointments, there has been no change in the Department’s policy and it still subsists to fulfill its vacancies on contractual basis inspite of the fact that five years have elapsed since the NRHM was launched. Similarly on the issue of specialists appointment at CHCs, the emphasis is still on contractual appointment. The Committee is constrained to observe that such stop-gap arrangement in the appointments by way of contract would lead to ripple effect on the quality of services being offered under NRHM. This deficiency impacts not only the limited financial resources but also have a bearing on the standard quality of services being offered. The Committee hopes that during the Twelfth Plan, the Department would address this issue. The Committee also notes that though the Department has detailed the measures taken to address the problems highlighted in RHS-2009, it has failed to shed light on the effectiveness of the measures so taken. The Committee desires to be apprised of the efficacy of the steps taken to wipe out the deficiencies as pointed out in RHS-2009.

IV. MISSION FLEXIBLE POOL 4.1 Mission Flexible Pool provides for activities like selection and training of ASHAs, up- gradation of CHCs and PHCs to First Referral Units and Indian Public Health Standards (IPHS), constitution of Rogi Kalyan Samitis and District Hospital Management Committees, Mobile Medical Units, untied funds for Sub-Centres etc. States have the flexibility of utilizing the funds as per their priorities for the approved activities. 4.2 The Committee has been informed that under the Mission Flexible Pool (MFP) an allocation of Rs.4970.50 crore was made in 2011-12 which was reduced to 4300.50 crore at the RE stage due to the cut imposed by Ministry of Finance on account of slow pace of expenditure of the Department. Explaining the reasons for slow pace of expenditure and the resultant reduction of allocation at RE Stage, the Department has stated that the spending on construction and infrastructure under MFP is characterized by long-gestation periods and delays leading to slowing of the pace of expenditure. The Committee is constrained to note that the under-utilisation of the budgeted funds has been mainly on account of delay in completing construction and infrastructure development which is indicative of slackness in monitoring of the projects, which in turn also indicates that periodic and regular follow-up action with the State Governments was not taken in this regard. Emphasing the fact that such delays will lead to cost-overrun, the Committee recommends to the Department to take appropriate remedial measures for addressing the issues contributing to delays and cost overruns. 4.3 The Committee has been further informed that an outlay of Rs.5152.00 crore has been approved for Mission Flexible Plan for the year 2012-13, which according to the Department has increased only to the tune of 19.8% (Rs.852 crores) as compared to the RE of 2011-12. This increase in allocation will be used to meet the increasing requirements of funds for human resources and operational costs on account of inflation. Further, the increased allocation will be used to fill the gaps of infrastructure and to roll the new scheme of Weekly Iron Folic Acid supplementation for adolescent boys and girls in order to tackle the problem of nutritional anaemia in the country. 4.4 The Committee sincerely hopes that the Department would be able to fully utilize the fund allocations approved for 2012-13. However, keeping in view its track record of reduction in funds at RE Stage on account of ‘slow pace of expenditure’, the Committee 56 would like the Department to be more vigilant while utilizing the budgeted amount and keep realistic targets in sight to ensure that the shortfall in the utilization of budget allocation does not become a regular feature year after year.

Upgradation of PHCs/CHCs 4.5 Upgradation of CHCs and PHCs which are to be upgraded to First Referral Units is another major component under Mission Flexible Pool. The Committee notes that in the years 2009-10 and 2010-11, some States viz. Bihar, Himachal Pradesh, Uttarakhand, Manipur, Mizoram, Goa, Kerala, Maharashtra, Andaman and Nicobar Islands, Chandigarh, Dadra & Nagar Haveli, Lakshadweep and Puduchery were not able to make operational even one FRU. The Committee expresses its anguish over such a sorry state of affairs. Though the intentions to provide critical healthcare to all under the aegis of NRHM is laudable, but what is needed is a proactive approach to convert intentions into actions. The Committee, therefore, recommends that in light of the fact that the first phase of NRHM has concluded, the Department should take a rational assessment of the factors responsible for drawbacks in making FRUs operational in many States as detailed above and take remedial measures accordingly to ensure more positive outlook in the second phase of NRHM (2012-17).

Rogi Kalyan Samitis 4.6 As per information made available by the Department, the Rogi Kalyan Samitis (RKS)/ Hospital Management Committees are constituted by all States/UTs at facility level including Sub Centre, PHCs and CHCs and District Hospitals. As on date 30,420 Rogi Kalyan Samitis have been set up in all States across the country. In order to ensure flexibility, funds are disbursed to States in one lump sum grant pool wise (e.g. Reproductive and Child Health Programme Flexible Pool) as per allocations approved. The Committee observes that out of Rs.147.18 crore allocated for High Focus States in 2011-12 an expenditure of only Rs.47.61 crore has been made. Similar has been the case in respect of Non-High Focus States and small States/UTs, the only exception being NE States where sizeable expenditure of the allocated outlay has been made. The Committee feels that this is yet another case of slack monitoring of the utilization of funds especially in high focus States, thereby creating gaps in critical health infrastructure. The Committee, therefore, impresses upon the Department to strengthen its monitoring network so as to keep a tab on the timely utilization of funds disbursed especially in the High Focus States. The Committee would like to know the details of the targets set vis-a-vis the achievements made under the Rogi Kalyan Samitis in the Eleventh plan. The Committee would also like to be apprised of the targets set for the Twelfth Plan especially with relation to the High Focus States as the situation there has not been very encouraging.

ASHA 4.7 ASHA – acroym for accredited social health activist - is one of the most important strategic interventions under the National Rural Health Mission, who is required to inform, interact, mobilize and facilitate improved access to preventive and promotive healthcare and also provide basic curative care through her drug kits. The requirement for ASHA is one per thousand population with relaxation to this norm depending upon the workload and terrain. ASHA is necessarily a woman of the village between the age group of 25 to 45 years, who would be selected by the Gram Sabha following an intense community mobilization process.

Training of ASHAs 4.8 Capacity building of ASHA is critical in enhancing her effectiveness as a link between the 57 community and the health facility. The initial orientation training is for a period of 23 days spread in 5 rounds over a period of 12 months and followed by periodic re-training for about 2 days once every alternate month, apart from the on-the-job training she would be getting. Training modules for this purpose have been developed based on a thematic approach and States have also constituted district and block training teams for this purpose. The Committee has been informed that upto 31st December, 2011, out of 8.61 lakh ASHAs selected, 6.2 lakhs have been trained in 5th module and 7.82 lakh have been given drug kits. ASHA training for Module 5 has been completed in all eight NE states. ASHA training for Module 5 in the States of Jharkhand, Odisha, Chhattisgarh, J & K and Punjab are either underway or integrated with 6th and 7th modules in other States. Training in module 6 and 7 covers a range of competencies in maternal, newborn and sick child care. ASHA is expected to be trained in all the competencies in Module 6 and 7 conducted in four rounds over 1 year period. Most States have initiated the roll out of the training in module 6 and 7, although the rate of progress varies substantially across the States. However as per information provided to the Committee, some States/Union Territories namely Jammu and Kashmir, Jharkhand, Rajasthan, Uttar Pradesh, Assam, Andhra Pradesh, Kerala, Punjab, Tamil Nadu, Andaman and Nicobar Islands, Delhi and Lakshadweep, training for the 6th and 7th Module is yet to take off. The Committee would like to know the reasons as to why the training for ASHAs with respect to the 6th and 7th module is yet to take off. The Committee impresses upon the Deaprtment to direct these State Governments/UTs to speed up the process of training of ASHAs in the 6th and 7th module. 4.9 Further, as per information provided, it has been found that in States like Himachal Pradesh, no training has been initiated for the selected ASHAs, while in some States like Goa, Daman and Diu and Puducherry, no selection of ASHA has been initiated. The Committee is of the view that the Department should take steps to ensure that these States start selection/training of ASHAs immediately so as to ensure uniformity in the selection and training modules vis-a-vis other States without further delay. The Committee would like to be apprised of the State-wise updated status of progress made in this regard.

Mobile Medical Units 4.10 Under NRHM, one Mobile Medical Unit (MMU), was to be provided in each district to serve under-served/unserved areas with the aim of taking healthcare to the door-step of the needy people. As per the latest details made available to the Committee there are 442 Districts where facility for MMUs under NRHM is available. The number of MMUs operating in these districts is 1952. The Committee has also been given to understand that many States have made their own arrangement for MMUs through NGOs or registered societies. State-wise disaggregated data in this regard is not maintained by the Ministry. Further, it was informed that a proposal for providing more MMUs to inaccessible districts was discussed in the meeting of Empowered Programme Committee of NRHM held on 8th February, 2012 and it was recommended for placing the same before the Mission Steering Group of NRHM for consideration and approval. The Committee is dismayed by the slow progress in procurement and provision of MMUs in the country and urges upon the Department to take immediate steps especially in High Focus States to ensure deployment of MMUs without further delay and also ensure proper monitoring of the same at regular intervals in States where they have already been deployed, so as to ensure accessibility of healthcare facilities to the masses in unserved and under-served areas.

V. RCH FLEXIBLE POOL 5.1 The main objective of RCH Flexible Pool is to bring about the change in the three critical health indicators: Infant Mortality Rate (IMR), Maternal Mortality Ratio (MMR) and Total Fertility Rate (TFR) consistent with the goal of National Population Policy 2002, the Tenth and Eleventh 58

Plans and Millennium Development Goals (MDGs). The Department has further informed that under RCH-II Programme, Government of India adopted a strategy of seeking need based Programme Implementation Plan (PIP) in respect of all the States/UTs, who consolidate the same on the basis of their District Action Plan (DAP). All such States’ PIPs are considered by the NPCC and accordingly against the approved value of the PIP, the funds are released to the States. The monitoring of expenditure is on quarterly basis. The final audit accounts come after 5-6 months after the close of the year. 5.2 The targets set under the National Rural Health Mission for Maternal Mortality Ratio (MMR), Infant Mortality Rate (IMR) and Total Fertility Rate (TFR) were 100 per 100,000 live births, 30 per 1000 live births and 2.1 respectively by 2012. As per the latest Sample Registration System (SRS) report 2007-09 of the Registrar General of India (RGI-SRS), Maternal Mortality Ratio (MMR) showed a decline from 254 per 100,000 live births in the period 2004-06 to 212 per 100,000 live births in the period 2007-09, Infant Mortality Rate declined from 58 per 1000 live births in the year 2005 to 47 per 1000 live births in 2010 and Total Fertility Rate declined from 3.0 in 2003 to 2.6 in 2009. By these figures the Committee feels that the targets set to be achieved by 2012 would not have been achieved till now. The Committee notes that none of the targets set by the Eleventh Plan for reduction in MMR, IMR and TFR has been met during the Eleventh Plan period. The Committee feels that the strategies adopted to achieve the goals of reduction in MMR, IMR and TFR need to be evaluated afresh so that with suitable modifications, they would correct the imbalance and help meet the targets set for MMR, IMR and TFR in the coming years. 5.3 To accelerate the pace of reduction of Maternal Mortality Ratio (MMR) in the country, the following steps are being undertaken by the Government of India under the National Rural Health Mission (NRHM), launched in the year 2005, across the country with a special focus on 18 States with weak public health indicators and infrastructure: • Promotion of institutional deliveries through Janani Suraksha Yojana. • Capacity building of health care providers in basic and comprehensive obstetric care. • Operationalisation of Sub-Centres, Primary Health Centres, Community Health Centres and District Hospitals for providing 24x7 basic and comprehensive obstetric care services. • Name Based Tracking of Pregnant Women to ensure antenatal, intranatal and postnatal care. • Mother and Child Protection Card in collaboration with the Ministry of Women and Child Development to monitor service delivery for mothers and children. • Antenatal, Intranatal and Postnatal care including Iron and Folic Acid supplementation to pregnant and lactating women for prevention and treatment of anemia. • Engagement of more than 800,000 Accredited Social Health Activists (ASHAs) to generate demand and facilitate accessing of health care services by the community. • Village Health and Nutrition Days in rural areas as an outreach activity, for provision of maternal and child health services. • Health and nutrition education to promote dietary diversification, inclusion of iron and folate rich food as well as food items that promote iron absorption. • A new initiative namely Janani Shishu Suraksha Karyakram (JSSK) has been launched on 1st June, 2011, which entitles all pregnant women delivering in public health institutions to absolutely free and no expense delivery including Caesarean section. 59

The initiative stipulates free drugs, diagnostics, blood and diet, besides free transport from home to institution, between facilities in case of a referral and drop back home. Similar entitlements have been put in place for all sick newborns accessing public health institutions for treatment till 30 days after birth. • To provide essential and basic Newborn Care and Resuscitation, Navjaat Shishu Suraksha Karyakram (NSSK) has been launched to address care at birth issues i.e. Prevention of Hypothermia, Prevention of Infection, Early initiation of Breast feeding and Basic Newborn Resuscitation. Newborn care and resuscitation is an important starting-point for any neonatal program and is required to ensure the best possible start in life. The objective of this initiative is to have atleast one person trained in Basic newborn care and resuscitation at every delivery. • This training is being imparted to Medical officers, Staff nurses and ANMs at CHC/ FRUs, 24x7 PHCs and Sub-centers where deliveries are taking place. • The training is for 2 days and is expected to reduce neonatal mortality significantly in the country. • As on date more than 66,900 health personnel have been trained in NSSK across the country. The Committee welcomes the above measures contemplated by the Department for accelerating reduction in MMR, IMR and TFR. The Committee would, however, like the Department to put in a place a rigorous monitoring mechanism of evaluation of the effectiveness of the measures so taken. 5.4 On the issue of justification for increase in allocation to Rs.4345.51 in BE 2012-13 from Rs.3785.00 in RE 2011-12, the Department has informed that State Programme Implementation Plans (SPIPs), are based on the District Action Plans in accordance with requirement of the State. During the year 2011-12, a new initiative viz., the Janani Shishu Suraksha Karyakram (JSSK) was launched. Besides this, the funds on account of procurement of some items such as RCH Drugs and Sanitary napkins, etc. will have to be released under this head and also escalation and the incremental increase in expenditure will have to be factored in, thereby contributing to enhancement in BE proposal of F.Y. 2012-13. 5.5 The Committee notes that while allocation for RE 2011-12 was Rs.3785.00 crore, actual releases were to the tune of Rs.3457.29 crore and the actual expendidture was Rs. 2814.90 crore which shows a shortfall in the utilization. States like Andhra Pradesh, Bihar, Gujarat, Himachal Pradesh, Uttar Pradesh and West Bengal have failed to optimally utilize their funds. The Committee would like to stress that though it is sympathetic to the Department’s demand for higher allocation of funds and ready to give due relief in terms of its inherent powers, it would simultaneously like the Department to improve its financial administration. The Committee is of the opinion that the stiff targets set for achieving IMR, MMR and TFR would fall by way side, if the budgeted amount is persistently under-utilised. The Committee, therefore, implores upon the Department to tighten its seat belts and ensure that the Department takes urgent and effective steps in order to ensure that the targets set do not remain a pipe dream.

ROUTINE IMMUNIZATION 5.6 With regard to the reasons for increase in allocation to Rs. 777.00 crore during 2012-13 as compared to previous years, the Department has informed that the allocation of Rs.777.00 crore under Routine Immunization during 2012-13 are proposed to be utilized for activities as per details mentioned below: 60

Sl. No. Activities Amount (Rs. in crore) 1. Procurement of Routine Vaccines 263.00 2. Pentavalent Vaccine (GAVI Supply, notional cost 164.19 adjustment) 3. Needles and Syringes 116.00 4. Cold Chain equipment 230.66 5. Grant in aid for Research/New Vaccine 3.15

TOTAL 777.00

The increased allocation is primarily on account of (i) notional cost adjustment of pentavalent vaccine (ii) cold chain equipment and (iii) increased provision for needles and syringes. Further, a sum of Rs.303.51 crore was utilized under procurement of vaccines and needles and syringes during 2011-12. As no cold chain items were procured in 2011-12, no cost adjustment was carried out under this Head. 5.7 Cold chain equipment is a sin-qua-non for success of Universal Immunization Programme (UIP). However, figures in some States raise an alarm bell. In Bihar out of 1648 PHCs/CHCs,1164 do not have any cold chain equipments and States/UTs like Dadra and Nagar (D&N) Haveli, Daman and Diu, Delhi and Puducherry have no cold chain equipment. The Committee regrets that a densely populated state like Bihar does not have cold chain equipment in majority of its PHCs/CHCs and States/UTs like D and N Haveli, Daman and Diu, Delhi and Puduchery have yet to open their account. The Committee feels that the Department should seriously direct these states to take immediate steps to ensure setting up of cold chain equipment without further delay so as to ensure implementation of UIP in both letter and spirit and if need be more funds and expertise may be provided by the Department to such laggard States.

PULSE POLIO PROGRAMME 5.8 On the issue of near about similar allocation made in BE 2012-13 (Rs. 776.46 crore) as compared to RE 2011-12 (Rs. 779.96 crore), the Department has informed that additional funds will be sought when a reassessment is made at RE 2012-13 stage. 5.9 Further the Department has informed that the financial achievement under the programme during 2011-12 is as under: (Rs. in crore) S1. Activities RE Utilization 2011-12 No. 2011-12 (till 26.03.2012) 1 Procurement of Oral Polio vaccine 480.62 471.81 2. Operational Fund 299.34 296.60

TOTAL 779.96 768.41

During the year 2011-12, one National Immunization Day (NID) and 8 Sub National Immunization Days (SNIDs) were held as against 2 NIDs and 8 SNIDs planned initially. Special Immunization Activities were also held e.g. to prevent circulation of virus from migratory population and vaccination of children during various religious occasions (like Urs, Shrawani Mela), continuous 61 polio vaccination at international border etc. During 2011-12 (financial year) no polio case was reported in the country as compared to 42 cases of polio reported in 2010. The last case of polio was reported with date of onset as 13th January, 2011 from Murshidabad, West Bengal. 5.10 Name based tracking of newborns for polio vaccination under the pulse polio programme has been piloted in high risk districts of Uttar Pradesh and Bihar. Currently, the concept of name based tracking of beneficiaries for routine immunization has been initiated under the Maternal and Child Tracking System (MCTS). The MCTS is designed to collate information of all pregnant women and children up to two years of age, so as to generate due list of beneficiaries for the maternal and immunization services. 5.11 On the issue of media reports pertaining to a child that developed a polio infection following the administration of polio drops, the Department has informed that such cases are called vaccine derived polioviruses (VDPV) cases. Vaccine-derived polioviruses (VDPVs) are extremely rare and emerge after prolonged multiplication of the virus contained in the oral polio vaccine (OPV) in the guts of children who have a pre-existing disorder of development of immunity or in populations with very low immunity due to low routine immunization coverage. 5.12 Despite this very rare occurrence of VDPVs, OPV is the safest and most effective way to protect children from polio and has been the vaccine of choice for over 195 countries which have successfully eradicated polio. More than 10 billion doses of OPV have been given to more than 2 billion children in the past ten years. The preventive measures being taken by the Government in this regard include: • All cases in which a vaccine derived polio virus is isolated are urgently investigated to determine the routine immunization coverage in the area and whether the VDPV is circulating in the area. Additional laboratory investigations are conducted for the child to confirm if the child was suffering from any immunological deficiency that could have led to emergence of VDPV. • Most VDPVs are detected in areas with low routine immunization coverage and immediate action is initiated to improve routine immunization in such areas. • The Government has declared 2012-13 as the Year of Intensification of Routine Immunization in India. As a part of this initiative a plan for improving routine immunization and thereby increasing population immunity has been developed and will be implemented from April, 2012 to March, 2013. • If the VDPVs are found to be circulating in an area, urgent mop up campaigns using trivalent OPV are also conducted to stop the circulation and reduce the risk of further VDPV emergence. There is no evidence that any of the VDPVs isolated in 2011 or 2012 were circulating in the area where they were detected. • The Government is maintaining a buffer stock of OPV to respond to any circulating VDPV. 5.13 The Government has sought advice on reduction of risk of occurrence of VDPVs in India from the India Expert Advisory Group (IEAG) for polio eradication during its meeting held on 15-16 March, 2012. The IEAG has informed that this is a part of the global polio end-game strategy that is likely to be discussed during a meeting of the Strategic Advisory Group of Experts on Immunization in Geneva in April 2012 and during the World Health Assembly in May, 2012. The IEAG suggested that a consultation of experts should be convened in India after the World Health Assembly to facilitate deliberations on the polio end game strategy that primarily involves reducing the risk of VDP emergence in India. 62

5.14 The Committee appreciates that the Department has been able to eradicate polio in the country with one or two exceptions. However, the Committees feels that the Department should not feel complacent on the success and ensure that the scourge of polio is not allowed to rear its head again.

JANANI SURAKSHA YOJANA 5.15 Janani Suraksha Yojana (JSY) launched on 12th April, 2005 as a safe motherhood intervention under NRHM, is being implemented with the objective of promoting institutional delivery among the poor pregnant women. Being implemented in all States/UTs, JSY is a 100 per- cent Centrally Sponsored Scheme and it integrates JSY benefits with delivery and post-delivery care. As per information supplied by the Ministry, the expenditure on the Scheme has increased from Rs.7.34 crore in 2005-06 to Rs.1618 crore in 2010-11. Similarly the.Institutional deliveries have increased from 108 lakhs to 168 lakhs and beneficiaries have increased from 38 lakhs to 113.39 lakhs during the same period. 5.16 The Yojana has identified ASHA as the main link between the Government and the poor pregnant women, whose main role is to facilitate pregnant women to avail maternal care services and arrange referral transport. In Low Performing States, all women, including SCs and STs opting for getting deliveries conducted in Government Health Care Centres/Institutions or accredited private institutions are eligible to receive cash assistance. 5.17 The Deaprtment further informed that a new Scheme namely the Janani Shishu Suraksha Karyakam was launched on 1st June, 2011 to ensure service guarantees and eliminate out of pocket expenses. The main entitlements of the Scheme include: (i) Free and zero expense delivery and C-section; (ii) Free drugs, diagnostics, blood and consumables; (iii) Free diet during stay in facilities; (iv) Free transport from home to health institution, between health institutions in case of referral and drop back home; (v) Exemption from all kinds of user charges and (vi) Similar entitlements for sick new born till 30 days after birth. 5.18 The Committee is given to understand that in several cases, the Ashas do not actually provide the required help and assistance and instead only add the numbers. In several cases, the mothers reach the hospital only after the delivery though they are shown to have been given institutional delivery. Such attitude of the Ashas should be strictly dealt with. A strict monitoring of the activities of the Ashas should be kept. The Janani Shishu Suraksha Karyakram is also a good programme and all efforts need to be made to make it a success. 5.19 As per the information furnished by the Ministry a name-based Mother and Child Tracking System (MCTS), has been launched in all the States for ensuring timely ANC, Institutional Delivery, PNC and immunization of the new born. The software application has been developed by NIC and the States are being trained on the same. The States are customizing the application for their State specific requirements. As a part of this process, the States are required to map all the public health facilities as per Census 2011 codes and a majority has been already mapped. The States have started uploading data on the central system. The States are in the process of capturing information on contact number of service providers and beneficiaries. The Ministry is continuously reviewing 63 the progress of the system, including the completeness and quality of uploaded data by the States/ UTs, so as to address the various issues relating thereto. Further, the Government of India has taken a policy decision to undertake Maternal Death Review (MDR) both at the health facilities and in the community. The purpose of the MDR process is to find the gaps in the service delivery which leads to maternal deaths and take corrective action to improve the quality of service provision. The guidelines and tools for MDR have been disseminated to the States by the Ministry in March, 2010. The majority of the States have initiated the process of MDR implementation and have constituted District Level MDR Committees. For capacity building of State Nodal Officers, a national workshop on MDR was held in December, 2010. Most states have completed State level orientation and have also planned for orientation/training of sub-district Level health functionaries in the PIP 2011-12. Tamil Nadu and Kerala have well-established systems of MDR for a number of years. Other states are now well into the process like Madhya Pradesh, Orissa, Assam and Maharashtra and have actually started reviewing deaths, identifying causes, doing a gap analysis and taking corrective action. Corrective measures include improving both coverage and quality of antenatal care, tirrtely detection of high risk pregnancies, micro birth planning, provision of free referral transport to get pregnant women to the public health facilities in time and operationalizing 24X7 PHCs and FRUs. 5.20 Additionally, a Mother and Child Protection Card have been developed as a collaborative effort of the Ministry of Women and Child Development and the Ministry of Health and Family Welfare. It has been disseminated to the states for implementation in the year 2010. This card is a maternal and child entitlement card, a counselling and family empowerment tool linking maternal, newborn and child care with the objective of strengthening continuum of care and improving key maternal and child health services through the Integrated Child Development Services (ICDS), Scheme of Ministry of Women and Child Development and the National Rural Health Mission (NRHM) of the Ministry of Health and Family Welfare (MOHFW), including Immunization and Janani Suraksha Yojana. Many States like U.P, Punjab, Rajasthan, Haryana, Bihar, Andhra Pradesh, Orissa, T.N., Karnataka and West Bengal have started implementing the Common MCH Card. Some other states have also initiated the process of implementing the Common MCH Card as communicated by them during discussions on their State Plans for 2011-12. The Ministry also informed the Committee that States have been advised to keep a provision in their PIP for 2011- 12 for printing and dissemination of the MCH Cards and ensuring availability at the field level. It is expected that in the year 2011-12, all the States and UTs will be issuing Common MCH Card to the pregnant women. 5.21 The Committee appreciates the joint efforts taken by the Ministry of Health and Family Welfare and Ministry of Women and Child Development to develop a mother and child protection plan. The Committee hopes that as informed by the Ministry all States and UTs would have completed the issue of such cards and recommends more funds should be allocated for such a scheme if need be as it would strengthen both maternal and child care protection for which funds and infrastructure should not be a constraint. 5.22 The Ministry of Health and Family Welfare further informed that it had commissioned an evaluation of the Janani Suraksha Yojana (JSY) by an expert group led by the Executive Director, NHSRC. The Committee has submitted its findings which are available in the form of a report. The report entitled “Programme Evaluation of the Janani Suraksha Yojana’ is available at the website: www.nhsrcindia.org. The following are the major findings/recommendations of the evaluation: 1. The JSY has undoubtedly increased the number of institutional deliveries and has enabled poor women to access public health facilities. 2. JSY funds are reaching most of the beneficiaries who deliver in institutions. 64

3. Services of FRUs (First Referral Units) are largely available in almost all districts in the public sector. 4. Exclusionary criteria for home and institutional deliveries which limit the JSY entitlement for the most vulnerable women should be removed. 5. There is a need to ensure that no user fees and provider fees are charged for pregnancy and newborn care and this should be well advertised. 6. Facilities should have a quality management system in place. Quality processes would include minimum standards of inputs like infrastructure, human resources, electricity, water, number of toilets, equipment and drugs and laboratory services. It would also include protocols of clinical care and review and administrative processes. 5.23 The Committee recommends that the gaps in implementation of the JSY Scheme highlighted by the said report may be removed at the earliest. The Committee desires to be kept apprised of the follow-up action taken on the findings of the Expert Group.

VI. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP) 6.1 The National Vector Borne Disease Control Programme is a comprehensive programme for prevention and control of vector borne diseases namely Malaria, Filaria, Kala-azar, Japanese Encephalitis (JE), Dengue and Chikungunya which is covered under the overall umbrella of NRHM. Central Government provides technical and financial assistance and also logistics support and the State Governments have to meet the other requirements and operational costs. NE States are provided 100 per cent central assistance under the programme. 6.2 The general strategy for prevention and control of vector borne diseases under NVBDCP is through Disease Management, Integrated Vector Management and Supportive Interventions. The Committee was informed that for the year 2010-2011, the Directorate of NVBDCP had projected their demands amounting to Rs.698 crore. However, allocation of Rs.418 crore had been made considering overall allocation of Ministry of Health and Family Welfare. Out of the allocation of Rs. 418.00 crore for 2010-11, the EAP component was Rs.165.26 crore (GFATM Rs.84.87 crore and World Bank Rs.80.39 crore). 6.3 The Department had informed that against a Plan Allocation of Rs. 430 crore for 2011-12, the expenditure was Rs. 412.66 crore till 23.03.12. Further, the target of bringing the number of cases to less than 1 per 100 populations could not be achieved by 2010 as envisaged by National Health Policy (2002), for elimination of Kala Azar. However, the target is set to be achieved by 2015. The Department has been allocated at outlay of Rs. 447.00 crore for the year 2012-13. The Committee is at pains to understand that a period of 10 years was not enough to eliminate Kala Azar and the target date has been further set back by three years. The Committee feels that the initiatives taken earlier for Kala-Azar elimination did not have the desired impact. The Committee would, therefore, like to be enlightened about the short-comings identified in the Kala Azar elimination programme and how the Department plans to re- orient its policies for achieving the desired results in terms of elimination of Kala-Azar. The Committee also desires that an evaluation of the implementation of the programme may be undertaken.

MALARIA 6.4 The National Health Policy (2002) has set the goal of reduction in mortality on account of malaria by 50 percent by 2010. At country level, the analysis revealed that cases have consistently declined from 2.08 million to 1.28 mil1ion during 2001 to 2011. Similarly Pf cases have declined 65 from 1.0 to 0.64 million cases during the same period. Reported deaths due to malaria have been around 1000 during all the years within this period with a peak in 2006 when an epidemic was reported in NE States. However in 2011 the reported deaths due to malaria were 463. This indicates declining overall endemicity of malaria in the country. The malaria situation is continuously monitored through monthly, annual reports and field visits. There is an overall improvement observed in the malaria situation at the country level. The state-wise situation also shows that most of the states have recorded a decline in total malaria cases, Pf cases and deaths. Except Andhra Pradesh and Madhya Pradesh all the project states have shown decline in number of cases in 2011 compared to 2010. The analysis of the state-wise data of 2011 shows that around 80% of malaria cases in the country are reported from 10 states namely Orissa, Jharkhand, Chhattisgarh, Maharashtra, Madhya Pradesh, Gujarat, West Bengal, Uttar Pradesh, Assam and, Andhra Pradesh. 90% of deaths in 2011 are reported by 8 states. Maharashtra was the highest contributor (24.6 %), followed by Orissa, Madhya Pradesh, Meghalaya, Assam, Mizoram, Chhattisgarh, and Jharkhand. Seven NE states (excluding Sikkim) contributed 13.26% to Pf cases, 8.61% to total malaria cases and 27.21% to the deaths due to malaria reported in the country in 2011. This shows that there is definite decline in contribution by the NE states to the caseload of the country. The major part of the NE states have difficult terrain, forested, sparse population, inhabited by tribal population with diverse treatment seeking behaviour, relatively poor health infrastructure environment conducive for high and perennial vector breeding etc. The prevailing vector in NE states is very efficient and predominant parasite species is Pf which is known to develop severity and mortality. These all factors are responsible for high transmission as well as deaths due to malaria. 6.5 With regard to measures taken to curb the Malaria problem in North-Eastern State, the Department informed that the tools like Rapid Diagnostic Test (RDT), Artesunate Combination Therapy (ACT) and Long Lasting Insecticidal Nets (LLINs) have been scaled up since 2009-2010. An evaluation was conducted by an independent agency in 2010 and the salient findings are as under: (i) On an average one net is being used by 2 persons. (ii) The usage of bed net is to the extent of 86% in the community. (iii) During the survey, it was observed that about 57% of population reportedly slept under the bed net during previous night. (iv) About 91% of fever cases were screened for blood test out of which 61% were examined within 24 hours of collection of blood sample and treated with appropriate anti-malarials including Act for Pf cases. 6.6 With regard to availability of manpower to monitor the Malaria endemic States, the Department informed that the status of key functionaries for National Vector Borne Disease Control Programme is as under: (i) District Malaria Officer: 520 are in position against 581 sanctioned. (ii) Multi Purpose Worker Male: 52774 are in place against 76074 sanctioned posts, though the requirement is 147069 to have one at each sub-centre. (iii) Lab. Technicians: 15094 are in position against 17858 sanctioned though total required number is 28,208. In North East States: (i) Out of 84 sanctioned posts of DMOs, 64 are filled up. (ii) Out of 8859 sanctioned MPWs (M), 8457 are filled up. (iii) Out of 1253 LTs, 1202 are filled up. 66

6.7 The Committee feels that there is still a considerable gap between what has been achieved and what needs to be achieved. The Committee is of the opinion that the Department has not been able to fill even the vacant sanctioned posts. Department may also consider sanctioning the required number of posts. The The Committee, therefore, recommends to the Department to closely monitor on a more proactive basis to fill the sanctioned manpower on an urgent basis and prepare a blue print to identify and create the required manpower on a war footing and if need be more funds and expertise may be provided to ensure that the huge backlog of cases could be eliminated.

JAPANESE ENCEPHALITIS 6.8 Japanese Encephalitis (JE) is a viral disease with a tendency of seasonal outbreaks. JE is endemic in 14 States out of which, Assam, Bihar, Haryana and Uttar Pradesh have reported repeated outbreaks. Japanese Encephalitis vaccination has been carried out in campaign mode in 112 JE endemic districts in 15 States since 2006. During the period 2006-07 to 2010-11, a total of 704.02 lakh children have been reported to be vaccinated in these campaigns which amounts to 79.9 percent coverage of the target population. 6.9 Total 8247 cases and 1169 deaths due to AES including JE have been reported in 2011 as compared with 2871 cases and 663 deaths in 2006. Though the cases have increased, the case fatality rate (CFR) has been reduced from 23% in 2006 to 14.1% in 2011. Total 54 Sentinel Sites in all the endemic states have been made functional to enhance surveillance. Immunisation coverage of children of 88.97% has been reported in 2010-11. Allocation of Rs.3.11 crore during 2011-12 has been increased to Rs.15.60 crare in 2012-13 for prevention and control of JE. JE vaccination by using SA-14-14-2 covering the children of 1-15 yrs. age were covered in endemic states. The coverage was noted to be the 66.61% of the targeted children during 2009. Under the remedial steps taken to overcome the shortfall of targets a special campaign was carried out in 7 districts of Uttar Pradesh and 2 districts of Assam (Dibrugarh and Sibsagar) along with 19 districts of other endemic states and 88.97% overage was achieved. To follow up, the leftover children along with new cohorts are covered under Routine Immunisation (RI). 6.10 The Committee is not happy with the physical achievements under the programme. Though the fatal cases have reduced, but the Committee cannot be in oblivion to the fact that the number of cases have increased. The Committee feels that though the fund allocation has been increased five fold from Rs.3.11 crore during 2011-12 to Rs.15.60 crore in 2012-13, a lot needs to be done in terms of physical achievements on the ground. The Committee feels that there is a need on the part of the Department to improve its physical achievements by recruitment of more manpower especially in JE endemic States.

VII. NATIONAL TB CONTROL PROGRAMME 7.1 Tuberculosis (TB) is a major public health problem in India causing significant economic loss to the country. TB is a curable and preventable disease and yet it causes significant morbidity and mortality, which is a cause of serious concern. As per the Global TB Report (2010) in 2009 out of the estimated global annual incidence of 9.4 million TB cases, 1.98 million were estimated to have occurred in India, thus catering to a fifth of the global burden of TB. The Revised National Tuberculosis Control Programme (RNTCP) has completed over thirteen years of its implementation with more than four years of full nation-wide coverage. Since its inception, the Programme has initiated over 13.68 million patients on treatment, thus saving nearly 2.5 million additional lives. As per the Global TB Report (2010), TB mortality in the country has reduced by 43%, from an estimated 42/lakh population in 1990 to 24/lakh population in 2009, and the prevalence of TB in the country has reduced by 67%, from 568/lakh population in 1990 to 185/lakh population. These 67 are encouraging trends and an indicator that RNTCP is steadily working towards achieving the United Nations’ Millennium Development Goals relating to TB by 2015. 7.2 As per the information furnished by the Department the Budget has been increased from Rs. 380.00 crore (excluding Rs. 20.00 crore earmarked for North Eastern States) in 2011-12 to Rs. 678.15 crore (excluding Rs. 32.00 crore earmarked for North Eastern States) in 2012-13. The Ministry informed the Committee that the enhanced allocation of funds will be spent on (i) strengthening and improving the quality of basic DOTS services and to align with health system under NRHM, (ii) deploying improved rapid diagnosis at the field level, (iii) expanding efforts to engage all care providers, (iv) strengthening urban TB Control, (v) expanding diagnosis and treatment of drug resistant TB, (vi) improving communication and outreach, and (vii) promoting research for development and implementation of improved tools and strategies. The funds will also be utilized in the implementation of DOTS-Plus Strategy (for treatment of drug resistant TB), in a phased manner in all the States of the country, as the cost of MDR-TB treatment is 300 times more than non MDR-TB. Out of the Plan fund allocation of Rs. 400.00 crore (including allocation for NE States), an amount of Rs.391.16 crore has been utilized. Further, a new project for providing commodity assistance, Anti–TB drugs under UNITAID, Rs. 3650 lakhs provision has been earmarked. 7.3 With regard to MDR-TB patients the Department has informed that DOTS strategy has significantly improved case detection and cure rates beyond 72% and 87% respectively. 28 accredited labs have been set up across the country to diagnose Multi Drug Resistant T.B (MDR- TB) and 15 are under process which shall be completed by March, 2013. 6944 patients have been provided treatment for MDR-TB upto 2011. Further, the Phase-II trials of the new molecule (TMC- 2007) for treating patients with MDR-TB are underway. It is a multi-country study and in India two centers namely, National Institute of Research in Tuberculosis, Chennai and All India Institute of Medical Sciences are participating. The analysis is underway and the study results are expected shortly. The Committee would like to know by when the analysis would be completed and its study results published since a lot of time has already elapsed since the clinical trials commenced. 7.4 The Committee observes that the fact that India accounts for a fifth of the global TB burden is indicative of the magnitude of the problem and reminds of the challenges ahead. Though DOTS (Directly Observed Short Treatment Course) has been found to be highly efficacious, the Committee believes that the TB patients being treated in the private sector which is largely unregulated, go unmonitored and there is no regulatory mechanism in place to ensure that the well-established and validated treatment regimen is followed there. The Committee would, therefore, like the Department to pay attention to this aspect while formulating its strategies for the Twelfth Plan. The Committee also desires to be apprised if any assessment has been made regarding cases of default in treatment of TB.

VIII. NATIONAL LEPROSY ERADICATION PROGRAMME 8.1 The National Leprosy Control Programme was launched by the Covernment of India in 1955. Multi Drug Therapy came into wide use from 1982 and the National Leprosy Eradication Programme was introduced in 1983. Since then, remarkable progress has been achieved in reducing the disease burden. India achieved the goal of elimination of leprosy as a public health problem, defined as less than 1 case per 10,000 population, at the National level in the month of December 2005 as set by the National Health Policy, 2002. The National Leprosy Eradication Programme is 100% centrally sponsored scheme. MDT is supplied free of cost by WHO. 8.2 The following are the financial and physical achievements of National Leprosy Eradication Programme. 68

A Physical achievement Activity Target Achievement (i) Annual New Case 10/100,000 Pop. Can be calculated after receipt of Detection Rate March, 2012 data 10.50/100,000 Pops (ii) Reconstructive Surgery 3000 2018 (Till Jan., 2012) Performed B-Financial Rs. 44.02 Cr. Rs.36.78 Cr. (As on 25.3.2012)

(b) Further a provision of Rs 44.02 Cr. and Rs. 51.00 Cr. has been made for the year 2011-12 & 2012-13 respectively. The enhanced allocation is proposed to cover the increase in all costs including remuneration of contractual positions and special activities to be undertaken during the year 2012-13, in 209 high endemic districts of 16 States/UTs.

8.3 The Department has further informed that the number of new cases reported by India shows a declining trend since 2003-04. The proportion of new cases accounted for by India is gradually reducing. During the year 2002-03, India accounted for 76.3% of the total Global cases and during year 2010-11 India accounted for 55.49% of the total number of new cases. There is no active search programme presently under way in the country; however, National Sample Survey to assess the Leprosy disease burden has been undertaken through National JALMA Institute, ICMR. The Survey has been completed in all the States/UTs. The report of the survey will be available by April, 2012. The Committee would like the Department to furnish the latest status update on survey conducted by National Sample Survey to assess the leprosy disease burden in the country.

8.4 As per information available to the Committee, the following States have shown the highest number of cases where leprosy has been detected during the last three years i.e. 2008 to 2011 namely Chhattisgarh, Bihar, Maharashtra, Gujarat, Uttar Pradesh and West Bengal. The Committee is constrained to note that India still accounts for more than 50% of the new leprosy cases worldwide. The efforts made so far have still not yielded the desired results. The Committee would, therefore, strongly recommend the Department to monitor the measures taken so far to eliminate this disease.

IX. NATIONAL TRACHOMA AND BLINDNESS CONTROL PROGRAMME

9.1 The National Programme for Control of Blindness (NPCB) was launched in the year 1976 as a 100% Centrally-Sponsored scheme with the goal to reduce the prevalence of blindness from 1.4% to 0.3% by 2020. Rapid Survey on Avoidable Blindness conducted during NPCB during 2006-07 showed reduction in the prevalence of blindness from 1.1% (2001-02) to 1% (2006-07).

9.2 On the reason behind reduction of allocation at RE 2011-12 stage and increase in same to Rs. 261 crore in BE 2012-13 and whether the same is as per projected requirements, the Department has informed that the unspent balances as on 31st March of the previous year were taken into consideration while releasing funds to the States. The States had reported an unspent balance of Rs.155.52 crore as on 31st March, 2011. Hence, only the balance amount of the allocated funds could be released to the States. As such, upto September, 2011, only an amount of Rs.123.20 crore was released. Hence, RE 2011-12 was proportionally reduced to Rs.252 crore. However, the Ministry has managed to release an amount of Rs.204.52 crore to the States based on balances with States and Districts. The projected expenditure during 2012-13 under NPCB is Rs.350 crore (including NE Region). An amount of Rs.221.37 crore has so far been utilized during 69

2011-12 (provisional). Pending approval of Twelfth Five Year Plan, NPCB will continue as per the existing pattern of assistance, approved during the Eleventh Five Year Plan. The emphasis will be on comprehensive eye care, quality service delivery, strengthening of eye care infrastructure, support for human resources and training and capacity building. It has also been proposed to set up a Multipurpose District Mobile Ophthalmic Units @ Rs.30 lakh each during the Twelfth Five Year Plan. 9.3 The Committee is not satisfied with the issue of substantial unspent balances remaining with States in the previous year viz. Rs. 155.52 cores as on 31st March, 2012. On the one hand the Department seeks certain projected amount, on the other it is unable to monitor whether the States are able to spend the amount within the time-frame. The Committee, therefore, impresses upon the Department to monitor effective and timely utilization of funds to justify seeking of enhanced allocations in the Budget. 9.4 As per information received from the Eye Bank Association of India, Hyderabad, there are around 666 Eye Banks existing in States/UTs in the country. As per available information, around 249 Eye Banks are functional to carry eye banking activities. It was targetted to develop/strengthen a network of 30 Eye Banks in the country during the Eleventh Five Year Plan by providing one time financial assistance upto Rs.15 lakh per unit through respective State Health Societies. The Committee hopes that the Department would have been able to achieve the targets set during the Eleventh Plan as one of the major causes of Blindness is the lack of proper eye banks for eye donation or collection resulting in low levels of eye transplants leading to blindness of the affected persons. The Committee would like to be apprised of the status of eye banks being set up in the country, which would help it keep track of the physical achievements on this front.

X. NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME 10.1 Iodine is an essential micronutrient required daily at 100-150 micrograms for normal human growth and development. Deficiency of iodine can cause physical and mental retardation, cretinism, abortions, stillbirth, deafmutism, squint and various types of goiter. Results of sample surveys conducted in 365 districts covering all the States/Union Territories have revealed that 303 districts are endemic where the prevalence of Iodine Deficiency Disorders is more than 10%. It is estimated that more than 71 million persons are suffering from goiter and other Iodine Deficiency Disorders in the country. 10.2 The outlay for the programme for the year 2011-12 was Rs.50.00 crore which was reduced to Rs.39.00 crore at RE. Some of the proposed activities i.e. supply of Salt Testing Kits to all States/UTs and honorarium to ASHAs did not take place. The fund utilization during the year 2011-12 under the programme was Rs.23.04 crore. The allocation under the programme for the year 2012-13 is Rs.50.00 crore. The activities i.e. supply of Salt Testing Kits to 303 endemic districts of States/UTs and payment of honorarium to ASHAs on testing 50 salt samples per month will be conducted during the fiscal year 2012-13. These have been approved by EPC and will be placed before next MSG meeting. 10.3 The Committee is dismayed with the utilization of funds allocated for the programme. The Department did not utilize a substantial amount of funds allocated which is against the principles of fiscal prudence. Moreover, in the face of 303 districts out of 365 surveyed being endemic does not augur well on the physical achievements front as well. The Committee expresses its displeasure at the state of the things and emphasizes the need to overcome the bottlenecks in the proper implementation of the said programme. 10.4 The Committee also expresses its concern over the fact that out of 365 districts surveyed in the country, 303 were found to be endemic. If a survey is carried out in all the 70 districts of the country it would not come as a surprise if the results throw a more alarming situation in hand. The Committee recommends that a focused intervention in all the States/ UTs need to be taken without undue delay in face of the spectre of Goiter looming over the country.

XI. INTEGRATED DISEASE SURVEILLANCE PROGRAMME

11.1 The objectives of the Integrated Disease Surveillance Programme are to establish a decentralized state based system of surveillance for communicable and non-communicable diseases and to improve the efficiency of the existing surveillance activities of disease control programmes.

11.2 On the reasons for reduction of allocation at RE 2011-12 stage from B.E. Stage 2011-12 and the utilization status, the Department has informed that vacant contractual positions are the key reason for under utilization of funds. Rs 42-57.00 crore would be needed for this component every year if all contractual positions under IDSP are filled up. Hence to account for this, the allocation for National Integrated Disease Surveillance Programme (IDSP) was reduced to Rs. 45.00 crore at RE 2011-12 stage (RE Rs.39.50 crore excluding NE States) from Rs.63.00 crore at BE stage (BE Rs.55.00 crore excluding NE States). Further, during 2011-12 a total of Rs.25.67 crore expenditure has been incurred (provisional). Also, less recruitment of technical staff affected capacity of State/District surveillance units to analyze and use surveillance data for local decision and outbreak responses. Further, all the ongoing initiatives/activities under this programme except strengthening of district public health labs are presently running as per schedule. Non-recruitment of Microbiologists for District Public Health Labs has affected the strengthening of labs. During the Twelfth Five Year Plan (2012-17) all the activities presently being undertaken under IDSP are proposed to be continued as a Central Sector Scheme with domestic budget.

11.3 The Committee observes that on the one hand the Department seeks funds justifying it by stating that funds are needed for contractual posts to be filled up every year, while on the other a substantial amount of it is saved by way of under-utilisation, thereby weakening the basic idea of the programme. Without quality and reliable data, the entire Surveillance Programme would lose its relevance. The Department should, therefore, convey better sense in using its wherewithal for augmenting its physical parameters with the finances allocated to it in the future.

11.4 With regard to Training to staff to be recruited in 2012-13, the Department has informed that Training Institutes have been identified and Training Material and curriculum is ready. Though the progress being made on the training front is appreciable, but the Committee feels that the States have been slow with the additional lists of persons required to be trained. The Committee, therefore, recommends that the Department should sound the States not only to provide the list of additional persons to be trained on a priority basis but also to provide feedback on the number of persons required to be recruited under this programme in the Twelfth Plan.

XII. NEW SCHEMES DURING THE TWELFTH PLAN

12.1 As per information provided by the Department, the following new schemes are proposed to be undertaken by the Department during the Twelfth Plan under the NRHM, as per the MOD signed between the Department and the Planning Commission:– • New Initiatives under CSS • NRHM 71

Strengthening of District Hospitals for providing advanced secondary care Providing free genetic medicines in all public health institutions in the country • Strengthening Govt. Medical colleges and Central Govt. Health Institutions • Establishing New Medical colleges • Setting up of State institutions of paramedical sciences in States and Setting up of college of paramedical education • Setting up of college of pharmacy in Government Medical Colleges • Strengthening of State drug regulatory system • Strengthening of State food regulatory system • Innovation based schemes 12.2 The Committee while being appreciative of the new Schemes proposed to be launched under this flagship programme feels that the absorptive capacity of various State Governments to absorb the funds under the Mission in the Eleventh plan leaves much to be desired and the Department needs to seriously analyse the reasons for in the majority of Schemes there was a massive underutilisation of funds disbursed to the States. The Committee, therefore, feels that before introducing so many schemes in the Twelfth Plan there is a need for the Department to seriously engage the States to shore up their infrastructure so that they are able to benefit in real terms and the funds percolate to them during the Twelfth Plan. 72

OBSERVATIONS/RECOMMENDATIONS — AT A GLANCE

PART-A HEALTH SECTOR

I. BUDGETARY ALLOCATION

Year BE RE Actual Expdt.

2007-08 2985.00 2331.39 2183.83

2008-09 3650.00 3650.00 3008.40

2009-10 4450.00 3825.25 3261.90

2010-11 5560.00 5139.55 4666.04 2011-12 5720.00 4450.00 4101.41

Total – XI Plan 22365.00 19396.19 17221.58

From a scrutiny of the above Table, the Committee is constrained to observe that there was substantial and persistent under-utilization of the budgeted funds during the Eleventh Plan. That the savings occurred under the Plan head underlines the fact that the development activities have been curtailed. Though the Committee is supportive of the Department’s demand for higher allocation of funds, it deprecates the Department for failing to optimally utilize its Plan Allocations over the last five years. The Committee observes that the underutilization of budgeted funds is indicative of slack monitoring on the part of the Department as well as formulation of the Budget Estimates in a ritualistic manner without application of proper financial yardsticks. The Committee, accordingly, impresses upon the Department to pay focused attention to streamlining its monitoring mechanism and ensure optimal and more efficient deployment and utilization of its financial resources for smooth execution of its Plan programmes. (Para 1.2)

The Committee observes that a shortfall in allocation of funds to the tune of Rs. 10507.53 crore vis-a-vis the proposed outlay for 2012-13 that too at a time when the Government has committed itself to raising its expenditure on health from roughly 1% of the GDP to 2.5% of the GDP by the end of Twelfth Plan is baffling, to say the least. The public expenditure on health in the country is one of the lowest in the world and total plan expenditure would need to rise substantially and consistently before the target expenditure level of 2.5% of GDP is achieved. The Committee, therefore, desires to know the reasons behind the substantially reduced allocation for 2012-13. The Committee also desires to know the rate at which the total Plan expenditure would need to grow annually, in order to meet the expenditure level of 2.5% of GDP by the end of the Twelfth Plan and what would be the share of the Centre and the States therein. The Committee, therefore, recommends that the Department should make all out efforts to convince the Planning Commission and the Department of Expenditure for enhancing the annual Plan allocation for the remaining four years of the Twelfth Plan and also at RE 2012-13 in such a way that the target of meeting expenditure level of 2.5% of GDP could be achieved. (Para 1.6)

72 73

From the information made available, the Committee gathers that some of the major programmes/heads which are likely to be affected due to substantially less allocation of funds include PMSSY, Financial Assistance for Strengthening and Upgradation of Medical Colleges, Establishment of New Medical Colleges in underserved States, Strengthening of tertiary care institutions like AIIMS, JIPMER, PGIMER, NIMHANS, Safdarjung Hospital and VMMC, RML Hospital, NPCDSC, Capacity Building for establishing Trauma Care Facilities in Government Hospitals on National Highways and the proposed National Urban Health Mission. The Committee is of the firm opinion that the above trend of allocation of funds would adversely impact the public health sector’s ability to cater to the healthcare needs of the people at large. The Committee is also aware that the absorption capacity of the States has witnessed improvement and their spending capacity is expected to pick up during the Twelfth Plan. Besides, presently more than 9 crore people of the country have been categorized as urban poor, mostly residing in urban slums. The level of availability of health care facilities to these poor people is worse than that available to the rural poor. Their health indicators are also worse than those of the rural poor. The Committee, accordingly, opines that non-rolling of National Urban Health Mission on account of no provision of funds would further impact the health indicators of poor people residing in urban slums. (Para 1.9) Taking all the above factors into consideration, the Committee recommends that the Department should once again assess its fund requirements realistically and thereafter move the Planning Commission for augmentation of financial resources for health sector for 2012-13 at RE stage. The Committee would like to be apprised of the follow-up action taken in this regard. (Para 1.10) From a perusal of the utilization trend of the allocation as given in the Table above, the Committee infers that the Department has failed to meet broad committed objectives of the Eleventh Five Year plan. The Committee feels that the Department needs to introspect the reasons for underutilization of funds practically in all of its major initiatives targeted to be achieved during the Eleventh Plan period and take appropriate corrective actions accordingly. In addition to dedicated approach, advance action plans may also be drawn for completion of all the projects in hand within the targeted timelines. (Para 1.13) The Committee’s attention has been drawn to faulty planning of the National Programme for Prevention and Control Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS). The Committee was informed that NPCDCS was launched in 2010 in 100 districts across 21 States. Under Cancer component of NPCDCS, various activities like early diagnosis of Cancer, Chemotherapy facilities etc. were envisaged. However, non-availability of adequate manpower, non-signing of MODs with State Governments, non- opening of Bank Accounts in States etc. led to reduction of BE of Rs.200.00 crore for 2011-12 to Rs.112.00 crore at RE stage and the actual expenditure was pegged even less at Rs.99.79 crore, which clearly reflects that the Department did not complete preparatory activities on time. From the information furnished the Committee gathers that Non Communicable Diseases (NCDs) are emerging as a leading cause of death in the country accounting for 42% of all deaths and that NCDs cause significant morbidity and mortality in population with considerable loss in potentially productive years of life. The Committee would, therefore, expect the Department to urgently initiate appropriate corrective measures to arrest shortfall in utilization of the budgeted amount for NPCDCS In future. (Para 1.14) The Committee recalls the following recommendations it has made in its 39th Report:– 74

“The Committee takes note of the fact that the Department has taken measures like for non-recurring grants, no fresh releases are being authorized unless audited Utilization Certificate for grant released in the year prior to the last year (i.e. with a ‘grace period’ of one year) has been received, subject to the condition that the sanction for the earlier grant does not permit a longer period of utilization. Further, the provisions of the General Financial Rules, which require that in case of recurring grants, funds for same purpose beyond 75% of the next year’s provision will not be released unless audited Utilization Certificate for the grants released in the previous year is received, are being strictly implemented. Impact of such measures does not seem to be very effective as number of pending UCs continues to remain very high. Not only this, such a trend also indicates that schemes are not being implemented as envisaged.”

“The Committee notes that as a further effort to maximize liquidation of UCs, a communication has been sent by the Secretary (Health) to the Principal Health Secretaries of all the States. If need be, this exercise needs to be pursued further with higher authorities.” (Para 1.18)

The Committee is deeply disturbed that no heed has been paid to the Committee’s above observations/recommendations, and a large no. of UCs are still pending under both the Centrally Sponsored and Central Sector Schemes. The additional measure taken by the Department by sending a communication from the Secretary (Health) to the Principal Health Secretaries of all the States has also been proved to be futile. The Committee, accordingly, recommends that the Department needs to have a serious introspection of the reasons for pendency of such a large no. of Utilization Certificates’ and come out with clear and innovative action plans for liquidation thereof. (Para 1.19)

The Committee is constrained to note that to a pointed query to the Department in this regard, the Department has either merely stated that the ATN has been submitted to the Audit or the ATN is under preparation. The Committee rather desires that details of the Action Taken by the Department on the Audit paras should have been made available to the Committee. The Committee also takes note of the fact that action on audit paras dating as far back to years 2008, 2009 are still under preparation stage. The Committee calls for a speedy action on the observations as contained in audit paras. The Committee would like to be apprised of the action taken in this regard. (Para 1.21) The Committee notes that the Eleventh Plan has concluded; however, the Twelfth Plan outlay of the Department is yet to be approved. The Committee feels that the delay in approval of the Twelfth Plan outlay is sure to impinge on the process of EFC/CCEA approvals which entails further delay in finalization and implementation of the Schemes/ Programmes of the Department for the Twelfth Plan. The Committee, therefore, recommends to the Government to hasten the approval of Twelfth Plan outlay and related proposals so that the Department is not hamstrung by lack of necessary approvals and the consequent delay in finalization and implementation of various schemes/ programmes in the Twelfth Plan period. The Committee desires to be apprised of the reasons for delay in approval of the Twelfth Plan outlay of the Department. (Para 1.23)

II. CENTRAL GOVERNMENT HEALTH SCHEME

Status of allocation of Plan funds and utilization thereof during the Eleventh Plan is as under: 75

(Rs. in crore) Year BE RE AE 2007-08 40.00 40.00 35.20 2008-09 50.00 59.37 45.45 2009-10 51.00 66.64 58.02 2010-11 68.65 80.81 57.21 2011-12 78.00 78.00 61.67 (Para 2.2)

The Committee is disappointed to note the continuous trend of under-utilization of Plan Funds during the last five years i.e. Eleventh Plan, more so when the Department has sought enhanced funds at RE stage during 2008-09, 2010-11 and 2011-12. The actual expenditure figures also indicate that the Department could not even utilize the funds allocated at BE stage except during 2009-10. The Committee, therefore, strongly recommends that the Department should devise strategies to utilize the allocated funds optimally before proposing the revised estimate so that the funds are not unnecessarily blocked and remain unspent. (Para 2.3)

The Committee observes that the Department has to undertake lot of ground work in CGHS and is of the view that for this purpose the targets need to be set, resources to be placed at the disposal in time and implementing agencies need to be made accountable for accomplishing the set targets from the very outset. (Para 2.4)

The Committee is given to understand that this deficit in allocation may adversely affect procurement of medicines. The Committee, therefore, recommends that the Department should try its best to convince the Planning Commission and Ministry of Finance, for enhancement of allocation at RE stage for procurement of medicines. (Para 2.5)

The Committee lauds the efforts made by the Department to bring about a significant reduction in pendency of reimbursement claims and hopes that the Department would strive to bring this figure further down with its sincere efforts. The Committee likes the Department to issue a circular intimating the simplified procedures and for dispelling any misgivings among the beneficiaries. (Para 2.6)

The Committee observes a lot of ambiguity in process of reimbursement of bills and the facts that are brought to the notice of the Committee are at variance. The Committee, therefore, recommends to the Department to issue a fresh circular in this regard addressing all the misgivings currently prevailing among beneficiaries. (Para 2.7)

The Committee notes the initiatives taken by the Department to simplify the bill reimbursement process under which the empanelled hospitals and diagnostic centers are required to submit their bills after discharge of the patient which will pay them the applicable amount as per the packagerates for the treatment within 10 days. However, on the basis of feedback received from various witnesses, the Committee is dismayed on the poor outcome of the above mentioned scheme. The Committee is of the view that assessment of the scheme should be done to gauge its performance as also to take corrective steps for its smooth functioning. (Para 2.8) 76

The Committee notices the hardships the beneficiaries have to face in getting their bills reimbursed. The Committee would like to suggest that the Department should continuously monitor the claim reimbursement mechanism and also ensure the claim adalats meant for settling pending claims are regularly held. The Committee understands that third Thursday of every month is designated as claims settlement day for interaction with the beneficiaries to sort out pending reimbursement claims. The Committee impresses that the Department may try to settle more and more pending claims on this day. (Para 2.9)

Keeping in view the success of the scheme, the Committee feels that these facilities should be made available at all the Wellness Centers across the country so that more and more CGHS beneficiaries can avail these facilities. Secondly, the Committee also suggests the Department to have a monitoring mechanism to gauge the performance of Preventive Health Checkup Scheme at regular basis so as to maintain the quality standards of diagnostics and treatment procedures. While appreciating Departments efforts to spread awareness about this scheme, the Committee would like to suggest that Department should publicize it through audio-video aids; newspapers in regional languages, etc. in order to expand the scheme to a wide range. Also the Department should make efforts to ensure that CGHS beneficiaries should understand the importance of Preventive Health Checkup Scheme and opt for it. (Para 2.10)

The Committee appreciates the Department’s effort to enable the provision of online connectivity of all CGHS Wellness Centers in the country which will enable CGHS beneficiaries to avail the healthcare services from any Wellness Centers across the country. The Committee observes that this is one of the revolutionary benefits accrued as a result of computerization and the Department deserves Committee’s appreciation in this regard. (Para 2.11)

The Committee appreciates that the above scheme is primarily for non-CGHS areas and is of the firm view that if at all it is implemented, it should be over and above of CGHS facility instead of replacing it. (Para 2.12)

The Committee feels that the purpose behind starting the double shifts in CGHS Wellness centers was that the beneficiaries need not have to take leave from their offices to see the doctor in the morning shift and further, patients’ load will also get distributed. Moreover, the Committee is of the view that double shift system needs an extended run along with wide publicity through local and print media. The viability of using same staff on rotation basis can also be looked into. In addition to this, the Department should be flexible and open to understand the reasons for low turnout and implement corrective action plan based on its assessment. The Committee, accordingly, impresses upon the Department to see the viability of implementing double shift system in other wellness centers also particularly those located at prominent places and catering to a considerably large number of beneficiaries. (Para 2.14)

The Committee appreciates the efforts made by the Department to expand the coverage of CGHS by increasing the number of Wellness Centers. The Committee is of the opinion that setting up of Wellness centers at given location should be put on fast track with emphasis on time bound completion of the projects. Further, the Department should not limit the scope of CGHS healthcare facilities to Delhi. NCR but across the length and breadth of the country alongwith assessment of workload vis-a-vis capacity of Wellness Centers and taking necessary remedial measures accordingly. (Para 2.15) 77

Despite the Department’s claim that the contractual appointments of retired doctors is being made to fill up the vacancies, Committee is constrained to observe on the basis of the feedback received from various stakeholders that there is still a huge gap between the doctors in position and the sanctioned strength. If all the vacancies had been filled up by contractual appointment as claimed by the Department, the vacancies would have ceased to exist. The Committee, therefore, observes that the Department should reassess the strategies adopted to fill up the vacancies and come up with realistic measures so that the shortage of doctors and paramedical staff in CGHS dispensaries can be overcome. (Para 2.19) The Committee is constrained to note that the reluctance of the private hospitals and diagnostic centers for empanelment is because of the low rates quoted by the CGHS for the specialized treatment and diagnostic procedures due to which the CGHS beneficiaries are deprived of highly specialized medical care and diagnostic facilities. The Committee hopes that the Department would rationalize the new package rates as committed in the meeting. (Para 2.20) One must not forget that the main objective of CGHS is to provide quality healthcare at economical rates to the targeted beneficiaries. The Committee, therefore, is of the view that the rates should be rationalized so that the beneficiaries should be able to avail high quality diagnostics, laboratories, specialized medical and surgical treatment in various private super specialty hospitals. The Committee, accordingly, recommends framing of a policy for revision of rates after every two years to realistically fix the rates of treatment as stated in 39th Report of the Committee on Demand for Grants 2010-11 and would like to be updated about the action taken by the Department in this regard. (Para 2.21) The Committee is happy to note that the computerization of various facilities of CGHS has brought about transparency and accountability in administration of CGHS and has proved instrumental in identifying the malpractices and negligence in drug procurement procedure. The Committee is of the opinion that the punishment in these cases should act as strict deterrence for all functionaries of CGHS. The surprise visits by the concerned authorities to check the records and verify the details of demand, supply and consumption pattern of drugs in CGHS Wellness Centers can be also considered for regulating the functioning at CGHS. The Committee, therefore, recommends that the Department should devise some checks and balances to ensure that incidence of fraud and corruption reported recently in media should not recur in future. (Para 2.23)

III. SAFDARJUNG HOSPITAL, NEW DELHI The Committee is of the opinion that in view the vanous expansion activities proposed to be undertaken by the Hospital during the Twelfth Plan, there is a need for increased allocation for the Hospital. The Committee, therefore, recommends that if need be, the Department may approach the Planning Commission and Department of Expenditure to increase allocation at RE stage 2012-13 and also seek enhanced funds for subsequent financial years of the Twelfth Plan as per the requirements. (Para 3.5) The Committee is very much concerned with the persisting vacant position in different categories of posts at the Hospital and VMMC. As per the information provided by the Department, the Committee finds that there is no noticeable change in the situation since 2010. As on 31.12.2010, out of total sanctioned strength of 4101 posts in different categories, as many as 582 posts were vacant and as on 31.12.2011, out of total sanctioned strength of 4056 posts, 487 are vacant in different categories. What is more worrisome is the shortfall in Group B medical posts have not changed since 2010. As 78 many as 28 medical personnel are still required to be in place out of total strength of 56. The status of vacant posts presents a sorry state of affairs. The Committee is not aware about the status of filling up of Group A posts initiated by the Department. But from its past experience, the Committee can only conclude that it would be a long drawn affair. Looking at the ever-increasing attendance of patients in the Hospital which was 23, 22,152 in the year 2011, the Committee concludes that to cater to the healthcare needs of such a high load of patients, the actual requirement of the medical, paramedical and Group D staff at the Hospital is higher than the sanctioned strength. The Committee is of the opinion that vacancies, irrespective of its category, directly or indirectly have an adverse impact on the quality and quantity of services being rendered by the Hospital in addition to the overstressing of the existing manpower. It seems that the Department has not given due attention to the status of vacancy positions in different cadres at SJH. The Committee, therefore, would like to impress upon the Department to review the manpower requirements of the Hospital considering the patient load and put all the efforts together to not only fill up the existing vacancies at the earliest, but also put up its case for increase in staff strength. (Para 3.7)

The Committee is happy to note that Department has acted positively to the Committee’s earlier recommendation and had taken steps to not only to fill up the vacant posts of Resident doctors but also after review of manpower vis-a-vis sanctioned strength had created more posts in different cadres. The Committee is of the opinion that the Department should take measures for reviewing the manpower strength year wise at a regular basis to ensure that the process of filling-up of the vacancies is initiated well in advance so that the duration of vacancy to any post is minimized to the lowest level and the ever increasing patient load in the hospitals is aptly tackled. (Para 3.10)

The Committee, therefore, would like to reiterate its earlier recommendation made in its DFG Report (2010-11) that the provision of the required accommodation facilities for nursing staff should be taken on priority basis and if feasible, it should be considered under the Re-Development Plan of the Hospital. In addition to this, the Committee is also of the opinion that the provision of transport facility from the hospital to staff quarter at Dwarka should be provided considering the distance of the hospital from Dwarka and the night duties of the nursing staff. The Committee should be updated in this regard. (Para 3.11)

Keeping in mind the achievement of the Re-development plan of SJH during Eleventh plan, the Committee recommends that the Department needs to have a serious introspection of the reasons for shelving the re-development Plan of SJH during Eleventh Plan. Further, the Department should take realistic measures and make all conceivable efforts so that the whole new re-development project gets completed within the given time period. For this to happen, from the very outset, targets need to be set, resources to be put to use judiciously and implementing agencies to be made accountable to accomplish the set targets. (Para 3.12)

The Committee fails to comprehend the reasons for the delay in recruitment of DM Nephrologist. Nonetheless, the Committee is surprised that no action has been taken in this regard so far and is dismayed that having invested so many funds in renovation of space, procuring equipments and training of staff for Renal Transplantation Unit, the project is yet to see the light of the day. The Committee feels that Department has failed to prioritize their activities before acting upon the projects. The Committee, therefore, is of the opinion that inspite of all good work done by the Department, the delay in filling up the post of DM Nephrology has superseded its effort in kick-starting the RT unit. (Para 3.13) 79

The Committee expresses its displeasure at unjustifiable delay in setting up of IVF Unit in SJH arising out of conflicting statements provided by the Department in this regard. The Committee feels that the development work has been carried out at snail pace and has failed miserably. The Committee would like to draw the attention towards Department’s statement as mentioned in 39th Report on DFG 2010-11 wherein it has been stated that second floor of old Cardiology Wing had been selected as site for setting up of IVF Unit and inspection was also carried out in August, 2009 along with the go-ahead for carrying out necessary renovation work. Now, the Committee has been informed that space constraint is hampering operationalization of IVF Unit. This clearly shows lack of accountability on part of Department and improper planning and mismanagement of resources. The Committee, therefore, recommends that Department should channelize its efforts in doing realistic assessment to remove all the bottlenecks in setting up of IVF Unit and chalk out a time bound action plan with regard to funds allocated for the purpose. (Para 3.14)

V. DR. RAM MANOHAR LOHIA HOSPITAL The Committee is not happy with the slow pace of construction work and recommends that the Department needs to make serious introspection of the reasons for delay in execution of various projects envisaged during 2011-12 and take all measures to see that the same reasons do not crop up again and hinder the progress of various projects/ programmes envisaged in current financial year. A realistic assessment of targets and dedicated timelines for their achievements would be a right step in this direction. (Para 5.4) The Committee would like to be apprised of the action plan for the construction of New Casualty Building, the physical and financial targets set therefor and the resources to be deployed w.r.t. the new projects. The Committee feels that the Department should strive to adhere to the time lines set for completion of various projects. (Para 5.6) The Committee is disappointed on the continuance of a large number of vacancies in different categories of post. Although new posts have been created in the category Senior Residents (SR) and Group ‘C’ Nursing, the process of filling up of these posts has not been started yet. The Committee is unable to comprehend as to why there has been always a substantial number of vacancies at any given point in time. At least, in case of Resident Doctors (RD), the Department can pro-actively step in to place the next batch of RDs well in advance. Since the hospital is catering the health needs of ever increasing patients, the Committee can easily visualize the amount of burden on the existing manpower. In such scenario, it is really a matter of concern that such a large number of vacancies is allowed to persist. The Committee, therefore, keeping in mind the OPD, IPD attendance of the Dr. R.M.L. Hospital, would like to suggest that Department should consider necessary steps to expedite the process of filling up of newly created posts of senior residents and nursing category which are integral part of health care services to ensure smooth functioning of the Hospital on priority basis. (Para 5.8)

VI. CENTRAL INSTITUTE OF PSYCHIATRY (CIP), RANCHI The Committee is hopeful that the funds earmarked for the projects would be utilized judiciously and optimally so that the envisaged projects are accomplished as per the timelines set in this regard. (Para 6.4)

VII. KALAWATI SARAN CHILDRENS HOSPITAL, NEW DELHI On the issue of Hospital staff in place as per the sanctioned strength in various categories, the following information has been furnished: 80

Sl. No. Group Sanctioned Post Filled Post Vacancy 01 A 44 30 14 02 B 150 137 13 03 C 589 426 163 04 D 170 157 13

TOTAL : 953 750 203 (Para 7.3) From the plain reading of the above information, it can be found that a large number of posts are lying vacant in all the service categories (Group A, B, C & D). The Committee, therefore, recommends that Department should take urgent steps to fill up the vacancies at the earliest so as to fulfil the objective of providing better quality of patient care to all patients. (Para 7.4)

VIII. LADY HARDING MEDICAL COLLEGE

In light of the activities undertaken by the Hospital; the Committee understands that underutilization of funds reflect that the Hospital has failed to accomplish the targeted activities during the Eleventh Plan. The Committee, accordingly, recommends that the Hospital should draw out definite action plan for realization of its targets and monitor construction of new hospital and other related buildings scrupulously. (Para 8.2) The Committee impresses upon the Department to take up the matter with the UPSC for expediting recruitment of regular staff to fill up a large number of vacancies existing in the Hospital. The Committee would like to be apprised about the preparatory steps taken so far to fill up the additional sanctioned 810 posts, which would be filled-up on availability of additional facilities under CRP. (Para 8.5)

IX. ALL INDIA INSTITUTE OF MEDICAL SCIENCES (AIIMS)

The Committee notes the fact that in spite of lot of developmental work being undertaken, most of projects have gone beyond the targeted time-line. The Committee has been informed that the delay in execution of various infrastructure development project is attributed to delay in approval of Master Plan of AIIMS which is pending due to clearance from various agencies like MCD, NDMC, CPWD etc. The Committee feels that time overruns are certain to result in cost overruns. The Committee, therefore, recommends that the Department should chalk out a time bound Action Plan for the projects which are yet to be executed and also for the projects underway. Further, the Committee would like to be apprised of the current status of various approvals and also the extent of cost overruns likely to be caused due to the delay in completion of projects. The Committee would like to be apprised about the targeted timelines for all the underway projects planned in AIIMS. (Para 9.8)

The Committee is not convinced that opening of Burns injury facilities in salient districts in the country would in any case reduce the requirement of an additional burns unit at AIIMS since Safdarjung Burns Ward is already burdened with patients. The Committee, accordingly, recommends that the Department should reassess the requirement of Burns Unit at AIIMS. (Para 9.9) 81

The Committee is extremely disappointed with the vacancy position in different categories of posts in AIIMS. Out of total sanctioned strength of 10639, 1468 posts are lying vacant in various categories. The Committee is perturbed to note that 303 posts of Assistant Professors are lying vacant in such a premier institute and feels that this would bound to adversely affect the quality of healthcare services rendered by the premier Institute of the country. Besides, this would also adversely impact the quality of medical education being imparted at AIIMS. (Para 9.11) The Committee observes that with a large number of posts lying vacant at Faculty level it would be practically difficult for the Institute to maintain the high standards of patient care and teaching for which it has been known for decades. The efforts made by Department to fill up the backlog vacancies came as sign of relief to the Committee. While appreciating the Department’s efforts, the Committee would, however, recommend to the Department to make all out efforts to fill up all the vacant posts existing in faculty, non- faculty and other categories in a time bound manner. (Para 9.13) The Committee cannot remain a mute spectator to the appalling circumstances prevailing in such a reputed Institute like AIIMS which is a role model for all medical institutes across the country and implore upon the Department to take proactive steps not only to fill up the vacant posts on a war-footing but also to initiate a blueprint to ensure a decent doctor-patient ratio, which would help the Institute to achieve the overall aim of the Institute to provide tertiary care and path breaking research. The Committee feels that the above objectives can only be possible when there is adequate number of doctors who could besides delivering quality healthcare to the patients also devote quality time for research activities. Hence, a realistic assessment of available manpower vis-a-vis sanctioned strength of the Institute is urgently required. (Para 9.15) The Committee is not convinced with the reply furnished by the Department. The Committee has merely opined that probability of utilizing the services of the students passing out from AIIMS may be explored in view of the huge vacancy position at AIIMS. However, it is surprising to note that an Institute like AIIMS has expressed its inability to retain students passing out of the Institute after graduation. The Committee, therefore, expresses its displeasure that its earlier recommendations made in 27th and 39th Reports have not been given adequate weight and lack of seriousness required on the part of the Institnte to implement the recommendation made by a Parliamentary Committee. The Committee implores upon the Department to explore the possibility of implementing its suggestion without any further delay. (Para 9.16)

X. NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES (NIMHANS), BENGALURU The Committee finds although the Plan allocation is lesser than what was projected by the Institute, it should be utilized effectively by prioritizing the activities/expenditure without having significant impact on the performance of the Institute. Prioritization would enable phasing out lesser priority areas to the subsequent years of the plan period. However, if the Department finds itself hamstrung midway, the Committee recommends the Department to approach the Planning Commission and the Department of Expenditure seeking for more funds at RE stage, as per its requirements. (Para 10.4)

XI. THE POST-GRADUATE INSTITUTE OF MEDICAL EDUCATION AND RESEARCH (PGIMER), CHANDIGARH From the perusal of status of different projects envisaged during the Eleventh Plan 82 period, the Committee notes that in many areas no or negligible achievements have been made as against the targets set. The Committee observes that this state of affairs clearly reflect that Institute has not drawn out its action plans for achieving the goals set in right perspective and targets could not be achieved despite availability of adequate funds. The Committee, therefore, strongly recommends the Department to make a checklist of all approvals required before the execution of works and approach the concerned agencies for getting this same. The Institute should draw definite action plans and timelines for completion of all the projected works to avoid cost overruns. (Para 11.2) The Committee is of the opinion that lack of funds should not hamper the progress of the projects and recommends that this could be achieved by proper monitoring and judicious utilization of the available funds. The Department should if required take up with the Planning Commission and Department of Expenditure for revision of funds at RE stage. (Para 11.3) The Committee takes note of the measures taken by the Hospital to fill up the vacancies in different categories. The Committee would appreciate if these posts get filled up as scheduled. (Para 11.4)

XII. NORTH EASTERN INDIRA GANDHI REGIONAL INSTITUTE OF HEALTH AND MEDICAL SCIENCES (NEIGRIHMS), SHILLONG The Committee is happy to note that the Department has chalked out a defined development plan of the Institute but has not been set any timelines/deadlines for the proposed initiatives. Since all the projects are under planning stage, the Committee would like the Institute should frame a time bound Action plan for execution of all projects emphasizing on judicious utilization of resources at the outset. The Committee, therefore, recommends to the Department to monitor execution of all the proposed new initiatives from the outset so that these are accomplished as targeted. (Para 12.3) With due regards for the measures taken by Institute for filling up the vacancies in faculty posts, the Committee is hopeful that 93 vacant posts of faculty will be filled soon to cater to the healthcare needs of patients from deprived region of North-East. (Para 12.6) The Committee notes that no further efforts have been made to fill up Group ‘B’ and ‘C’ Technical Posts which is evident from huge number of posts numbering 131 (Group B) and 190 (Group C) out of sanctioned strength of 608 and 352 lying vacant respectively. The Committee is unable to comprehend as to how the Institute is working effectively with such a large number of vacancies. The Committee opines that the manpower and infrastructure are two foremost requirements for smooth functioning of any Institute. The Committee, accordingly, recommends the Department to put relentless efforts to attract technical manpower by special incentives and special recruitment drives to facilitate early filling up of the vacancies. The Committee would like to be updated on the issue. (Para 12.7)

XIII. PRADHAN MANTRI SWASTHYA SURAKSHA YOJANA (PMSSY) The Committee observes that although the ground work under the all packages more or less has been started, the completion has spilled over to 2012-13. It is self revealing situation to comprehend the correlation between pendency of work under the scheme and under-utilization of funds. The Committee is perturbed to note the slow pace of implementation of Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) scheme, one of the 83 key initiatives of the Department launched with the objective of correcting regional imbalances in the affordable tertiary healthcare services as well as to augment facilities for quality medical education in the country. Almost all the projects proposed under the programme are running beyond schedule. The Committee observes that the delay in operationalization of this ambitious project would certainly lead to the cost overruns. The Committee, therefore, recommends to the Department to streamline monitoring of the progress of the project and strive to meet the new targets set under PMSSY. (Para 13.6) The Committee recommends that the Department needs to have a serious introspection of the reasons which led to not only in delay in completion of targeted projects but also resulted in underutilization of funds and cost overruns as the Department has to seek approval for the revised estimates for the project. The Committee expects that the Department would meet its deadline to start AIIMS like Institutes functional from this academic session 2012-13 i.e. August, 2012. (Para 13.8) The Committee impresses upon the Department to learn from the hurdles being faced in the rolling out of Phase I of the project and make a serious effort to plug all the possible loopholes to ensure timely completion of the targeted projects. (Para 13.11) From the perusal of the Details of Targets set and achieved, the Committee notes that percentage of work completed in respect of up gradation of State Government Medical colleges, is well below the targeted deadline. The Committee only hopes that the Department ensures to meet the new deadlines set in this regard. (Para 13.13) The Committee appreciates the Department for taking timely suitable action to meet the faculty and equipments needs of the six AIIMS like Institutes. The Committee hopes that all the exercises would be completed well within the dedicated timelines and all the Institutes would be made functional from the current Academic session 2012-13. (Para 13.16)

XIV. DEVELOPMENT OF NURSING SERVICES From the perusal of the physical targets set vis-a-vis achievements made, it can be seen that in one area the Department has crossed the physical targets set but in other areas, the Department has missed the targets by almost 50%. The Committee would like to suggest that a better planning model should be put in place enabling the Department to achieve all targets, instead of over-achieving one facet of the plan, and missing on other fronts. The Committee would like to be apprised the reasons for reduction in allocation from Rs.34.00 crore (BE) to Rs.25.00 crore at RE stage. Whether the reduction in allocation indicates that the targets originally conceived were either shelved or could not executed? (Para 14.3) The Committee is happy that the Department has acted on its advice, but it feels that yet a lot is to be achieved in this regard as the number of faculty trained till date is miniscule as compared to the grants in aid given to the States. The Committee, accordingly, impresses upon the Department to take its recommendations in right perspective and act on it with vigour and urgency it calls for. (Para 14.6) The Plan funds allocated for the programme for 2012-13 arc Rs.22.50 crore against the projected outlay of Rs.55.00 crore. Given the fact that the provisional expenditure exceeded the allocated funds during 2011-12, the Committee is surprised to find a huge gap of Rs.32.50 crore between the projected and budgeted funds for 2012-13. The Committee was also apprised of many on-going programmes and new schemes proposed under development of nursing services. Further, upgradation of RAK College of Nursing into Centre of Excellence is also under process. The 84

Committee, therefore, recommends that additional funds be allocated at RE Stage so that lack of funds does not hamper the developmental activities undertaken by the Department. (Para 14.7) The Committee is not happy with the slow pace of upgradation of RAK College on account of one reason or the other. The Committee feels that the Department should have acted in an earnest manner to get all the approvals in right time. The Committee had desired to be apprised of the timelines originally set for the project and the new proposed timelines but the Department has chosen to remain silent and non-committal in this regard. The Committee would like to be updated about the status of this project regularly. (Para 14.9) The Committee was apprised that Indian Nursing Council has taken a number of measures to meet the shortage of nurses which include relaxation of norms and conditions applicable in nursing education both for students and teachers as well as Institutions. The Committee expected that these initiatives clubbed with improvement in the pay scales of nurses subsequent to the sixth pay commission’s recommendations and creation of more dwelling units for nurses would have mitigated the problem of shortage of nurses. The Committee, however, feels that still much is to be achieved in this regard. The Committee, accordingly, recommends that concerted efforts need to be made by the Department to fill up the vacancies at the earliest. (Para 14.11) The Committee reiterates its earlier stand on the matter of availability of accommodation for nurses. The Committee is now worried in the light of the fact the nothing significant has happened till now and it seems not enough attention has been paid to its recommendation as contained in its 39th Report on DFG (2010-11). The Department in its Action Taken Note on Committee’s 39th Report has informed that the demand and availability of residential accommodation for nurses is being assessed in consultation with the concerned hospitals. The Committee would like to be apprised of the outcome of the said exercise, and also the follow-up action taken thereon. The Committee is of the opinion that if the Department does not pay proper attention to seriousness of the matter it would fail to get desired and significant results in the Twelfth Five Year Plan also. (Para 14.12) The Committee is happy to note that this issue has been given due weightage by the Department as the steps taken by INC regarding maintenance of live registers of Nurses seems to be encouraging. The Committee, therefore, recommends that the Department should made adequate efforts to materialize the proposed initiatives during the Twelfth Plan and see that these are not bogged down by beaurocratic delays. The Committee would like to be updated on the progress made in this regard. (Para 14.14)

XV. NATIONAL MENTAL HEALTH PROGRAMME

It is evident that the Department has not achieved the set targets during 2011-12. The Committee is of the view that unless the targets are met with the required pace, these backlogs are bound to happen and the spillover of components of programme to the next year is unavoidable. The Committee recommends that the Department needs to take proactive approach and try to bring all the States on board for effective implementation of the programme besides having regular interactions with them. It is high time that the problem areas hampering implementation of the programme are identified and suitable and timely action is taken accordingly. (Para 15.5) The Committee is shocked to see the mismatch between requirement of manpower under NMHP and the personnel actually available. The Department has also stated that 85 there is shortage of the qualified mental health manpower in the country. The Committee is unable to accept the Department’s statement when so many efforts are being invested in strengthening and upgradation of the institutions, training of personnel and research activities. Further, the Committee also notes that the last National survey of Mental Health Resources was carried out a decade back in 2002, which clearly indicates casual attitude on part of Department in this matter. The Committee would like to be apprised of whether the Department is taking any steps to conduct the next National Mental Health survey and parameters on the basis of which such surveys are carried out by the Department. (Para 15.7) The Committee notes that till date only 123 seats have been created under the scheme which is very small considering the actual requirement. The unsatisfactory level of performance of the overall programme and gaps in physical targets and achievements and above all the giant gap in in-position strength vis-a-vis the actual requirement of manpower further strengthens the point that the Department should take up the matter on priority basis and identify the loopholes in the action plan in the implementation of the schemes under the programme and should take necessary steps to expedite all the developmental projects in the field of Mental Health. (Para 15.9) The Committee expresses its displeasure to note that although the Department has proposed to expand DMHP in all the districts across the country, final approval is yet to be given by bureaucratic authorities. With this fate of affairs, the Committee can visualize as to what would be the ultimate results. The Committee, therefore, directs the Department to take urgent and remedial measures to rectify the existing deficiencies and, if need be, approach the Planning Commission as and when it proposes to expand the Mental Health Programme. (Para 15.10) Majority of districts in the country have not still been covered under DMHP, which was initiated way back in 1996. Almost 16 years have passed but the scenario seems to be at standstill. With about 500 districts still remaining outside the reach of this vital aspect of the programme, the Committee can only hope that the matter regarding extension of District Mental Health Programme to all the district of India would be taken up earnestly during the Twelfth Five Year Plan and the failure of the Department to extend the District MHP in the Tenth and Eleventh Plan would not be repeated. The Committee, therefore, recommends that the Department should make all out efforts to accomplish all the set targets within the set time line. The Committee would like to be apprised of breakthrough made in the programme. (Para 15.11)

XVI. CENTRAL DRUGS STANDARD CONTROL ORGANISATION (CDSCO) The Committee feels that the Department should strive to act more vigorously in the area of sample checking to prevent the menace of availability of spurious and sub-standard drugs in the market. (Para 16.5)

Generic Medicines The Committee lauds the efforts made by the Department for promoting availability of generic medicines in the country which is a giant leap for ensuring affordable healthcare for every citizen of the country. But the Committee also observes that still much is to be done and achieved in this direction. The Committee impresses upon the Department to make dedicated efforts for opening of more Jan Aushadi Stores as envisaged. The Committee would like to be apprised about the status of its proposed initiative for supply of generic medicines for all in public health facilities in the country during the Twelfth Plan. 86

The Committee would also like to be informed as to whether the Department is making any effort to ensure prescription of generic only drugs by the doctors. (Para 16.7)

XVII. VACCINE MANUFACTURING UNITS The Committee is concerned about the huge dependency of the country on Private Sector to meet its requirement of vaccines under the Universal Immunization Programme and hopes that the revival of these three PSUs is ensured in targeted timelines, since a lot of time has already elapsed since their closure. As informed, the upgradation of BCGVL, Guindy, and PII, Coonoor is likely to be completed by the middle of 2014 and end of 2014 respectively. Suspension of vaccine manufacturing licenses of these units was revoked in 2010, since then period of more than 2 years has already elapsed and the Department could only get approval of the upgradation plans of these two units. The Committee expresses its serious concern on the slow pace of upgradation process of these units and recommends that its high time the Department should buckle up its shoes to complete upgradation projects in letter and spirit so that requirement of vaccines could be met indigenously. The Committee would like to be apprised periodically about the progress made at BCGVL, Guindy and PII, Coonoor in achieving cGMP compliance. (Para 17.3) The Committee has been constantly monitoring the progress of upgradation of these three vaccines producing PSU’s and is equally perturbed with the dependence on private players on account of closure of these units. Hence, the Committee is delighted that production of vaccines has again started in these units. The Committee, however, hopes that soon the no. of doses of DPT and TT Vacines produced at CRI, Kasauli, meet the national demand. Similar aspirations are there for BCGVL, Guindy and PII, Coonoor. The Committee, accordingly, would like to be updated on the measures that would be taken to increase the production of vaccines in these units to meet the national requirements simultaneously working upon fulfilling of cGMP norms. (Para 17.5) The Committee is not convinced with the evasive reply given by the Department. The efforts or step taken by the Department to regulate the cost of vaccine finds no mention in the reply furnished by it. The Committee, therefore, impresses upon the Department to furnish realistic efforts being made by it to regulate the costs of vaccines. (Para 17.6) The Committee fails to understand as to how the funds of the Department remain under-utilized even after undertaking so many activities in CRI, Kasauli. The underutilization of funds reflect mis-match between the targets set and achieved. The Committee feels that in order to step up production of vaccines at the Institute to meet the national requirements optimum utilization of funds is required; which can only be achieved by chalking out foolproof action plans and dedicated timelines for all the activities envisaged in the Institute. The Committee hopes that the Institutes would make good use of the enhanced allocations. (Para 17.9) The Committee is constrained to note that it has sought to know as to how the enhanced Plan allocation to the tune of Rs.35.00 crore for 2012-13 is proposed to be utilized. The Department reply is casual and evasive since it has stated that the proposed increase in BE 2012-13 to the tune of Rs.1806.70 lakh as compared to RE 2011-12 i.e. (Rs.739.88 lakh) is due to increased targets of vaccine production specially DPT group of vaccines; for rain water harvesting project proposed to be executed by Irrigation and Public Health Department of Himachal Pradesh; and upgradation of existing facilities like Animal House, Yellow Fever, Anti Sera, etc. The Committee is unable to comprehend as to why the Department has chosen to give restricted reply and directs the Department to give complete and coherent reply to the information sought by the Committee. (Para 17.10) 87

XVIII. HEALTH SECTOR DISASTER PREPAREDNESS AND MANAGEMENT INCLUDING EMERGENCY MEDICAL RELIEF

However, the Committee is not convinced with the reasons cited for not procuring one mobile Hospital due to the delay in refraining specification by Technical Sub-Committee which truly reflect no-preparedness on the part of the Department. The Committee, therefore, recommends the Department should even in the absence of any major disaster, acquire all necessary equipments and create the required infrastructure in order to get it fully equipped to face any disaster instead of waiting for the disaster to happen and then move forward for getting prepared to face the same. Almost cent percent under utilisation of allocated funds indicates lack of seriousness and lacklustre approach on the part of the Department for any eventuality. (Para 18.2)

The Committee welcomes and appreciates the aforesaid initiatives proposed to be taken by the Department during the Twelfth Plan. The Committee infers that these measures would certainly help in building a taskforce to strengthen the facilities to be utilized at the time of emergency during disaster subject to the condition that these are implemented in letter and spirit. The proposals of capacity development for medical intervention in various types of disasters and developing Emergency Medical Services if rightly designed result in saving human life. The Committee would recommend the Department to take all necessary steps for initiation of these projects without any procedural delays and to keep a close watch on the progress of new initiatives from the outset so that these are accomplished as targeted. The Committee would like to be informed of the progress made with respect to the new initiatives on quarterly basis. (Para 18.4)

XIX. ASSISTANCE FOR CAPACITY BUILDING

The Committee is constrained to note that during 2012-13, 46 out of 160 Government hospitals are yet to be identified to provide financial assistance for capacity building. This clearly indicates lackadisical attitude of the Department which ultimately results in delay in achieving the set targets. The Committee, accordingly, persuades the Department to play a proactive role in implementation of the scheme so the capacity building target in all 68 Government Hospitals including 46 new hospitals could be achieved well in time. (Para 19.6)

The Committee is happy that the Department has put in place a mechanism for monitoring the scheme. The Committee impresses upon the Department that corrective measures, wherever required, be taken to check any element of delay. (Para 19.7)

XX. RASHTRIYA AROGYA NIDHI (RAN)

The Committee is happy to note full utilization of funds during 2010-11 and 2011-12. The Committee would like to be apprised as to whether any record of number of beneficiaries utilizing funds under RAN has been kept. The Committee is of the opinion that since this service is meant for poor people, the publicity of these scheme should be done in a wider scale in vernacular languages so that the really needy and deserving poor people may avail benefits of the scheme. (Para 20.5)

XXI. NATIONAL TOBACCO CONTROL PROGRAMME

The Committee notes with regret that the allocations made at BE stage was reduced drastically at RE stage during the entire Eleventh Plan period except the year 2008-09. The 88

Committee fails to comprehend the reasons for same. However, the Department could optimally utilize nearly complete reduced allocations made at RE stage. The Committee also feels that a lot more needs to be done to eliminate the scourge of Tobacco related diseases and Department should make all out efforts to utilize entire allocations made at BE stage for the year 2012-13. (Para 21.3)

The Committee, while appreciating the efforts made by the Department on the issue of setting up of Tobacco Testing Laboratories, expresses its displeasure as the laggard approach taken by Department on the matter of setting up of National Tobacco Regulatory Authority (NTRA). The Committee, therefore, recommends that the Department should prepare a blueprint by the time the said authority would be set up and keep the Committee regularly updated of the progress made in this regard. (Para 21.4)

XII. TELEMEDICINE

The Committee appreciates this new initiative of the Department aiming at extending the outreach of health services to a vast population but is apprehensive that the casual approach of the Department has resulted in surrendering of Rs.19.00 crore out of Rs.20.00 crore allocated for E-health during 2011-12. The Committee is skeptical of the success of the programme since the programme is yet in planning stage and large milestones have to be travelled till some visible impact is seen of the programme. The Committee, accordingly, impresses upon the Department to draw up clear action plans and dedicated timelines for implementation of the programme. The Committee would like to be apprise of the progress of the programme on quarterly basis. (Para 22.3)

XXIII.THE NATIONAL PROGRAMME FOR HEALTH CARE OF THE ELDERLY (NPHCE)

The Committee is happy to note the activities undertaken under NPHCE and plans for the year 2012-13. The Committee feels that the inadequacy of funds available for elderly population of the country might create hurdles in implementation of planned activities. The Committee, therefore, is of the firm opinion that the paucity of funds should not block the progress of the proposed projects and Department should seek more funds, if required, for the timely completion of the projected endeavors at RE stage. (Para 23.3)

XXIV. DISTRICT HOSPITALS

The Committee, on the basis of physical targets achieved till date, is not convinced with the steps taken for monitoring utilization of allocated funds by various colleges. It seems as if the monitoring is being done on the basis of exchange of words only. The Committee, therefore, would like the Department to take some stringent measures to put a mechanism in place for checks and balances to ensure proper communication and coordination among the concerned authorities at Centre, State and college levels. Further, in view of the fact conceded by the Department that the formalities to be completed by college authorities would be time consuming, the Committee opines that measure to expedite the process of getting approvals from the authorities at various levels to accomplish the objectives of the scheme as envisaged should also be looked into. The Committee would also like to be apprised of the measures taken by the Department for encouraging utilization of allocations by the two colleges in the North Eastern Region who had received funds under this scheme. The mechanism put in place for active monitoring of progress made by the colleges receiving funds under the scheme may also be communicated to the Committee. (Para 24.4) 89

XXV. HUMAN RESOURCES FOR HEALTH The utilization status of Plan funds allocated in 2011-12 shows reduction of Rs.100.00 crore at RE stage and even lesser actual expenditure by the year end. The reasons cited for this under-utilization of funds were non-receipt of proposals and MOUs from the State of UP, change in some districts proposed by the States. In view of consistently huge shortage of manpower in heath sector, the Committee is not convinced with the progress of programme carried under development of human resources for health. It seems that Department’s approach is ‘Nursing- centric’ as can be seen from the Department’s strategies, as furnished to the Committee, about the proposed utilization of funds earmarked for 2012-13. The Committee is well aware of the looming shortage of manpower in Nursing category, but finds it strange that majority of expenditure is being allocated for Nursing profession when the availability of medical/paramedical professionals is also not satisfactory. Accordingly, the Committee, recommends that Department should strike a balance while allocating the scarce financial resources of the country. (Para 25.2) The Committee appreciates the steps, the Department proposes to take during the Twelfth Five year plan for building Human Resources. However, the Committee is at loss to understand how the Department would be able to achieve the huge and ambitious targets set, by 2020. The Committee, therefore, would like to be apprised of the detailed and comprehensive action plan the Department proposes to adopt from the year 2012 to 2020. The Committee is also apprehensive of how the Department would be able to retain the additional doctors so as to improve the doctor: population ratio to1: 1000 from current 1: 2000 by 2020 when there is no mechanism to prevent migration of doctors to foreign pastures after completing their studies in home country. The Committee, therefore, recommends that in addition to preparation of detailed and comprehensive plan to increase human resources for health, the Department should also devise a mechanism for retaining such doctors who have been trained at subsidized and valuable financial resources of the country. (Para 25.4) 90

PART-B

NRHM

II. BUDGETARY PROVISIONS The Committee is constrained to observe that shortfall has been reported every year in the utilization of the allocated funds. Utilization has failed to keep pace with the allocation as indicated above. The Committee feels that such worrisome trends in the utilization of funds allocated does not augur well for a flagship scheme like NRHM which was designed to complement state efforts on the health front. The Committee observes that such a huge and persistent under-utilization of the budgeted funds is certain to have a bearing on the achievements of National Health Goals and calls for streamlining the existing monitoring of expenditure. The Committee, therefore, strongly recommends that the Ministry needs to take some innovative yet practical measures to streamline the monitoring mechanism of utilization of funds and ensure that the utilization of funds allocated is carried out in an optimal and judicious manner in the Twelfth Plan (2012-17) so that the Goal of the Mission, i.e., to provide effective and quality primary healthcare to the rural population throughout the country with special focus on 18 states with weak health indicators and weak infrastructure could be fulfilled. (Para 2.1) The Committee views with serious concern the trend of allocation of funds and utilization thereof in the year 2011-12 in some other crucial programmes such as National Programme for Control of Blindness(B.E.-Rs.261 crore, A.E-Rs.221.37 crore), Iodine Deficiency Disorder Control Programme (B.E.-Rs.47.00 crore, A.E-Rs.23.04 crore) and National T.B Control Programme (B.E-Rs.400.00 crore, A.E-Rs.264.62 crore) are some of the other programmes under which financial performance level during the Eleventh Plan so far has also been far from satisfactory. The Committee has been repeatedly cautioning the Department year after year to take remedial measures to ensure optimum utilization of funds but the situation has not improved. The Committee, therefore, recommends even at the cost of repetition that the Department should take appropriate measures to ensure proper utilization of funds allocated under the above heads and obviate large variations in approved allocation and actual expenditure. The Committee desires to be apprised of the steps taken in this direction and the success achieved in ensuring optimal utilization of the budgeted funds. (Para 2.3) The Committee, at the same time, observes that the above programmes are too vital to be allowed to be plagued with under-funding which can have very serious implications for the access to quality healthcare for those who are residing in rural areas. The Committee, therefore, recommends that the fund-crunch should not be allowed to come in the way of effective implementation of the above programmes and quantum of funding be enhanced for them. (Para 2.4) The Committee takes note of the fact that the Department intends to carry forward the NRHM programme into the Twelfth Plan (2012-17). The Committee has been given to understand that a Cabinet note on continuation of NRHM under the Twelfth Plan has been sent to the Cabinet Secretariat for approval. The Committee hopes that in the second phase the programme would bring more fruitful results. The Committee would, however,

90 91 recommend that in the meanwhile the Department should undertake a review of NRHM and take concrete and concerted efforts to plug the gaps and bottlenecks in the implementation of the programme that existed in the first phase, so that the result in the second phase would be far better than the performance in the first phase. (Para 2.5) The Committee feels that insufficient allocation of funds would needlessly affect schemes as mentioned above as these schemes are the bedrock for effective and efficient delivery of healthcare services to the rural population under the NRHM. The Committee, therefore, recommends favourably that the Ministry of Finance and Planning Commission should relook at the cutting down of plan allocations so drastically so as to ensure that these life line schemes of ensuring success of NRHM programmes remain on track. The Committee observes that enhancement of allocation under the on-going schemes of NRHM is also important from the point of view of raising public spending on health from the current 1% (roughly) of the GDP to 2.5% of GDP by the end of the 14th Plan. The Committee would. like the Department to bring the above observation to the notice of the concerned authorities of Planning Commission and also acquaint it with their response in the matter. The Committee also recommends that the Department should strive towards deploying the available resources more efficiently so that the allocated funds are spent fully to justify higher allocation. (Para 2.7) The Committee observes that 3861 number of pending UCs amounting to Rs.5171.06 (as on 29.02.2012) crore is too large to be comfortable with. The Committee had earlier recommended that the monitoring of pending UC’s needed to be strengthened further. However, pending UCs do not show any improvement. The Committee feels that the Ministry of Health and Family Welfare should co-ordinate with the State Governments to appoint a senior officer in the various Health Departments of the respective State Governments to ensure timely submission of utilization certificates immediately on utilization of funds allocated, which would go a long way in ensuring fiscal prudence. (Para 2.9) The Committee would like the Department to resolve the issue of pending utilization certificates in both the programmes as their pendency has a direct impact on the release of funds to be made to the States. (Para 2.10) The Committee feels that these problems could have been addressed appropriately by now. At least in the second phase of the scheme, Government should concentrate on all these problems so that the Mission can be implemented with a meaningful results. (Para 2.11) The Committee is not pleased with the stand taken by the Ministry that for continuation of all ongoing schemes from Eleventh Plan to Twelfth Plan, their appraisal and approval will be done at the appropriate stage. The Committee feels that the Department should set up realistic and time bound schedules for appraisal and approval of these schemes from Eleventh to Twelfth plan so as to ensure smooth functioning of the schemes set to be launched in the Twelfth Plan. The Committee, therefore, recommends that the deadlines be fixed for appraisal and approval so as to ensure that the Twelfth Plan Schemes do not suffer from teething problems. (Para 2.13)

III. INFRASTRUCTURE STRENGTHENING Healthcare Units The Committee, however, cannot feel complacent with the situation. Out of the total shortfall in the SCs, CHCs and PHCs, Bihar with a shortfall of 5263 Sub-Centres, 626 PHCs 92 and 552 CHCs and Uttar Pradesh with a shortfall of 5823 SCs, 698 PHCs and 582 CHCs continue to be an eyesore and may lead to fallback of targets set in the NRHM to provide Universal Health Coverage for all. The Committee, therefore, impresses upon the Department to undertake special efforts in these States to ensure that the shortfall in setting up of SCs, PHCs and CHCs are taken on a warfooting with dead lines fixed for completion of the same and penalties for non-completion of the deadlines set. (Para 3.1) The Committee also notes with disdain that in the 129 District Hospitals sanctioned for renovation and upgradation in Uttar Pradesh, not even one has been completed as on 31st December, 2011. The Committee, therefore, impresses upon the Department to look into the reasons for the same and also depute a senior officer of the Department to personally take up the task of completion of the renovation/upgradation of these district hospitals with the State authorities within a designated time-line. The Committee should also be kept posted of the developments taking place in this regard on a regular basis. Furthermore, the Committee would also like to be kept apprised of the progress made towards the completion of all SCs, PHCs, CHCs and District Hospitals in all States on a six- monthly basis so as to ensure continuity in completion of such infrastructure which is the most important aspect of provision of uniform healthcare for all under the aegis of NRHM. (Para 3.2) The Committee on the basis of the above statistics given by the Department finds that inspite of Committee’s recommendation and its concern shown on contractual appointments, there has been no change in the Department’s policy and it still subsists to fulfill its vacancies on contractual basis inspite of the fact that five years have elapsed since the NRHM was launched. Similarly on the issue of specialists appointment at CHCs, the emphasis is still on contractual appointment. The Committee is constrained to observe that such stop-gap arrangement in the appointments by way of contract would lead to ripple effect on the quality of services being offered under NRHM. This deficiency impacts not only the limited financial resources but also have a bearing on the standard quality of services being offered. The Committee hopes that during the Twelfth Plan, the Department would address this issue. The Committee also notes that though the Department has detailed the measures taken to address the problems highlighted in RHS-2009, it has failed to shed light on the effectiveness of the measures so taken. The Committee desires to be apprised of the efficacy of the steps taken to wipe out the deficiencies as pointed out in RHS-2009. (Para 3.4)

IV. MISSION FLEXIBLE POOL The Committee is constrained to note that the under-utilisation of the budgeted funds has been mainly on account of delay in completing construction and infrastructure development which is indicative of slackness in monitoring of the projects, which in turn also indicates that periodic and regular follow-up action with the State Governments was not taken in this regard. Emphasing the fact that such delays will lead to cost-overrun, the Committee recommends to the Department to take appropriate remedial measures for addressing the issues contributing to delays and cost overruns. (Para 4.2)

4.4 The Committee sincerely hopes that the Department would be able to fully utilize the fund allocations approved for 2012-13. However, keeping in view its track record of reduction in funds at RE Stage on account of ‘slow pace of expenditure’, the Committee would like the Department to be more vigilant while utilizing the budgeted amount and keep realistic targets in sight to ensure that the shortfall in the utilization of budget allocation does not become a regular feature year after year. (Para 4.4) 93

Upgradation of PHCs/CHCs

The Committee expresses its anguish over such a sorry state of affairs. Though the intentions to provide critical healthcare to all under the aegis of NRHM is laudable, but what is needed is a proactive approach to convert intentions into actions. The Committee, therefore, recommends that in light of the fact that the first phase of NRHM has concluded, the Department should take a rational assessment of the factors responsible for drawbacks in making FRUs operational in many States as detailed above and take remedial measures accordingly to ensure more positive outlook in the second phase of NRHM (2012-17). (Para 4.5)

Rogi Kalyan Samitis

The Committee feels that this is yet another case of slack monitoring of the utilization of funds especially in high focus States, thereby creating gaps in critical health infrastructure. The Committee, therefore, impresses upon the Department to strengthen its monitoring network so as to keep a tab on the timely utilization of funds disbursed especially in the High Focus States. The Committee would like to know the details of the targets set vis-a-vis the achievements made under the Rogi Kalyan Samitis in the Eleventh plan. The Committee would also like to be apprised of the targets set for the Twelfth Plan especially with relation to the High Focus States as the situation there has not been very encouraging. (Para 4.6)

ASHA

The Committee would like to know the reasons as to why the training for ASHAs with respect to the 6th and 7th module is yet to take off. The Committee impresses upon the Department to direct these State Governments/UTs to speed up the process of training of ASHAs in the 6th and 7th module. (Para 4.8)

The Committee is of the view that the Department should take steps to ensure that these States start selection/training of ASHAs immediately so as to ensure uniformity in the selection and training modules vis-a-vis other States without further delay. The Committee would like to be of the State wise updated status of progress made in this regard. (Para 4.9)

Mobile Medical Units

The Committee is dismayed by the slow progress in procurement and provision of MMUs in the country and urges upon the Department to take immediate steps especially in High Focus States to ensure deployment of MMUs without further delay and also ensure proper monitoring of the same at regular intervals in States where they have already been deployed, so as to ensure accessibility of health care facilities to the masses in unserved and under-served areas. (Para 4.10)

V. RCH FLEXIBLE POOL

The Committee notes that none of the targets set by the Eleventh Plan for reduction in MMR, IMR and TFR has been met during the Eleventh Plan period. The Committee feels that the strategies adopted to achieve the goals of reduction in MMR, IMR and TFR need to be evaluated afresh so that with suitable modifications, they would correct the imbalance and help meet the targets set for MMR, IMR and TFR in the coming years. (Para 5.2) 94

The Committee welcomes the above measures contemplated by the Department for accelerating reduction in MMR, IMR and TFR. The Committee would, however, like the Department to put in a place a rigorous monitoring mechanism of evaluation of the effectiveness of the measures so taken. (Para 5.3)

The Committee would like to stress that though it is sympathetic to the Department’s demand for higher allocation of funds and ready to give due relief in terms of its inherent powers, it would simultaneously like the Department to improve its financial administration. The Committee is of the opinion that the stiff targets set for achieving IMR, MMR and TFR would fall by way side, if the budgeted amount is persistently under- utilised. The Committee, therefore, implores upon the Department to tighten its seat belts and ensure that the Department takes urgent and effective steps in order to ensure that the targets set do not remain a pipe dream. (Para 5.5)

ROUTINE IMMUNIZATION

The Committee regrets that a densely populated State like Bihar does not have cold chain equipment in majority of its PHCs/CHCs and States/UTs like D&N Haveli, Daman & Diu, Delhi and Puduchery have yet to open their account. The Committee feels that the Department should seriously direct these states to take immediate steps to ensure setting up of cold chain equipment without further delay so as to ensure implementation of UIP in both letter and spirit and if need be more funds and expertise may be provided by the Department to such laggard States. (Para 5.7)

PULSE POLIO PROGRAMME

The Committee appreciates that the Department has been able to eradicate polio in the country with one or two exceptions. However, the Committees feels that the Department should not feel complacent on the success and ensure that the scourge of polio is not allowed to rear its head again. (Para 5.14)

JANANI SURAKSHA YOJANA

The Committee is given to understand that in several cases, the Ashas do not actually provide the required help and assistance and instead only add the numbers. In several cases, the mothers reach the hospital only after the delivery though they are shown to have been given institutional delivery. Such attitude of the Ashas should be strictly dealt with. A strict monitoring of the activities of the Ashas should be kept. The Janani Shishu Suraksha Karyakram is also a good programme and all efforts need to be made to make it a success. (Para 5.18)

The Committee appreciates the joint efforts taken by the Ministry of Health and Family Welfare and Ministry of Women and Child Development to develop a mother and child protection plan. The Committee hopes that as informed by the Ministry all States and UTs would have completed the issue of such cards and recommends more funds should be allocated for such a scheme if need be as it would strengthen both maternal and child care protection for which funds and infrastructure should not be a constraint. (Para 5.21)

The Committee recommends that the gaps in implementation of the JSY Scheme highlighted by the said report may be removed at the earliest. The Committee desires to be kept apprised of the follow-up action taken on the findings of the Expert Group. (Para 5.23) 95

VI. NATIONAL VECTOR BORNE DISEASE CONTROL PROGRAMME (NVBDCP) The Committee is at pains to understand that a period of 10 years was not enough to eliminate Kala Azar and the target date has been further set back by three years. The Committee feels that the initiatives taken earlier for Kala-Azar elimination did not have the desired impact. The Committee would, therefore, like to be enlightened about the short- comings identified in the Kala Azar elimination programme and how the Department plans to re-orient its policies for achieving the desired results in terms of elimination of Kala- Azar. The Committee also desires that an evaluation of the implementation of the programme may be undertaken. (Para 6.3)

MALARIA

The Committee feels that there is still a considerable gap between what has been achieved and what needs to be achieved. The Committee is of the opinion that the Department has not been able to fill even the vacant sanctioned posts. The Department may also consider sanctioning the required number of posts. The Committee, therefore, recommends to the Department to closely monitor on a more proactive basis to fill the sanctioned manpower on an urgent basis and prepare a blue print to identify and create the required manpower on a war footing and if need be more funds and expertise may be provided to ensure that the huge backlog of cases could be eliminated. (Para 6.7)

JAPANESE ENCEPHALITIS

The Committee is not happy with the physical achievements under the programme. Though the fatal cases have reduced, but the Committee cannot be in oblivion to the fact that the number of cases have increased The Committee feels that though the fund allocation has been increased five fold from Rs.3.11 crore during 2011-12 to Rs.15.60 crore in 2012-13, a lot needs to be done in terms of physical achievements on the ground. The Committee feels that there is a need on the part of the Department to improve its physical achievements by recruitment of more manpower especially in JE endemic States. (Para 6.10)

VII. NATIONAL TB CONTROL PROGRAMME

With regard to MDR-TB patients the Department has informed that DOTS strategy has significantly improved case detection and cure rates beyond 72% and 87% respectively. 28 accredited labs have been set up across the country to diagnose Multi Drug Resistant T.B (MDR- TB) and 15 are under process which shall be completed by March, 2013. 6944 patients have been provided treatment for MDR- TB upto 2011. Further, the Phase-II trials of the new molecule (TMC-2007) for treating patients with MDR-TB are underway. It is a multi-country study and in India two centers namely, National Institute of Research in Tuberculosis, Chennai and All India Institute of Medical Sciences are participating. The analysis is underway and the study results are expected shortly. The Committee would like to know by when the analysis would be completed and its study results published since a lot of time has already elapsed since the clinical trials commenced. (Para 7.3) From the plain reading of the above information, it can be found that a lar8e number of posts are lying vacant in all the service categories (Group A, B, C& D). The Committee, therefore, recommends that Department should take urgent steps to fill up the vacancies at the earliest so as to fulfill the objective of providing better quality of patient care to all patients. (Para 7.4) 96

The Committee observes that the fact that India accounts for a fifth of the global TB burden is indicative of the magnitude of the problem and reminds of the challenges ahead. Though DOTS (Directly Observed Short Treatment Course) has been found to be highly efficacious, the Committee believes that the TB patients being treated in the private sector which is largely unregulated, go unmonitored and there is no regulatory mechanism in place to ensure that the well-established and validated treatment regimen is followed there. The Committee would, therefore, like the Department to pay attention to this aspect while formulating its strategies for the Twelfth Plan. The Committee also desires to be apprised if any assessment has been made regarding cases of default in treatment of TB. (Para 7.4)

VIII. NATIONAL LEPROSY ERADICATION PROGRAMME The Department has further informed that the number of new cases reported by India shows a declining trend since 2003-04. The proportion of new cases accounted for by India is gradually reducing. During the year 2002-03, India accounted for 76.3% of the total Global cases and during year 2010-11 India accounted for 55.49% of the total number of new cases. There is no active search programme presently under way in the country; however, National Sample Survey to assess the Leprosy disease burden has been undertaken through National JALMA Institute, ICMR. The Survey has been completed in all the States/UTs. The report of the survey will be available by April, 2012. The Committee would like the Department to furnish the latest status update on survey conducted by National Sample Survey to assess the leprosy disease burden in the country. (Para 8.3) The Committee is constrained to note that India still accounts for more than 50% of the new leprosy cases worldwide. The efforts made so far have still not yielded the desired results. The Committee would, therefore, strongly recommend the Department to monitor the measures taken so far to eliminate this disease. (Para 8.4)

IX. NATIONAL TRACHOMA AND BLINDNESS CONTROL PROGRAMME The Committee is not satisfied with the issue of substantial unspent balances remaining with States in the previous year viz. Rs.155.52 cores as on 31st March, 2012. On the one hand the Department seeks certain projected amount, on the other it is unable to monitor whether the States are able to spend the amount within the time frame. The Committee, therefore, impresses upon the Department to monitor effective and timely utilization of funds to justify seeking of enhanced allocations in the Budget. (Para 9.3) The Committee hopes that the Department would have been able to achieve the targets set during the Eleventh Plan as one of the major causes of Blindness is the lack of proper eye banks for eye donation or collection resulting in low levels of eye transplants leading to blindness of the affected persons. The Committee would like to be apprised of the status of eye banks being set up in the country, which would help it keep track of the physical achievements on this front. (Para 9.4)

X. NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAMME The Committee is dismayed with the utilization of funds allocated for the programme. The Department did not utilize a substantial amount of funds allocated which is against the principles of fiscal prudence. Moreover, in the face of 303 districts out of 365 surveyed being endemic does not augur well on the physical achievements front as well. The Committee expresses its displeasure at the state of the things and emphasizes the need to overcome the bottlenecks in the proper implementation of the said programme. (Para 10.3) 97

The Committee also expresses its concern over the fact that out of 365 districts surveyed in the country, 303 were found to be endemic. If a survey is carried out in all the districts of the country it would not come as a surprise if the results throw a more alarming situation in hand. The Committee recommends that a focused intervention in all the States/ UTs need to be taken without undue delay in face of the spectre of Goiter looming over the country. (Para 10.3)

XI. INTEGRATED DISEASE SURVEILLANCE PROGRAMME The Committee observes that on the one hand the Department seeks funds justifying it by stating that funds are needed for contractual posts to be filled up every year, while on the other a substantial amount of it is saved by way of under-utilisation, thereby weakening the basic idea of the programme. Without quality and reliable data, the entire Surveillance Programme would lose its relevance. The Department should, therefore, convey better sense in using its wherewithal for augmenting its physical parameters with the finances allocated to it in the future. (Para 11.3) Thought the progress being made on the training front is appreciable, but the Committee feels that the States have been slow with the additional lists of persons required to be trained. The Committee, therefore, recommends that the Department should sound the States not only to provide the list of additional persons to be trained on a priority basis but also to provide feedback on the number of persons required to be recruited under this programme in the Twelfth Plan. (Para 11.4)

XII. NEW SCHEMES DURING THE TWELFTH PLAN The Committe while being appreciative of the new Schemes proposed to be launched under this flagship programme feels that the absorptive capacity of various State Governments to absorb the funds under the Mission in the XIth plan leaves much to be desired and the Department needs to seriously analyse the reasons for in the majority of Schemes there was a massive underutilisation of funds disbursed to the States. The Committee, therefore, feels that before introducing so many schemes in the XIIth Plan there is a need for the Department to seriously engage the States to shore up their infrastructure so that they are able to benefit in real terms and the funds percolate to them during the XIIth Plan. (Para 12.2)

MINUTES

VIII EIGHTH MEETING (2011-2012)

The Committee met at 11.00 A.M. on Monday, the 9th April, 2012 in Room No. G-074, Ground Floor, Parliament Library Building, New Delhi.

MEMBERS PRESENT 1. Shri Brajesh Pathak — Chairman

RAJYA SABHA 2. Shri Janardhan Dwivedi 3. Dr. Vijaylaxmi Sadho 4. Shri Balbir Punj 5. Dr. Prabhakar Kore 6. Shrimati Vasanthi Stanley 7. Shrimati B. Jayashree 8. Shri Derek O’Brien

LOK SABHA 9. Shri Ashok Argal 10. Dr. Monazir Hassan 11. Dr. Sanjay Jaiswal 12. Shri P. Lingam 13. Shri Datta Meghe 14. Dr. Jyoti Mirdha 15. Dr. Chinta Mohan 16. Shri M.K. Raghavan 17. Dr. Arvind Kumar Sharma 18. Shri Ratan Singh

SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R.B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director

WITNESSES

Department of Health and Family Welfare HEALTH SECTOR 1. Shri P.K. Pradhan, Secretary

101 102

2. Shri Jagdish Prasad, Director General (Health Services) 3. Shri R.K. Jain, Additional Secretary & Financial Advisor 4. Shri Keshav Desiraju, Additional Secretary 5. Shri L.C. Goyal, Additional Secretary & DG (CGHS) 6. Shrimati Shakuntala Gamlin, Joint Secretary 7. Shri Arun Kumar Panda, Joint Secretary 8. Shri Debasish Panda, Joint Secretary 9. Shri S.K. Rao, Joint Secretary 10. Shrimati Sujata Krishnan, Joint Secretary 11. Shrimati Dharitri Panda, CCA NRHM SECTOR 1. Shri P.K. Pradhan, Secretary 2. Dr. Jagdish Prasad, Director General (Health Services) 3. Shri R.K. Jain, Additional Secretary & Finance Advisor 4. Shri L.C. Goyal, Additional Secretary & DG (CGHS) 5. Shrimati Anuradha Gupta, Additional Secretary & Mission Director(NRHM) 6. Shri Arun Kumar Panda, Joint Secretary 7. Shri Debasish Panda, Joint Secretary 8. Shri Manoj Jhalani, Joint Secretary 9. Shri Amit Mohan Prasad, Joint Secretary 10. Shrimati Sujata Krishnan, Joint Secretary 2. At the outset, the Chairman welcomed the Members of the Committee and briefed them about the agenda of the meeting i.e., examination of Demands for Grants (2012-13) of the Ministry of Health and Family Welfare and taking of oral evidence of the Secretary of the Department of Health and Family (Health and NRHM Sector), in this regard. 3. The Committee, thereafter, in the first half, heard the oral evidence of the Secretary and other officials of the Department on the schemes/programmes pertaining to the Health Sector. 4. The Secretary made a power point presentation and inter-alia highlighted issues such as key challenges facing the Health Sector like inadequacy of human resources for Health, increasing burden and incidence of communicable, non-communicable and chronic diseases, rising cost-of- health-care, need to raise public expenditure on health, action on social determinants of Health, need for robust health information and, surveillance systems to ensure real-time data, robust regulatory framework etc. Members sought clarifications and the Secretary and other officers of the Department replied thereto and assured to furnish detailed written replies to those queries, which remained unanswered. The witnesses then withdrew from the meeting. 5. * * *

(The Committee then adjourned at 1.15 P.M. for lunch to meet again at 2.00 P.M.) 6. The Chairman, again in the second half, welcomed the Secretary and other officers of the Department of Health and Family Welfare and took their oral evidence on schemes/ programmes pertaining to NRHM sector of Department of Health and Family Welfare.

*** Relates to other matter. 103

7. The Secretary, Department of Health and Family Welfare, made a power-point presentation on NRHM and inter alia highlighted issues such as achievements under NRHM vis-a-vis goals set for Eleventh Plan strategic framework of NRHM, trends in State Governments Health Budget, increased release and expenditure of funds under NRHM, addition of human resources under NRHM, strengthening of Health facilities, Mobile Medical units, mainstreaming of AYUSH under NRHM, Janani Suraksha Yojana, Janani Shishu Suraksha Karyakram, Vector borne diseases, National Disease Control Programmes, Health Management Information System, proposed and approved outlay for major components under NRHM for 2012-13, etc. Members sought clarifications on the activities and achievements of the Department and deliberated on the adequacy or otherwise of budgetary allocation on different schemes/programmes of NRHM. Members also sought information on issues/schemes like mobile medical vans in rural areas, details of physical and financial achievements under NRHM, ASHA Modules, shortage of doctors, etc. The Secretary and other officers from the Department replied to a few queries raised by the Members during the course of the meeting and assured to furnish detailed written replies to the remaining queries, which remained unanswered. 8. A verbatim record of the proceedings of the meeting was kept.

9. The Committee adjourned at 5.30 P.M. to meet again on the 10th April, 2012. XI ELEVENTH MEETING (2011-12)

The Committee met at 3.00 P.M. on Monday, the 23rd April, 2012 in Main Committee Room, Ground Floor, Parliament House Annexe, New Delhi. MEMBERS PRESENT

RAJYA SABHA 1. Shri Brajesh Pathak — Chairman 2. Dr. Prabhakar Kore 3. Shri Balbir Punj LOK SABHA 4. Dr. Jyoti Mirdha 5. Shri M.K. Raghavan 6. Shri Ashok Agral 7. Shrimati Harsimrat Kaur Badal 8. Dr. Monazir Hassan 9. Shri P. Lingam 10. Shri J.M. Aaron Rashid 11. Dr. Arvind Kumar Sharma SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R.B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director 2. At the outset, the Chairman welcomed the Members of the Committee and apprised them of the agenda of the meeting, i.e., consideration and adoption of draft 54th, 55th, 56th and 57th Reports on Demands for Grants (2012-13) pertaining to Departments of Health and Family Welfare, AYUSH, Health Research and AIDS Control, respectively. He invited Members to share their specific suggestions for improvements and incorporation in the Draft Reports. 3. The Committee then discussed the four draft Reports. A few changes were suggested by Members for incorporation in the Reports. After some discussion, the Committee adopted all the four Reports with some modifications. The Committee, thereafter, decided that the Reports may be presented to the Rajya Sabha and laid on the Table of the Lok Sabha on Wednesday, the 25th April, 2012. The Committee authorized its Chairman and in his absence, Shri Balbir Punj and Dr. Prabhakar Kore to present the Reports in Rajya Sabha, and Dr. Jyoti Mirdha, and in her absence, Shri J.M. Aaron Rashid to lay the Reports on the Table of the Lok Sabha.

4. The Committee adjourned at 3.30 P.M.

104 ANNEXURE

ANNEXURE-I

Projects Estimated Scheduled Exp. On Physical achievements (2011-12) cost date of 2011-12 completion 1234 5 Covering of Nallah Rs.24.50 August 2012 Rs.10.00 Work awarded by CPWD, Project Phase-II crores crores Managers, to M/s Rama Construction Co. in July, 2011. Completion period is one year. (Rescheduled date of completion is August, 2012. Modernization of Rs.13.00 February Rs.1.98 The phase II work is completed. OPD crores 2012 crores Area is fully functional. Connecting Ansari Rs.37.16 February 25.00 MOU entered between AIIMS and Nagar Campus with crores 2013 DMRC in the month of Oct 2011. JPNTC Motorable Work awarded by DMRC and Subway. started site. Additional lifts in Rs.4.25 Completed Rs.l.00 Two lifts are functional and Hospital crores balance four lifts work is under progress and is expected to be completed by January, 2011. Lift RPC Rs.1.12 Completed Rs.0.32 crores Air Conditioning of Rs.3.95 September Rs.0.70 The work is under progress and Main Hospital crores 2012 is expected to be completed by (Replacing AHU’s) March, 2012. Construction of Rs.60.00 November Rs.30.93 Work entrusted to HSCC and work Under ground crore 2012 awarded by HSCC to M/s V3S in parking at Masjid the month of November, 2011. Moth Time allowed for execution of work is 12 months. Construction of Rs.l1.0 Shelved. Rs.0.00 Proposal is replaced by a new Facilitation Block crore. nine storeyed block for Private ward and facilitation facilities also. The plans are finalised and submitted to NDMC who have forwarded the same to DUAC/DFS. Tenders are in process of invitation. Construction of Rs.6.00 completed Rs.3.60 Work completed for Civil work boundary wall crore and for Electrical work tender at Jhajjar is yet to be invited.

107 108

1234 5

Master Plan & Site Rs.20.00 2107 Rs.0.10 Work as per site requirement is development work crore being taken up by HSCC. at Masjid Moth. Minor Capital Works Rs.128.13 2011-12 Rs.35.00 crore Centre for Dental Rs.39.64 2011-12 Rs.0.77 Construction is complete Research crore (Engg.) Running expenditure being booked for services, maintenance, etc. JPN Apex Trauma Rs.138.53 2011-12 Rs.12.50 Construction is complete. Centre crore (Engg.) Running expenditure being booked for services, maintenance, etc. Construction of OPD Rs.9.50 2011-12 Rs.9.50 A transit OPD is being built at at Jhajjar crore Jhajjar Campus in a single floor building. Approval of Standing Finance Committee received. Development of Rs.5.00 September Rs.5.00 At Jhajjar 300 acres land allotted. Campus at Jhajjar crore 2012 An open drain is to be shifted – Shifting of open and built underground Work Drain entrusted to Irrigation Deptt. Haryana as Deposit Work Total :- Rs.136.40 crores Printed at : Bengal Offset Works, 335, Khajoor Road, Karol Bagh, New Delhi-110005.