A recent audit by the Comptroller and Auditor General (CAG) of India on the management of public health infrastructure and health services in Maharashtra has revealed serious weaknesses, systemic neglect, chronic resource shortages and financial inefficiencies in the state’s public health care 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 report was tabled on the last day of the winter session of the Maharashtra Assembly on Saturday.
The audit revealed widespread staff shortages, with a 27 per cent shortage of doctors and 42 per cent vacancies for specialist doctors in district hospitals. There is a shortage of 22 percent, 35 percent and 29 percent of doctors, nurses and paramedical staff in the primary and secondary health service sectors under the Department of Public Health (PhD) 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 shortage of doctors, nurses and paramedical staff in women’s hospitals is 23 percent, 19 percent and 16 percent respectively. “The shortage of doctors/specialists, nurses and paramedical staff under the Medical Education and Drug Department (MEDD) was 37 percent, 35 percent and 44 percent respectively. The overall shortage of doctors, nurses and paramedics in the state under PHD and MEDD was 27 per cent, 35 per cent and 31 per cent respectively,” it said.
The report states that the shortage of doctors, nurses and paramedics and others in AYUSH colleges and hospitals is 21 percent, 57 percent and 55 percent respectively.
Trauma care centers under the jurisdiction of PHD and MEDD were understaffed by 23 percent and 44 percent, respectively. The report also flagged the lack of training for doctors, nurses and paramedics under PHD.
“The government may fill up the vacancies in the health sector in a timely manner to ensure optimal and quality delivery of public health services,” the CAG recommended, while suggesting to increase the sanctioned number of doctors under the public health department.
The report also pointed out that the state government has not done gap analysis to assess the manpower requirement in health care institutions as per Indian public health norms. 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. Moreover, 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 audit also observed supply of equipment, decommissioning/decommissioning of equipment and improper storage of medicines and drugs in health institutions. 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.
The audit showed that the Department of Medical Education and Medicine relied only on analysis reports of drugs and medicines provided by suppliers without conducting independent quality control tests. Biomedical waste management, an important aspect of public health, remains neglected, with many health services failing to comply with disposal standards.
Funding for key health programs is also underutilized. Between 2016 and 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.
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.
Public health expert Dr Rajesh Sharma described the findings as a “wake-up call for Maharashtra’s healthcare system”.
“Persistent gaps in staffing, infrastructure, and funding utilization 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,’ said Dr Sharma.
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