It has, for example, mentioned Bir Hospital’s failure to start the construction of an international standard health facility in Duwakot, Bhaktapur, despite the budget allocation of Rs 500m in the fiscal year 2021/22. The proposed hospital is said to be completed within three years, but the construction process has yet to commence.
Similarly, the National Public Health Laboratory failed to spend Rs 12.64m allocated to it for the construction of a laboratory building, the OAG report states. Furthermore, the government's plan to build basic hospitals in all 753 local units has also stalled. Although 655 local units were permitted to construct basic hospitals, construction is underway in only 414 local units, while work has not begun in 241 units. The OAG report says that the government spent Rs 6.96bn on building basic hospitals in the fiscal year 2021/22. In the fiscal 2021/22, the Health Ministry allocated Rs 3.12bn to procure equipment such as ICU, PICU, HDU, ventilator, and oxygen plant for federal, provincial, and municipal hospitals, community hospitals, and medical colleges. But while the ministry spent Rs 3.10bn on these equipment, it is unclear whether it has been put to use. The OAG has instructed the ministry to prepare a report on the use of such equipment and maintain an integrated data system. It has also directed the ministry to keep up-to-date records of the equipment procured for Covid-19 isolation and quarantine centers. According to the OAG report, the Health Ministry procured syringes for immunization at Rs 6.74 per unit in the fiscal year 2021/22, compared to Rs 4.41 in the fiscal year 2020/21. Interestingly, the ministry had estimated the cost at Rs 8.17 per syringe in the fiscal year 2021/22, resulting in an additional financial burden of Rs 53.35m. The report also raises the issue of several government hospitals and medical bodies violating the established norms while preparing cost estimates for procuring various equipment It says BP Koirala Institute of Health Sciences, Bharatpur Hospital, and Health Insurance Board violated public procurement laws by eschewing the competitive bidding process to procure furniture and equipment worth Rs 14.37m, Rs 28.78m, and Rs 4.8m, respectively. In the fiscal year 2021/22, the OAG report further states, the Health Ministry provided grants worth Rs 449.5m to 38 community hospitals and organizations without completing the required procedures outlined in Section 4 of the Guidelines Related to Subsidy for Community Hospitals, 2016. The OAG report also states that 7.6 percent of the rotavirus vaccine and 79.3 percent of the BCG vaccines had expired due to the lack of proper management of vaccination programs. Similarly, nearly half of the VTM, RNA Extraction, Automated RNA Extraction, and Antigen kits, with a combined worth of Rs Rs 298.12m, are set to expire without being used. Four million doses of China-donated Sinovac Covid-19 vaccine are also set to expire in 10 months. The government has not used the Sinovac vaccine, citing a lack of technical tests. The OAG has also identified a number of issues with the Department of Health Services' procurement and payment practices. Specifically, the department has released full payments to suppliers before the equipment installation and staff training, which violates the procurement contract. The OAG has instructed the department to ensure that suppliers abide by the procurement act and take action against officials who release payments before the work is completed. The department has released payments of Rs 445m to four suppliers for various equipment, including automated biochemistry analyzers, hematology machines, an ERCP machine, portable X-ray machines, and hemodialysis machines. The OAG also noted that suppliers took more than eight months to supply and install 50 sets of ICU ventilators that were urgently needed at various government hospitals. In addition, the OAG report says, the department has been procuring medicines using money received from the Gavi Fund through UNICEF, which goes against the practice of making spending through the budgetary system. According to the report, the Department of Drug Administration (DDA) has not been able to perform its monitoring responsibility effectively. The DDA monitored only 3,663 out of 33,474 pharmacies, and only 72 out of 187 drug producers. The OAG has also raised the issue of DDA’s failure to properly manage the medical waste and expired medicines, which could pose a significant risk to public health. The OAG has also pointed out the failure of the National Public Health Laboratory to procure and install 35 pathological test equipment despite receiving the budget for the same. Furthermore, the OAG has directed the National Tuberculosis Center to make effective use of equipment and infrastructure after discovering that the center was not utilizing a culture machine costing Rs 7m, NK analyzer costing Rs 2.25m, autoclave costing Rs 800,000, and centrifuge costing Rs 300,000. Similarly, the OAG report states that the National Academy of Medical Sciences (NAMS) has been neglecting the upkeep and maintenance of medical equipment. The report states that seven ventilators, one USG equipment, one patient monitor, eight Hamilton ventilators, and two CareFusion ventilators are in need of repair. The lack of functioning equipment has adversely affected the hospital's service delivery, the report notes. The OAG has also directed NAMS to expand its pharmacy to reduce the waiting time for patients to get medicines. The report reveals that NAMS has been unable to install a CT simulator and Thermotherapy machine for cancer treatment, even four years after procurement. NAMS has also been called out for disbursing Rs 31.77m as medical expenses to its staff without verifying procurement bills. The OAG has instructed NAMS to recover the amount. The OAG report also states that the construction of a 400-bed neonatal building, a 300-bed cardiac center, and a 200-bed oncology center at the BP Koirala Institute of Health Sciences (BPKIHS) remains incomplete, even five years after the contracts were awarded. According to the report, the administration of BPKIHS released Rs 32.21m as cost variation of the neonatal building without approving the variation. The OAG has instructed BPKIHS to recover the amount from the contractor. The building, which was supposed to be completed in three years, still remains incomplete. Furthermore, the decision to terminate the bidding process for the procurement of dental materials has cost BPKIHS an additional Rs 5bn. The institute awarded the procurement contract to the only bidder at a cost of Rs 19.97m. However, in the previous bidding, one of the bidders had quoted around Rs 14.92m for the same tender. The OAG also found discrepancies in the preparation of cost estimation for procurement. In addition, the report revealed that Paropakar Maternity and Women's Hospital has been referring patients to private hospitals and diagnostic centers insteading of repairing its equipment. For instance, the hospital referred 4,200 patients to other hospitals for MRI services in the fiscal year 2020/21. It has affected service seekers as they are forced to pay as much as Rs 3,000 for MRI which would cost only Rs 1,000 at the maternity hospital.
