Fill vacancies , ensure adequate medicine supply & revise CGHS package rates: PSC to CGHS- Extract of 145th PSC report ON HEALTH AND FAMILY WELFARE (Ministry of Health and Family Welfare) (Presented to the Rajya Sabha on 15th March, 2023) (Laid on the Table of Lok Sabha on 20.3.023)-

 Fill vacancies , ensure adequate medicine supply & revise CGHS package rates: PSC to CGHS- Extract of 145th PSC report ON HEALTH AND FAMILY WELFARE (Ministry of Health and Family Welfare) (Presented to the Rajya Sabha on 15th March, 2023) (Laid on the Table of Lok Sabha on 20.3.023)- 

 DEPARTMENT OF HEALTH AND FAMILY WELFARE  GOI

EXRACT of CHAPTER-3

SCHEMES/PROJECTS OF DEPARTMENT OF HEALTH AND FAMILY WELFARE CENTRAL GOVERNMENT HEALTH SCHEME:

 3.1 Under this Scheme, Primary Health Care facilities are provided to 42.55 lakh beneficiaries through 336 Allopathic CGHS Wellness Centres and 97 AYUSH Units across the country. At present, 1750 Private Hospitals and 292 Diagnostic Centres are empanelled under the scheme. Funds to the tune of Rs. 2137.94 crore have been allotted under the revenue head and Rs. 82.30 crore has been allocated under the capital head in BE 2023-24. With respect to the fund allocation and utilisation status for the year 2022-23, the Ministry submitted the following information: Head BE 2022-23 RE 2022-23 Actual Expenditure till 14.02.2023 Revenue (including NER) * 1812.07 1907.11 1396.92 Capital** 37.93 38.16 4.29 Total 1850.00 1945.27 1401.21 * So far as Revenue Head is concerned, there are pending payments from MSD to GMSD to the tune of Rs. 95 crores and for other cities, to the tune of Rs. 45 crores. ** Sanction issued to CPWD for Rs. 24.88 crore under the head of account Major Works in Capital Section.

 3.2 The Committee notes that in Financial Year 2022-23, under revenue head approximately 73% of the funds have been utilised vis-a-vis RE 2022-23. However, under the capital head, the actual expenditure is just 11% of the Revised Estimates 2022-23. Pending payments under the revenue head have been cited as the reason for underutilisation of funds and expenses to the tune of Rs. 24 crore is yet to be accounted under the capital head. 

3.3 The Committee, therefore, recommends the Ministry to ensure smooth and timely flow of funds and settle the pending bills at the earliest. However, under the Scheme, even after considering all the cited expenses under the revenue and capital head, funds still remain unutilised. The Committee believes that such an important employee’s welfare scheme that is tasked with providing health care services must exhibit maximum utilisation of funds. The Committee, accordingly, recommends the Ministry to continue making efforts for maximum utilisation of the allotted funds under the Scheme. 

14 Vacancy position under CGHS 

3.4 On a specific query with regards to the status of recruitment of allopathic non-gazetted and gazetted officers category under CGHS, the Ministry submitted that the CHS Division of Ministry of Health and Family Welfare recruits Medical Officers through UPSC. A list of 340 candidates selected through Combined Medical Examination for filling up vacancies including the vacancies under CGHS has been provided by UPSC. It is hoped that once the selected candidates join CGHS the vacant posts shall be filled up.

 3.5 The Ministry further stated that the sanctioned strength of Allopathic Medical Offices is 1541 against which 346 posts are vacant. As an interim measures retired Doctors are appointed on contract basis (extendable on yearly basis) against vacant posts till regular incumbents are in position. The sanctioned strength of non-gazetted staff under CGHS is 4566 against which 1778 posts are vacant. CGHS has already communicated the vacancies to the staff Selection Commission (SSC) for recruitment of suitable candidates and once the lists are received from SSC, the vacant posts shall be filled up.

 3.6 The Committee notes that approximately 22% posts in Allopathic Medical Offices and 39% posts in Non-Gazetted staff are vacant. The Committee feels that the shortage of doctors is a major problem that pervades the Indian healthcare system. Under CGHS, the Government has also been employing retired doctors for filling the vacancies in CGHS dispensary. However, the Committee observes that the doctor to population ratio still remains skewed in many cities that are covered under CGHS. The Committee accordingly recommends the Ministry to assess the requirement of doctors in CGHS dispensaries across the country and ensure that adequate doctor to population ratio is maintained in all the CGHS cities. The Committee further recommends the Ministry to expedite the recruitment of 340 candidates selected through Combined Medical Examination for filling up vacancies including the vacancies under CGHS.

 3.7 On a specific query with regard to the status of the CGHS buildings at Vasant Vihar, Vasant Kunj, Alaknanda and Rohini-Sector 16, the Ministry submitted that the Wellness Centre at Vasant Kunj is already functioning in CGHS building. CGHS is pursing with CPWD Authorities for handover of building with completion certificate at Vasant Vihar, Alaknanda and Rohini Sector-16 to enable CGHS to shift the Wellness Centres to its own buildings. Ayurvedic and Homeopathic units are not sanctioned at these locations. 

3.8 The Committee is dismayed to note that Wellness Centres at Vasant Vihar, Alaknanda and Rohini Sector-16 have not yet been shifted to CGHS buildings. The Committee in its 134th Report had observed this delay in handing of the CGHS Wellness Centres at Vasant Vihar, Alaknanda and Rohini Sector-16 to CGHS by CPWD. The Committee in its 134th Report had explicitly noted that the CGHS buildings are ready but the Wellness Centres are still running from rented buildings, however, even after one year, the completion certificates have not been obtained from CPWD. Accordingly, the Committee reiterates its recommendation that the Ministry must obtain the completion certificate from CPWD and shift the Wellness Centres to the new buildings at the earliest. The Committee further recommends the Ministry to coordinate with the 15 concerned Project agencies and ensure timely completion of construction projects in all the CGHS cities. 

3.9 The Committee further notes that certain other issues such as non availability of medicines in CGHS dispensaries, delay in clearance of the dues owed to the private hospitals, viability of the CGHS rates, poor experience of the beneficiaries etc persist in the CGHS ecosystem. Issues of basic medicines been indented in some CGHS dispensaries have also been noted. The Committee recommends the Ministry to ensure consistent supply of medicines under CGHS through Schemes like the Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP). The Committee further observes that empanelling top private hospitals for providing comprehensive tertiary care is challenging under the present CGHS rates. The Committee accordingly recommends that a grading system for hospitals may be devised where CGHS rates are standardised for each category of hospitals. The Committee also recommends the Ministry to make an assessment on the budget required for expanding the pool of empanelled hospitals under the Scheme. The Committee has observed that CGHS rates for treatment and diagnosis have not been revised for many years and therefore, recommends that it may be revised keeping in view the present market rates.