A recent audit by the Comptroller and Auditor General (CAG) has exposed serious weaknesses, systemic neglect, chronic resource shortages and financial inefficiencies in Maharashtra’s public healthcare system. Covering the years 2016 to 2022, the report paints a grim picture of the health sector struggling to meet the demands of its population, particularly in rural areas.
The audit revealed widespread staff shortages, a 27 percent shortage of doctors and a 42 percent vacancy rate in district hospitals. Nurses and paramedics are also in short supply, with gaps of 35 percent and 31 percent, respectively. Tertiary care hospitals fared worse, with 57 percent of nursing positions and 44 percent of paramedical roles vacant. The report highlights how acute staff shortages are overburdening health workers, and increasing disparities in access to care, particularly in rural areas.
The infrastructure of the state is also below Indian Public Health Standards (IPHS). Only 7 percent of the district hospitals meet the standards of maternal and child health services. Emergency and diagnostic facilities are woefully inadequate as hospitals lack the necessary imaging equipment. Also, 70 percent of health infrastructure projects planned under the 2013-2014 development plan are incomplete. A Rs 31.91 crore hospital in Amravati, completed in 2015, has not been operational due to administrative delays, an example of system inefficiency.
The report also highlighted serious inefficiencies in procurement. Between 2016 and 2022, the state’s primary supplier, Haffkine Bio-pharmaceutical Corporation, failed to deliver 71 percent of requested drugs and equipment. Existing medical supplies were often improperly stored or maintained, rendering them ineffective. Biomedical waste management, an important aspect of public health, remains neglected, with many healthcare facilities failing to comply with disposal standards, posing significant environmental and public health risks.
Funding for key health programs is also underutilized. From 2016 to 2022, 76 percent of the budget allocated for urban health missions and 50 percent for rural health programs have not been spent. Disease eradication initiatives such as the National Tuberculosis Eradication Program and the National Leprosy Eradication Program have failed to meet their targets due to inadequate funding and ineffective implementation.
Emergency preparedness is another weak area. Hospitals lack basic fire safety equipment, and there are no systems to monitor or improve the efficiency of facilities during a crisis. The report criticized the failure of healthcare institutions to adhere to fire safety standards, leaving patients and healthcare staff unprotected during emergencies. With random inspections of food quality in public hospitals, even basic patient needs such as customized diets are often neglected.
Public health expert Dr Rajesh Sharma described the findings as a “wake-up call for Maharashtra’s healthcare system”. He said, “Persistent shortages in staffing, infrastructure and funding have weakened the system to handle the growing health demands of the population. Addressing these issues requires an urgent, multi-pronged approach from both policy makers and administrators. “
To address these challenges, the CAG recommended filling up staff vacancies through faster recruitment processes and increasing the health budget to meet national benchmarks. Infrastructure projects need to be completed without further delay, while regulatory bodies must enforce strict compliance with licensing requirements and biomedical waste management regulations. The report also called for the adoption of the Clinical Establishment Act, 2010 to ensure uniform standards for private healthcare.
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