Of venal & corrupt Health Administration

http://bagchiblog.blogspot.in/5/2012of venal & corrupt health administration

All is surely not well with the Health Administration of the country. The other day two shocking revelations were made in the press. One of them related to detection of serious irregularities by the Parliamentary Standing Committee on health and family welfare in respect of advices and letters of recommendations from some experts submitted to the Drug Controller General of India (DCGI) regarding several drugs. These recommendations, apparently, read the same, word-for-word, as those submitted by the drug companies concerned. Experts’ endorsements are crucial testimony for country’s Central Drugs Standard Control Organisation for allowing launch of drugs in the market.

                                              

The disclosure revealed a nexus between some experts and a few drug companies enabling unquestioned endorsement of the scientific recommendations of their own products for onward transmission to DGCI. These are required to be submitted by the experts after due consideration of the drugs’ content and their efficacy. Evidence, however, has been unearthed indicating that the experts merely affixed their signatures to the recommendations submitted by the companies concerned. Worse, some were submitted on the day of their receipt by the experts, obviously without according to them due consideration. More alarming was the fact that the experts are from a few iconic medical institutions of the country and some of them happen to be working as professors in these institutions.

The innocent, ignorant and unwary patients will be at the receiving end if drugs are pushed in such a manner by the drug companies in collusion with highly placed medical experts without being evaluated in regard to their therapeutic potential. Suspect efficacy of drugs will hit all classes of people across the board and with high drug prices it would be a sort of double whammy for them. Already, people are suffering under the weight of their medical bills. A recent report said that the “out-of-pocket” expenditure – the percentage of expenditure incurred by households on medicines – has increased by 75% during the past couple of years. High medical costs, along with rising prices of essentials, are biting the common man. According to 2011 World Health Organisation estimates about 70% Indians spend their entire income on healthcare and purchase of drugs. With the prices of drugs for common ailments like cardiac disease, hypertension, diabetes creeping up northwards, market watchers are asking for State intervention. Poor are simply unable to afford many drugs. Decrying the ineffectiveness of the National Pharmaceutical Pricing Policy even ruling party politicians are concerned about common man’s woes. 

Such improperly evaluated medicines can also adversely impact exports once they fail to live up to their claims. India is considered the pharmacy of the world. While the domestic retail market in 2008 was estimated to be valued at more than Rs. 55000 crores ($10 billion app.), exports were worth around Rs. 38000 crores ($6 billion app). Unless checked, corrupt practices at the stage of approving and launching a drug in the market would amount to shooting oneself in the foot. 

The health sector is somehow saturated with corruption, whether at the Centre or in the states. A former central minister of Health & Family Welfare was involved in several scandals during his tenure, including what is known as the “vaccines scam”. He ordered the public sector units to discontinue manufacture of various essential vaccines only to throw open the entire market to one of his cronies for easy pickings. Ultimately, the other day he was charged by the Central Bureau of Investigations in a Delhi court for abusing his authority and permitting a medical college to admit students without having necessary faculty and clinical facilities. Establishment of medical colleges has become a very paying proposition. Politicians, in collusion with money bags, bribe their way into acquiring prime lands for establishing such colleges, the approval and later recognition for which is easily obtained by pulling strings and money changing hands. The President of the Indian Medical Council, Dr. Ketan Desai, and two others were arrested last year for taking hefty bribes for granting recognition to a medical college. No wonder, the quality of medical education leaves much to be desired. Barring a few reputed hospitals, medical institutions and (elderly) private physicians, the general quality of medical attention to the patients is poor, more so to those belonging to the economically weaker sections.

The National Rural Health Mission (NRHM) appears to have become a goldmine for corrupt politicians, doctors and administrations. The ambitious goal of the Mission is to “improve the availability of and access to quality healthcare by people, especially for those residing in rural areas, the poor, women and children”. The second news report was about the sleaze detected NRHM in Madhya Pradesh where, one after the other, two directors of health services have been caught with huge amounts of liquid and fixed assets - all disproportionate to their respective incomes. In the earlier case even the minister in-charge was involved along with the principal secretary of the department of health, an IAS officer, who, mercifully, is being prosecuted. The minister resigned but escaped prosecution. In the recent case, the director was found to be in possession of assets worth more than Rs. 100 crores (Rs.1 billion app). Serious irregularities were detected in the process of tendering and procurement of medicines, mosquito-nets, etc. During the raid at the director’s residence his wife reportedly advised the Lokayukta (Ombudsman) officials to raid the houses of ministers to whom a crore (Rs. 10 million) of rupees was required to be delivered every month.

 One can imagine the astronomical sums that have been poured into the Mission from the fact that in Uttar Pradesh alone Rs 10000/- crores are believed to have been siphoned off. Two chief medical officers and three other officials were murdered and scores of engineers, doctors, administrators and ministers have been charge-sheeted by the CBI.

Conscious of the abysmal level of public expenditure on health (1.4% of GDP) the government has been allocating huge amounts of tax-payers’ money to the states in an effort to achieve universal health coverage, including cashless treatment. The Centre’s resolve to boost government spending can potentially make high-quality care accessible to all. It has not shied away from making necessary allocations as can be imagined by the way the system has been milked by the powers-that-be at the Centre and in the states, especially, in MP and UP. No wonder, despite the (now waning) growth story India ranks below the Sub-Saharan Africa in many international health-related indices. While the corrupt, cannibalistic predators do not allow the benefits of outlays to reach the needy, high drug prices and raging inflation prevent millions from buying essential medicines because of pervasive poverty – a significant facet of the Indian growth story.

 Clearly, the corrupt hordes in the government wouldn’t allow it to achieve its own “goal” of building a healthy and strong India.

 

Of venal politicians and their corrupt parties

The Outlook magazine, a popular national weekly, has been publishing excerpts from the taped conversations of Niira Radia, the now (in)famous lobbyist of, inter alia, the House of Tata, with several individuals, including the former Indian Telecommunications Minister, A Raja. In one of the tapes published in the issue of 14th February 2011 of Niira Radia’s conversation with one Manish, an employee at Vaishnavi Communications (another corporate communication consultancy firm) Radia says “In the middle of the night (Raja, the Minister) called Anil Ambani to come and collect his LoI (Letter of Intent) for a dual technology license” and “...when you ask Mr. Raja why are you doing this, his view is ‘what do you do, I have a party to run”.

The last bit of what Raja said is not only significant but also carries the nub of what has now come to be known as the “2 G scam” (the scam related to frequency allocation for mobile telephony to favoured parties) of the Ministry of Telecommunication & IT that he headed as also of many other scams. That Raja was required to, through his acts of omissions and commissions in the Ministry, ensure that the party coffers are filled as much as possible has now become somewhat of a standard political practice. He, most probably, had the same mandate before he was re-nominated for the Telecommunications Ministry in 2009. And, likewise, before him even Dayanidhi Maran, again of the Dravida Munnetra Kazhagam (DMK), may also have had to work according to the same mandate. Clearly, DMK was keen on Telecommunications Ministry only for the reason that it could be milked for the benefit of the party and, of course, its patriarch M Karunanidhi. If, in the process, the ministers involved made some billions on the side the party bigwigs would, seemingly, have no objections.

Whether Raja, in his previous avatar as the head of the Ministry of Environment & Forests (MoEF), did not do the same is open to question. After all, during his tenure in MoEF in UPA I government the epithet “rubber stamp” was largely used for the ministry. It would clear each and every project that came its way for environmental clearance regardless of the adverse impact that they would have on the country’s environment. Maybe it is hearsay, but the e-mails that are circulating in the country with photographs of his palatial modern-looking residence with extensive grounds could not have been inherited by a person who claims to be a dalit (a member of former depressed class). How it was built and what the sources of his resources are still a mystery.

Obviously, Raja’s party, the DMK, a regional outfit, has imbibed what its senior alliance partner, the Indian National Congress, has been adept in for a long time. The latter has, according to credible reports circulating for years, has been creaming the government decisions taken during its decades in power at the Centre and in the states to fill its own coffers. In the early years, Soviet money found its way not only to the Communist Party of India but also to the Congress. The thriving rupee trade between the two countries, particularly big-ticket imports of defence equipment, facilitated the illegal transfer of funds. That the Soviets had infiltrated into the Indian establishment within the country and abroad is, of course, another story. The Mitrokhin Archives threw generous spotlight on it and is now a part of history. It, inter alia, made a mention of the Soviet money getting to India with minsters like Lalit Narain Mishra, the then Minister for Foreign Trade, as conduit. His corrupt ways were legendary but in no way comparable to what happens today. Tales about his accepting briefcases full of currency used to be rife in Delhi during the early 1970s. Not only did he enrich the Congress, he enriched himself, too, but, unfortunately, to no avail. He was, reportedly, bumped off in 1975. He was, after all, “the man who knew too much”.

If the Soviets transferred funds to the Congress, the US could not have been left behind. The late Daniel Patrick Moynihan, a one-time US ambassador to India, in a collection of personal letters and journal entries edited by Steven R Weisman, a public policy fellow at Washington-based Peterson Institute, in a book “Daniel Patrick Moynihan: A Portrait in Letters of an American Visionary”, asserted that US had paid money through the CIA to the Congress Party. The charge was later taken advantage of by the late Jyoti Basu, a former communist chief minister of West Bengal, who speculated that the money was, probably, disbursed in the early 1970s to contain Naxalism, a violent and rabid movement of the Left, which had spread like wild fire in West Bengal. Although, the current Congress spokesperson rubbished the allegations, he wouldn’t know what transpired forty years ago between two hardnosed politicians like the late Indira Gandhi and the then all-powerful US secretary of State, Dr. Henry Kissinger.

Last year the octogenarian eminent lawyer, Ram Jethmalani, accused the Congress of receiving payments from the Union Carbide Corporation (UCC) after the Bhopal gas tragedy and demanded that all the correspondence between the Union Government and the company should be made public. He said that the then Union Government enacted a legislation abrogating the rights of thousands of dead and grievously injured victims to sue the company for compensation and appropriated the same to itself without the victims’ consent. It then promptly filed a suit for payment of adequate compensation the results of which are well-known. Not only a measly sum of $ 470 million was settled as compensation in an in camera sitting of the Supreme Court in the chamber of the then Chief Justice to which the UCC lawyers, reportedly, had come straight from the Prime Minister’s Office then headed by the late Rajiv Gandhi, the settlement also extinguished all financial liabilities of the UCC and the rights of the victims to file civil and criminal cases against the corporation – a very favourable turn of event for it.

Apparently, the quantum of compensation to be paid by the Corporation was also treated like a deal like the ones struck during those very years for import of Westland helicopters, HDW submarines and the (in)famous, though very effective, Bofors howitzers. However, the intense public resentment that was aroused as a sequel to the farcical judgement of June 2010 in the criminal case against the Indian bigwigs of Union Carbide India Ltd. the current coalition government led by the Congress at the Centre was forced to file a curative petition in the Supreme Court against the 1989 compensation settlement –generally branded as “collusive”. Agreeing that there had been an error in settling for the very meagre amount of compensation, it has now sought enhancement of compensation to the victims from Rs 750 crore (75 billion) to Rs 7,700 crore (770 Billion). That and the chain of events that followed the tragedy made it amply evident the collusive arrangement between the then Union Government and the UCC. In the aftermath of the tragedy, an overriding desire, among other things, on the parts of the state and Union governments, both then ruled by the Congress, to protect the interests of the company was clearly discernible. Jethmalani may well be right in making his accusation.

In our kind of democracy, which has progressively assumed an aberrant form, priorities of the political participants in the act of governance have got mixed up. Political parties seek power to exercise it not on the basis of Jeremy Bentham’s “Greatest Happiness Principle” but to ensure their own happiness and well-being as also of their members. This is true both, at the Centre and in the states. The ministers, like Raja, who are in a position to swing deals, direct their efforts towards enriching their party as also themselves. The basic idea is to enable the party to have enough means to swing elections in its favour by buying votes or managing polling booths or even buying legislators, if it came to that, for garnering support when it fails to get a clear majority. Having enough cash in party coffers is very essential as the going rate of a legislator could be in billions. All major national and regional parties are guilty of this sin.

Hence, it would seem as if governments in India exist only for the political players who happen to capture their reins. Milking of the state by way of foul means permeates the system spreading an environment that is utterly unethical. No wonder, party men like Raja who are pushed to head ministries for their proven record of venality indulge in massive scams, stoking further the already pervasive corruption in the Indian administration.