Audit report on AES deaths puts Bihar govt in dock

An audit report by the accountant general has blamed lack of health policy to poor management of various government schemes for food, nutrition, sanitation, hygiene, health, education and overall welfare for AES deaths in Bihar.

Bihar does not have a health policy and its budget also does not focus on any specific area of attention in health sector despite the scourge of acute encephalitis syndrome (AES) for over a decade, which, per official records, claimed 155 lives as this year.

Patients suffering from AES at Sri Krishna Medical College and Hospital (SKMCH) in Muzaffarpur, June 21, 2019. (Parwaz Khan /HT File)

The observation is part of findings of an audit report of the accountant general submitted to the Bihar government recently in the aftermath of AES catastrophe. The report blames lack of health policy to poor management of various government schemes for food, nutrition, sanitation, hygiene, health, education and overall welfare.

The report also highlights that Bihar, the second worst performing state in the country in the 2nd edition of the health index analysis by Niti Ayog, had witnessed decreasing trend during 2014-19 in terms of proposals by the health department, approval by the Central and actual expenditure, even as preventive, case management and rehabilitation system did not strengthen over the same period.

The report quotes superintendent of SKMCH in Muzaffarpur as saying that malnutrition in children, hot and humid conditions and low baseline sugar level were the responsible factors for the causalities due to AES.

The report also blames the poor fund management, saying it remained parked at the state level and could not reach the targeted groups in areas like AES-affected Muzaffarpur blocks for timely measures and early symptomatic treatment.

“The government failed to ensure healthy lives and promote general well-being as committed in the Sustainable Development Goals (SDGs) due to poor planning, meagre fund utilisation and management of the health issues. It had no structure for assessment, evaluation and strategy to handle the health crisis,” the report says, adding that the health department violated the standard operating procedure (SOP).

Against the total allocation of Rs 37,258.26 crore in the last five years starting 2014-15, the expenditure by the health department was Rs 26,894.23 crore (72% ), while savings remained Rs 10,364.03 crore (28%).

“Funds were surrendered as funds were not requisitioned by the concerned districts, scheme was not sanctioned due to model code of conduct, allocated fund under National Health Mission (NHM) was not released by the government of India (GoI), estimation of transfer and posting of employees, stock of medicine, tools and plant, diet etc. was not done, prescribed norms were not followed timely, funds were not withdrawn due to technical reasons etc,” it adds.

The audit team sought information related to budget allocation and release of funds in connection with AES, but it was not provided. An allotment letter found by the audit team, however, revealed that an administrative approval of ₹2.96 crore was accorded by the Bihar health department for establishment of encephalitis ward at SKMCH, Muzaffarpur, and Rs 1.66 crore was transferred in September 2015 to Bihar Medical Services and Infrastructure Corporation Limited (BMSICL), Patna. However, it could not take shape.

Sanjay Kumar, principal secretary, department of health, said he was aware of the report, but had not seen it. “Once I got through the report, it will be better for me to comment. As far as health policy is concerned, the Centre has one. It needs to be contemplated if states should also have individual policies. We will see the report and do whatever is required to improve things further,” he said.