Performance Audit on Public Health Infrastructure and Management of Health Services, Himachal Pradesh

An audit of Himachal's health infrastructure and services for 2016-21, with human resource data updated to March 2023. It found two of every five posts vacant across the health system, specialists almost entirely absent from the remotest districts, and the state yet to adopt the Indian Public Health Standards it is measured against.

State: Himachal Pradesh
Audit period: 1 Apr 2016 — 31 Mar 2021
Presented: 21 Dec 2024

Findings

An overall shortfall of 41.87 per cent in human resources across all categories as of March 2023, and 41.47 per cent among staff actually deployed at health institutions.
“there was an overall shortfall of 41.87 per cent in human resources across all categories in the State while shortfall in human resources deployed at health institutions was 41.47 per cent as of March 2023.”Executive Summary
In civil hospitals, Kinnaur and Lahaul & Spiti had a 100 per cent shortage of specialists; nine of twelve districts were short by more than 69 per cent, and only Shimla was near full strength.
“In CHs, two (Kinnaur and Lahaul & Spiti) out of 12 districts had 100 per cent shortage, nine districts had a shortage of more than 69 per cent and only one district (Shimla) had a shortage of seven per cent of Specialists.”Executive Summary
Doctor shortfalls ranged from nine to 56 per cent in medical college hospitals and from seven per cent in Hamirpur to 57 per cent in Kinnaur in civil hospitals, with no shortfall in Kullu.
“Shortfall in the category of doctors when compared with State sanctioned strength ranged from nine per cent to 56 per cent in Medical College hospitals (MCHs)... The shortfall in availability of doctors in Civil Hospitals (CHs) was lowest (seven per cent) in Hamirpur district and highest (57 per cent) in Kinnaur district. There was no shortfall in Kullu district.”Executive Summary
The state has not adopted the Indian Public Health Standards, though both IPHS and state norms were used to evaluate its district hospitals.
“Though the State has not adopted IPHS norms yet, both IPHS and additional standards issued by Government of India and the norms set by the State were used to evaluate the healthcare facilities in district hospitals.”Executive Summary

Findings

An overall shortfall of 41.87 per cent in human resources across all categories as of March 2023, and 41.47 per cent among staff actually deployed at health institutions.

“there was an overall shortfall of 41.87 per cent in human resources across all categories in the State while shortfall in human resources deployed at health institutions was 41.47 per cent as of March 2023.”Executive Summary

In civil hospitals, Kinnaur and Lahaul & Spiti had a 100 per cent shortage of specialists; nine of twelve districts were short by more than 69 per cent, and only Shimla was near full strength.

“In CHs, two (Kinnaur and Lahaul & Spiti) out of 12 districts had 100 per cent shortage, nine districts had a shortage of more than 69 per cent and only one district (Shimla) had a shortage of seven per cent of Specialists.”Executive Summary

Doctor shortfalls ranged from nine to 56 per cent in medical college hospitals and from seven per cent in Hamirpur to 57 per cent in Kinnaur in civil hospitals, with no shortfall in Kullu.

“Shortfall in the category of doctors when compared with State sanctioned strength ranged from nine per cent to 56 per cent in Medical College hospitals (MCHs)... The shortfall in availability of doctors in Civil Hospitals (CHs) was lowest (seven per cent) in Hamirpur district and highest (57 per cent) in Kinnaur district. There was no shortfall in Kullu district.”Executive Summary

The state has not adopted the Indian Public Health Standards, though both IPHS and state norms were used to evaluate its district hospitals.

“Though the State has not adopted IPHS norms yet, both IPHS and additional standards issued by Government of India and the norms set by the State were used to evaluate the healthcare facilities in district hospitals.”Executive Summary