Summary:
New Delhi, Aug 8 (PTI) The Comptroller and Auditor General of India, in its audit report tabled on Monday, highlighted several lapses in the procurement and supply chain of drugs under the Central Government Health Scheme (CGHS), which led to a shortage of drugs at wellness centres.
The CAG report also highlighted violations in connection with reimbursement of claims made by health care organisations (HCOs).
The audit noted that the health ministry did not ensure a periodic revision of the drug formulary, which is maintained by the Medical Stores Organisation (MSO) for the CGHS and government hospitals.
The drug formulary of June 2015 was revised only in February 2022, it said.
"The non-revision of the drug formulary during the period June 2015 to February 2022 meant that the procurement process in CGHS did not take into account the newer drugs prescribed by doctors," the report said.
The drug formulary helps to focus on commonly prescribed drugs and formulation, so that the maximum numbers of diseases are reasonably covered and availability of drugs can be ensured.
The MSO did not finalise the procurement rates of all drugs listed in the drug formulary, the CAG said, underlining that of the 2,030 drugs listed in the formulary, it had finalised the rate contracts for only 220 to 641 from 2016-17 to 2020-21. "As a result, CGHS could not procure the drugs listed in formulary, leading to shortage of drugs in wellness centres," the report said.
It further said the CGHS did not place an indent on the government medical store depots (GMSDs) for the complete quantity of drugs approved by the ministry for provisioning.
The GMSDs did not supply the indented drugs to the CGHS in a timely manner and the complete quantity as indented.
"Due to inefficiencies in procurement and supply of drugs, there were persistent shortages of drugs in wellness centres.
Against the annual requirement of 1,169 drugs in CGHS, there were only six to 290 drugs available in wellness centres," it said.
The report noted that due to the shortage of drugs at the wellness centres, a huge amount of drugs was procured through authorised local chemists (ALCs).
In Delhi, 74.7 to 93.61 per cent of the expenditure was incurred on procurement of drugs through ALCs from 2016-17 to 2020-21.
"Deficiencies in the supply chain of drugs in CGHS led to non-availability of generic drugs in wellness centres, resulting in placing of indents by wellness centres on ALCs for branded drugs at higher rates," the report said.
The audit noted that ALCs all over the country did not supply the prescribed brand of drug as indented by the wellness centres and instead, supplied drugs manufactured by different companies in violation of the conditions of the contract.
Also, there were delays, short supplies and excess supplies of drugs by the ALCs to the wellness centres.
There were also cases of expired drugs and drugs having a short shelf life being supplied by the ALCs to the wellness centres.
An analysis of the data dump provided by the CGHS relating to prescription, procurement, storage, supply of medicines and reimbursement of medical claims of HCOs revealed several inaccurate and erroneous entries.
It also highlighted several inefficiencies in the processing, approval and finalisation of claims submitted by HCOs.
The CGHS released Rs 70 crore to the Bill Clearing Agency (BCA) in June 2010 for making provisional payments to HCOs towards the reimbursement of medical claims.
The provisional payment to the HCOs was discontinued in October 2015.