Performance Audit Report on Public Health Infrastructure and Management of Health Services in West Bengal for the year ended March 2022, Government of West Bengal

A performance audit of West Bengal's three-tier public health system — sub-centres, primary and community health centres, and district hospitals — covering human resources, delivery of healthcare services, drugs, equipment, infrastructure, financial management and centrally sponsored disease control programmes.

State: West Bengal
Audit period: 1 Apr 2017 — 31 Mar 2022
Presented: 25 Jul 2026

Findings

Specialist doctor posts were 36 per cent vacant and general duty medical officer posts 49 per cent vacant statewide; in the test-checked districts the shortage was around 41 per cent.
“There was a significant shortage in the cadre of Medical Officers (Specialists & General Duty Medical Officers). At the State level, the shortage of Medical Officers (Specialists) was 36 per cent and that of Medical Officers (General Duty Medical Officers) was 49 per cent, while in the test-checked districts, the shortage in the cadre of Medical Officers was around 41 per cent.”Executive Summary
89 per cent of sub-centres had no male health worker; in community health centres the shortage of specialist medical officers was 91.14 per cent, and in district hospitals general duty attendants were short by 63.20 per cent.
“As many as 89 per cent of the Sub-Centres (SCs) in the State did not have any Health Worker (Male). The shortage of Medical Officers was 54.27 per cent, while shortage of specialist MOs was 91.14 per cent, in the Community Health Centres (CHCs) of the State. In the District Hospitals, the shortage of General Duty Attendants was 63.20 per cent.”Executive Summary
55,000 deliveries were conducted at home across the state in three years and 99.56 per cent of them had no skilled birth attendant, yet not one sub-centre had been upgraded with facilities for conducting deliveries.
“MOs did not visit 45 per cent of the SCs, even once a month. Though 55,000 deliveries had been conducted at homes, across the State, in the last three years, none of the SCs had been upgraded with facilities for conducting deliveries. The Traditional Birth Attendants and ASHA were not even trained with necessary skills, in 12 per cent of the SCs. Moreover, 99.56 per cent of home deliveries were not assisted by Skilled Birth Attendants.”Executive Summary
Emergency obstetric care, including caesarean section, was unavailable in 90 per cent of primary health centres, and 70 per cent of them had no functional beds; 35 per cent of registered pregnant women were never checked even once by a medical officer.
“Accident and other Emergency/ Casualty services were not available in 71 per cent of PHCs; while, Emergency Obstetric Care, including surgical interventions like caesarean section and other medical interventions were not available in 90 per cent of the PHCs in the State. As high as 70 per cent of the PHCs did not have any functional beds. Of the pregnant women registered, 35 per cent had not got checked-up even once, by MOs-PHC, out of their four scheduled ante-natal check-ups.”Executive Summary
Of the state's 348 community health centres, 284 had no emergency obstetric care, 22 had no newborn care and 51 no emergency care for sick children; 285 of them had no blood storage unit.
“Of the 348 CHCs in the State, Emergency Obstetric Care, including surgical interventions like caesarian sections and other interventions, were absent in 284 CHCs. There was no provision of new-born care in 22 CHCs, while emergency care to sick children had not been provided in 51 CHCs.”Executive Summary
In district hospitals 63 per cent of notified essential drugs had never been procured, and the department had no documented drug policy as of March 2022.
“The Department did not have any documented drug policy, as of March 2022... In District Hospitals, 63 per cent of notified essential drugs had never been procured. Many of the other drugs had remained out of stock for long periods.”Executive Summary
57.33 per cent of the oxygen generating plants received under PM CARES and corporate social responsibility funding were not commissioned or not functional as of December 2023, and ICU ventilators and oxygen concentrators were found lying packed in test-checked hospitals.
“ICU ventilators and Oxygen Concentrators received under PMCARES were not made operational and were found lying packed in test-checked hospitals. In the State, 57.33 per cent of the Pressure Swing Absorption (PSA) oxygen generating plants, received under PMCARES and Corporate Social Responsibility (CSR) scheme, were either not commissioned and/ or not functional as of December 2023.”Executive Summary
Health sector spending stood at 1.23 per cent of GSDP against the National Health Policy target of 2.5 per cent by 2025, and capital expenditure on health fell 12 per cent over 2017-22 even as revenue expenditure rose 125 per cent.
“As of 2021-22, the level of health sector expenditure in the State (1.23 per cent of GSDP) was far below the target (2.5 per cent by 2025) set in the National Health Policy (NHP).”Executive Summary

Findings

Specialist doctor posts were 36 per cent vacant and general duty medical officer posts 49 per cent vacant statewide; in the test-checked districts the shortage was around 41 per cent.

“There was a significant shortage in the cadre of Medical Officers (Specialists & General Duty Medical Officers). At the State level, the shortage of Medical Officers (Specialists) was 36 per cent and that of Medical Officers (General Duty Medical Officers) was 49 per cent, while in the test-checked districts, the shortage in the cadre of Medical Officers was around 41 per cent.”Executive Summary

89 per cent of sub-centres had no male health worker; in community health centres the shortage of specialist medical officers was 91.14 per cent, and in district hospitals general duty attendants were short by 63.20 per cent.

“As many as 89 per cent of the Sub-Centres (SCs) in the State did not have any Health Worker (Male). The shortage of Medical Officers was 54.27 per cent, while shortage of specialist MOs was 91.14 per cent, in the Community Health Centres (CHCs) of the State. In the District Hospitals, the shortage of General Duty Attendants was 63.20 per cent.”Executive Summary

55,000 deliveries were conducted at home across the state in three years and 99.56 per cent of them had no skilled birth attendant, yet not one sub-centre had been upgraded with facilities for conducting deliveries.

“MOs did not visit 45 per cent of the SCs, even once a month. Though 55,000 deliveries had been conducted at homes, across the State, in the last three years, none of the SCs had been upgraded with facilities for conducting deliveries. The Traditional Birth Attendants and ASHA were not even trained with necessary skills, in 12 per cent of the SCs. Moreover, 99.56 per cent of home deliveries were not assisted by Skilled Birth Attendants.”Executive Summary

Emergency obstetric care, including caesarean section, was unavailable in 90 per cent of primary health centres, and 70 per cent of them had no functional beds; 35 per cent of registered pregnant women were never checked even once by a medical officer.

“Accident and other Emergency/ Casualty services were not available in 71 per cent of PHCs; while, Emergency Obstetric Care, including surgical interventions like caesarean section and other medical interventions were not available in 90 per cent of the PHCs in the State. As high as 70 per cent of the PHCs did not have any functional beds. Of the pregnant women registered, 35 per cent had not got checked-up even once, by MOs-PHC, out of their four scheduled ante-natal check-ups.”Executive Summary

Of the state's 348 community health centres, 284 had no emergency obstetric care, 22 had no newborn care and 51 no emergency care for sick children; 285 of them had no blood storage unit.

“Of the 348 CHCs in the State, Emergency Obstetric Care, including surgical interventions like caesarian sections and other interventions, were absent in 284 CHCs. There was no provision of new-born care in 22 CHCs, while emergency care to sick children had not been provided in 51 CHCs.”Executive Summary

In district hospitals 63 per cent of notified essential drugs had never been procured, and the department had no documented drug policy as of March 2022.

“The Department did not have any documented drug policy, as of March 2022... In District Hospitals, 63 per cent of notified essential drugs had never been procured. Many of the other drugs had remained out of stock for long periods.”Executive Summary

57.33 per cent of the oxygen generating plants received under PM CARES and corporate social responsibility funding were not commissioned or not functional as of December 2023, and ICU ventilators and oxygen concentrators were found lying packed in test-checked hospitals.

“ICU ventilators and Oxygen Concentrators received under PMCARES were not made operational and were found lying packed in test-checked hospitals. In the State, 57.33 per cent of the Pressure Swing Absorption (PSA) oxygen generating plants, received under PMCARES and Corporate Social Responsibility (CSR) scheme, were either not commissioned and/ or not functional as of December 2023.”Executive Summary

Health sector spending stood at 1.23 per cent of GSDP against the National Health Policy target of 2.5 per cent by 2025, and capital expenditure on health fell 12 per cent over 2017-22 even as revenue expenditure rose 125 per cent.

“As of 2021-22, the level of health sector expenditure in the State (1.23 per cent of GSDP) was far below the target (2.5 per cent by 2025) set in the National Health Policy (NHP).”Executive Summary