Corruption In WHO IBRD ADB India Health Projects
P. S. Remesh Chandran
Editor, Sahyadri Books & Bloom Books, Trivandrum
It is assumed that you have already read in full the article 'WHO IMF IBRD And ADB Money To India Health Finances Human Rights Violations And Corruption' in Sahyadri Books Online, Trivandrum. You may need more details. Here are a few draft unedited chapters from proposed book under the same title, published here as a stop-gap arrangement for your use, till the original book is released. Please feel free to use the information if needed- Editor.
I. WHO
WHO used to get its funding from Member States’ (MSs) Assessed Contributions based on their wealth and population and their Voluntary Contributions. Assessed Contributions are committed, predictable, and flexible and the country cannot question how WHO spends it. The other source of funding is Voluntary Contributions from Non-State Actors (NSA). Voluntary Contributions can be part-flexible and not category-specific, or not at flexible and category-specific or issue-specific. 80% of WHO’s funding is from voluntary contributions. WHO has twenty four programme areas and they cannot use voluntary contributions in these areas as needed or as they choose. All needed programme areas won’t be able to attract sufficient voluntary contributions and as a result these needed areas receive less funding than needed. Ten areas receive 80% of all voluntary contributions and fourteen areas receive less than 2% of the voluntary contributions. So the WHO tries to balance the budget by appropriating the fourteen areas against assessed contributions and non category-specific voluntary contributions, and then ten against category and issue-specific voluntary contributions. The budget always remains unbalanced. Some areas become lavishly funded and some remain neglected.
Through the years the inevitable happened. WHO began to focus on the favourite areas and began to neglect others. If they cannot raise funds for these areas, what else can they do unless member states voluntarily raise non category and issue-specific contributions? Gradually the contributor preferences became the norm for WHO funding. And the Non State Actors began to influence, and even force, WHO in policy-making and decision-making. The member states, especially the poor states, lost their importance and their much-needed projects and the rich states and the richer Non State contributors took over WHO.
In the past the world countries looked up to the WHO for guidance and help. No more do they. Its influence and hold have steadily been waning through the years and now its place is being taken by multi national health financing organizations which lend money for an interest. Today the WHO no more standards in health matters but is giving way to these multi nationals to decide how developments in the health sector should go and what standards to be set. Today they decide what the WHO’s policies should be and in which areas it should work. Today the WHO’s policies and areas of work always supplement theirs as they have become the biggest fund-givers to the WHO. The member states which originally made WHO possible and funded it through decades are gradually made to suffocate for the single reason that they have the same single vote power like the major fund-givers like the USA who back these multi nationals and neo liberals. All member states having only one vote make many attempts by these multinationals to totally commercialize the health sector fail and soon they will be forcing the World Health Assembly to change the voting system to being based on the amount of contribution. These are the powers behind the World Bank also- the many foundations, consultancies and corporations. They are the greatest investors in the health-damaging industries also- the liquor, the tobacco, the chemicals. They are one and the same. The meaning: they are buying out the World Health Organization. If there are no-profit players in the health sector, especially health financing, they are pushed out by WHO now. Their initiatives do not receive their due respect with WHO.
Many saints in this field are just fronts for cut-throat for-profit health organizations. The ultimate goal of even some famous charity foundations is nothing but legitimizing the multi nationals’ greed.
So what happens when health financing goes from member states to corporate sector? They have a policy for corruption and a provision for bribes. Their officers and even board members are prone to corruption and bribes. They are famous for oiling the wheels of bureaucracy with money. Corruption and bribes which were rampant under member state financing have their field day under corporate health financing. The member state financing had at least a commitment at least in papers against corruption and bribery. Corporate health financing does not have any such commitments. For profit, it is legitimate for them to give bribes and ignore corruption. They will still have their profit.
Since when World Bank emerged as the major-most player in health financing, i.e. the major-most financier who gives loans to countries for interest, the WHO who gave grants-in-aid instead of loans with interest was pushed to the back. The gradual and steady work of neo-liberal financing consortiums that are on the back of World Bank made this happen successfully. The power and push of neo-liberal financiers are such that developing countries which depended solely on WHO for interest-free and repayment-free health financing turned to World Bank in spite of the future burden of repayment and interest. Why did this happen? And how did this happen? Private foundations which made their fortunes from cut-throat free market enterprises and global trade agreements began to shift their sympathy from WHO to World Bank for pure financial reasons and began to cut contributions to WHO and to flow more money to World Bank coffers. Sure they began to get more say in international health policy-making and decision-making. No wonder WHO though the years have been loosing its chieftain’s role in international health policy-making and decision-making.
The WHO succumbing to the methods of these neo liberal organizations also meant WHO succumbing to corruption also in a global scale.
Since 2000, more than 100 Global Public Private Initiatives were formed in the health sector, heavily backed and promoted through legislation by countries like the USA. Soon they took over global health control and gulped down in some cases and replaced in mosrcases WHO in the field. It became clear to the world that if these private initiatives guised for the time as public-private partnership ventures were not given a free hand in health care in all countries, WHO will be wiped out along with all non-profit health care financiers it associates itself with. The terrified WHO had no other way but to cut relations with not-for-much-profit initiatives like the Global Fund for AIDS, TB, and Malaria (Global Fund) and the Global Vaccine Alliance (GAVI). Remember that GAVI had heavily financed several health projects in India. What place once occupied by the Global Fund and GAVI was shamelessly taken over by the more-private-than-public initiative Gates Foundation. India Government celebrated their coming to India Health like ….. The contribution to India Health on account of this change was weakening the famous Free Hospital System of India and strengthening the Pay Hospital System which these ‘philanthropic foundations’ want.
Up to 2010 the WHO and its general body World Health Assembly kept themselves away from organizations functioning in the health sector for making profits. In 2010 the united effort of these for-profit organizations succeeded in sabotaging this decades-long policy of the WHO and moved the World Health Assembly to adopt a new framework for health governance, named FENSA (Framework for Engagement with Non-State Actors), which came into effect in 2016 and took into its policy and decision making process ‘the strong opinions and views’ of for-profit organizations. Gradually the ‘strong opinions and views’ of these for-profit organizations began to shape the opinions and views of the WHO.
The United States is a stubborn criticizer of all WHO programmes except those funded by them for specific projects of their or their country’s corporations’ interest. All their contributions are towards specific projects. They do not like to contribute to the core budget of the WHO as a member state. When they stop funding a specific programme but the programme has to go on, the funding has to come out of its core budget which has been crippling the WHO resources for thirty years. For thirty long years, the US has been trying to cripple the WHO this way by freezing contributions. During these thirty years it has been spending a million times more money on foreign soil on wars for political reasons. It is like the US literally forcing the WHO to become a polio victim who won’t be able to stand or walk on its own anymore. Even its Polio Eradication Programme is making it a polio victim. This programme is funded slightly through Voluntary Contributions and mostly through issue-specific contributions, the biggest contributors being the US and the US-based Microsoft’s owner’s Gates Foundation for a time. In fact they flooded the WHO with funds for polio and hijacked the programme for their corporations’ benefit: the US alone delivered a total of US$ 902 million hitherto through the Global Polio Eradication Initiative; the Gates Foundation delivered US$ 682m in 2008, 134m in 2011, 204m in 2013 and 95m in 2017. These funds are drying up through years and now have come to only a trickle. Soon it would eat into the WHO’s core budget because the programme has to be carried on as polio has not gone away completely. And at this junction, the US will not increase its member state contribution or the Gates Foundation its non-member state contribution towards polio eradication. They are working in unison to wreck the WHO’s core budget so that that charade of a World Health Assembly could bring more reforms favouring Private Initiatives and allowing the private sector to take over global health policy-making and decision-making.
The WHO’s budget to run its core projects and also its headquarters in Geneva, 5 regional offices and 180 country offices comes to just US$ 2.2 billion which is a moderate figure, compared to the fact that it is only 30 percent of India’s annual spending on National Health Mission. Many drug companies have 300 times higher turns over. Clearly many developing countries like India and China could easily have enhanced their voluntary contributions and saved the WHO’s socially important programmes without having yielding to imperialist countries and non-state actors, but US diplomacy won’t allow them. India has actually become a partner of US in obstructing WHO initiating meaningful discussions on key issues of social importance which happen to be against the business interests of many over-developed countries and multi nationals. For example, both share the same interest for protecting US trade agreements and patent rights and ignoring how detrimental most of them are to the interests of health.
II. IBRD
The five constituents of the 189 member states-strong World Bank Group which offers flexible loans with maturities as long as 30 years are International Bank for Reconstruction and Development (IBRD), International Development Association (IDA), International Finance Corporation (IFC) and Multilateral Investment Guarantee Agency (MIGA) and International Centre for Settlement of Investment Disputes (ICSID). India is one of the founder members of IBRD, IDA and IFC and a member of MIGA. She did not join ICSID. India has US$ 6098.3 million worth of shares in IBRD and is the 7th largest shareholder. In IDA, IFC and MIGA also India has considerable worth of shares and proportionate percentage of votes.
India has been drawing funds from the World Bank mainly through IBRD and IDA. As on 31 December, 2011, India has drawn total assistance of US$ 42124.96 million from IBRD. Of this amount, part of assistance for the sector of urban infrastructure (water & sanitation) reached health. As on 31 December 2011, the total assistance from IDA to India was US$ 39,506.5 million, the bulk of which went to the sector of health. IFC made available about US$3.6 billion to India till now, almost all of which went to health and education. In addition, the World Bank assistance programmes guided by Country Partnership Strategy lent $3 billion to $5 billion each year to India over the five years of 2013-17. Sixty percent of this financing went to state government-backed projects, most of which in the health, sanitation and transportation sectors.
World Bank supported US $ 1500 million of the US $ 22,000 million Clean India Mission Project approved on 15 December 2015 with closing date on 31 January 2021, US $ 106 million of the US $ 151.50 million Integrated Child Development Services (ICDS) Project approved on 6 September 2012 with expiry date on 30 August 2022 and US $ 255 Million of the US $ 510 million National AIDS Control Support Project approved on 1 May 2013 with expiry date on December 31, 2019. All these projects drowned in corruption. The money was squandered in procurement and administrative spending by bureaucrats, politicians, supervisory personnel and supply companies. And then more money from the rest was pilfered by way of bogus vouchers. Items supplied inferior in quality and performance and further worsened public health conditions. ‘Immunization of children from one year to two years age remained below 54 percent and despite the largest child-nutrition program funding in the world, 48% of children below five years age remained low height for age, 43% low weight for age, and 20% low weight for height. Pregnant women could not be guaranteed at least three antenatal hospital visits during pregnancy. Maternal and infant mortality became the highest in Asia and childhood diseases and infectious diseases common.’
Though the World Bank invested US$ 2.6 billion in India Health during thirty years, the development in the health and nutrition sectors were very poor. Compared to other countries, this amount did not bring the development it ought to have brought. The World Bank mistook this failure to be due to lack of education and poverty instead of intelligently assessing this failure to be due to corruption. What amounts actually reached people through projects after deducting the amounts pilfered as corruption from this enormous assistance did indeed bring its share of development. Only that, had there been no corruption the development would have been dramatic. =The World Bank was too slow and hesitant in accepting that corruption in India was unexpectedly heavy to withdraw from further financing. Foolishly and blindly it continued to be the largest financier in the health sector in India. Why they did not accept this failure was because it would be construed as a failure in policy. It was they who were the main players in advising India on national health policies. They further erred in beginning to employ those very ‘experts’ in India who were the master minds behind this corruption to advise on how to rectify mistakes of the past. This happened in the early 1990s and that was when serious corruption in health sector began in India. They identified population growth putting a strain on government resulting in progress being not as rapid as expected as an important factor, forgetting the fact that for three decades it was they who were financing and advising India Health on population control, and their earlier projects were emphasizing on sterilization. They forget that even in the late 1960s, even before the World Bank came to India with its 3.6 percent of total program funding for family planning services, the Female Loop Insertion had been picking up speed, among educated Indians of course. The above said amount of US$2.6 billion was spent not limited to the health and nutrition sectors but in the population control sector also. They also admitted that ‘80 percent of this health spending was for private health services on the belief that the poor would frequently bypass public facilities to seek private care’. Totally wrong: the Indian poor always go first to government hospitals. So, that was what the ‘Indian Experts’ were advising them: to neglect government hospitals and spend 80 percent of the resources for the development of the private hospitals! The last they were to admit was that the projects had flaws which their experts could not foresee. They themselves say ‘support has evolved slowly, in phases, from simple beginnings, learning all the way. Then what to say when world talents help prepare, scrutinize and approve projects after tedious and time-consuming processes and find flaws?
It took another 30 years and needed Wall Street Journal to bring out the heavy corruption in World Bank projects in India Health and the World Bank to admit they misjudged and corruption gulped down the lion’s share of the project money they flowed to India. Why the blacklisting of scores of companies every year who were entrusted with World Bank tenders in India did not open the eyes of the World Bank personnel to corruption implies the Indians were not alone in corruption.
Till the 1990s, development in the health sector in India was mostly centred on public hospitals and free services. The World Bank, in their own words, ‘made use of a change of leadership in the Ministry of Health and Family Welfare at that time’ to self-assume the role of policy advisor and to turn the government to focusing project spending on development of private hospitals and payment services by beginning to fund Disease Control Projects and State-Level Health Reform Projects. It covered leprosy, tuberculosis, malaria, cancer, mental illness and whatever was in the book. By the time they finished with these projects, the famous free public hospital system of India had deteriorated and the large private hospitals system deep-rooted. When it came up with financing the National AIDS Control Project, the Golden Gate of Corruption in India was opened. Of course ‘one-third of a million cases may have been prevented’ in their estimate, but this project opened up a million new avenues for corruption in diverse fields.
An Indian doctor, Dr. Kunal Saha first reported to INT, the anti-corruption unit of the World Bank in May 2007 that the use of faulty HIV/AIDS test kits mass purchased for the World Bank-funded First National AIDS Control programme and supplied by the Government of India to hospitals and blood banks in the country gave false negative results and did not reliably detect HIV-contaminated blood which could therefore be accepted for use in blood transfusions. The US Center for Disease Control (CDC) certified the kits’ accuracy and tried to cover up the fraud and World Bank officials began a series of misleading public press releases to discredit Dr. Saha in India and abroad. The WB criticized his findings as just personal opinions and the India government accused Dr. Saha, who worked as a senior HIV/AIDS researcher at the Columbia University in New York and Ohio State University in Columbus and Ohio for more than 12 years and who is a recognized expert in the field of HIV/AIDS research with two decades of research and clinical experience, of having no credibility.
Soon the compelling evidence collected by Dr. Saha appeared in the Indian press and the CDC assembled their own experts and refuted the allegations as baseless. He proved that though there had been several earlier complaints against the kits distributed by Monozyme, Ltd. as October 2004, the agency or the government had not withdrawn the kits, the kits had caused danger to public health in West Bengal in 2006 and Chhattisgarh in 2007 and since then in many other states and that these faulty diagnostic kits may have been transmitting HIV in India.
No one knew how high in the hierarchy of officials in the World Bank the India Health Corruption has reached. The frightened World Bank engaged more experts and flooded the world press with more misleading information. But the United States legislation on the disbursement of funds stopped everything and the World Bank was forced to release their anti-corruption unit INT’s report on Indian health projects which revealed not a few skeletons.
Seven months later World Bank’s Detailed Implementation Review confessed to using the CDC to conceal the fraud, not acting immediately to arrest the potential spread of HIV through the project and admitted Dr. Saha’s report was a real red alert. The same year, the World Bank’s Anti-Corruption Unit took him into the six-member team reviewing the Second National HIV/AIDS Control Programme financed by the World Bank with US$ 191 million.
Two years of test results by one hospital showed that the Monozyme-supplied SD Bioline kits were yielding a high false negative rate.
Five Voluntary Counseling and Testing Centers had complained to Municipal/ District AIDS Control Societies that Monzyme-supplied S.D. Bioline HIV ½ Rapid Test Kits were producing invalid/false negative/discordant results.
Procurement of diagnostic test kits and blood bank equipment was riddled with fraudulence and corruption, which were markedly pronounced where they were decentralized procurements.
The World Bank knew from the beginning that these kits had serious problems, allegations were correct and an unknown number of Indian citizens may have contracted HIV through these kits used for testing.
Despite the public release of the INT report in January, the World Bank continued to tell the world that the HIV test kits were not faulty.
Accelerating Universal Access to Early and Effective Tuberculosis Care
Accelerating Universal Access to Early and Effective Tuberculosis Care was another programme in 2016 which followed the DOTS programme of the 1990s and aimed at funding quality diagnosis and treatment services for people who were affected with TB-affected. The foreign supervisors and the Indian collaborators did not accept the simple fact that medicine is more important in this disease than care and later restructured and reduced the funds for procurement of drugs from 85 percent to 40 and increased the funds for consultancies and services from 15 percent to 60. Why should there be another evidence to prove that the World Bank’s personnel and their Indian counterparts were more eager to divide the money among consultants and support staff than procuring drugs for curing and preventing TB?
The general consensus is that if the bank spends $25 billion on projects, $5 billion will vanish in corruption. 10 percent of the amount is standard in corruption. In Nigerian projects, it was found to be 40 percent. In Indian health projects it must be more than half. Not only in health projects but in other projects also this is what is happening in India. In the Lucknow-Muzaffarpur National Highway Project the INT which investigated the allegations found that huge amounts of money were stolen through forged and falsified invoices in exchange for cash payment as bribes to officials. Bank had to disbar the supervision consultant for five years and took no action against the Bank personnel involved.
III. ADB
Asian Development Bank headquartered at Manila in Philippines finances 7 projects in the health sector in India. India has 6.359% of subscribed capital and 5.386% of total voting power in the ADB and ranks number 4 among the 20 largest countries in subscription.
Out of the total 3.4 billion Ordinary Capital Resources (OCR) for Water and Other Urban Infrastructure and Services laid out in the Country Operations Business Plan 2016-2018 for India, Urban Health Care gets a handsome amount of 315.5 million Dollars out of which it supports National Urban Health Mission 2017 and 2018 for a total amount of 0.8 million US Dollars. These missions include projects in Kerala also and a considerable portion of this amount is sent to Kerala. These are figures for just the two years of 2017 and 2018. In addition, there are co-financing and re-financing of projects, and there are other years.
Project No: 47354-002 Supporting National Urban Health Mission, Approved on 16 Dec 2013 was US$ 225,000 as Technical Assistance Special Fund and US$ 600,000 as Technical Assistance Special Fund (Supplementary). This project has been closed now. Project No: 47354-003 Supporting National Urban Health Mission, Approved on 28 May 2015 was US$ 300 million as Ordinary Capital Resources, US$ 2 million as Japan Fund for Poverty Reduction and US$ 500,000 as Technical Assistance Special Fund. This project is running now. More than equal funds earmarked for sanitation and clean water heads also reached Kerala Health in other years. Think how much amount from these may have reached Kerala from the Asian Development Bank alone.
‘Beyond their medical significance, hospitals are a product both of culture and technology.’
The Asian Development Bank’s conception of hospitals while extending sustenance money to Kerala’s hospitals is, ‘Hospitals are places for help and healing. Though going to hospitals is seldom an enjoyable experience they, like health problems, are here to stay. Beyond their medical significance, hospitals are a product both of culture and technology, and they should prepare themselves for today’s challenges and those of tomorrow, and be able to tap into the latest technologies and knowledge. To deliver sustainable, inclusive, and resilient healthcare in Asia for decades to come, they should be people-centered, and put people’s needs, values, and experiences at the heart of their design, construction, and operation. Build hassle-free hospitals, which do not create negative healthcare experiences. Even their environments should be therapeutic and salutary.’ (From ADB’S Blog 15 May 2018 Tuesday). The World Health Organization, the heaviest financier to Kerala’s hospitals, holds the same view.
Corruption In ADB India Health Projects.
If we look for news of corruption in the ADB, we will not see any. Why? It is because it is not accountable to anyone in the world, except to the presidents of their member countries. It self-declared immunity and enjoys diplomatic privilege everywhere. How will people find out if there is corruption if that International Financing Institution does not publish its project funding details and investigation reports. That is why it is headquartered in Philippines, not in the United States, to escape from making financial dealings and data sheets public. After blocking every avenue for people to check corruption inside an institution, and making project details inviolately private records, ADB claim their anti-corruption procedures are the world’s best, the thief guarding records efficiently.
Even while claiming ADB is totally corruption-free, every year there are hundreds of allegations, reports and investigations on corruption and fraud in ADB projects. In 2012, ADB banned 42 companies and 38 individuals with 240 investigations. In 2013, it was 31 companies and 30 individuals and 250 investigations. It is general estimate that 30 per cent of development money in any project in the world is lost to fraud and corruption. Still ADB claims it is an angel, a saint, after its Office of Anticorruption and Integrity debarring a total of 499 firms and 474 individuals for corruption or fraud. Half of the complaints and allegations were from staff against unscrupulous and corrupt other staff, following an inevitable new policy formulated by the OAI encouraging the whistle blowers among staff. ADB never makes public their project procurement-related reviews. Though is loud about its anti-corruption policies ADB does not like accountability. It hates accountability. If a country wants to take ownership of the anti-corruption activities related to a project in their country, they will be given that ownership readily: one burden less. The most corrupt countries in the world, for example India, will naturally want to own the anti-corruption efforts related to the ADB projects in their country and sure, they will be given that ownership, so that they can rig their anti-corruption activities associated with a project against their own corruption in the project. Where have we heard about more absurd a vigilance policy than in ADB?
The environmental impact of several ADB projects in many countries has been well documented because those permanent damages are there for all to see, document and evaluate. That is not the case with corruption in ADB projects. It is a well guarded secret, known only to its president, board of directors and investigating officers. It is doubted if even the president of the country where the project is carried out would ever know about the corruption in that project. Their executives are not answerable to anyone, including the parliament and law court in that country, of any country. Such is the set up. If you want loan, accept the set up and accept the conditions. Ask no questions and reveal nothing to anyone, including the president and parliament of your country.
The mismanagement, incompetence, deception of donors, and fraud in ADB’s projects in Afghanistan which were reported audited by Price Waterhouse Coopers of UK was brought to light by the Whistleblowers’ Protection Group in the US- Government Accountability Project (GAP). The leaked report showed that ‘reports to donor countries were exaggerated and project achievements were fabricated, technical assistances were politicized favoring select constituencies, and the ADB rented lavish, unneeded project offices in the capital while urgent poverty reduction programmes were dropped for want of funds’. These Afghan projects funded by the donor agencies Poverty Reduction Cooperation Fund of UK and the Danish Aid Agency DANIDA, would have brought grander follow up funds from other donors, if successful.
An infant and maternal health programme which only needed less than $100,000 was dropped from the project stating there was no money for the programme. Another programme, which was a milking cow for corrupt ADB officials, had no invoices, competitive quotations, purchase orders or receipts amounting to $455,000, almost 60 percent of total equipment expenses for that programme. These frauds by officials were portrayed by ADB in their website as mere mismanagement and shortcomings. Money diverted for an unauthorized purpose but shown in records as having given to a Non-Governmental Organization for purchasing a mobile clinic for Northern Afghanistan were maternal mortality rates were the highest in the world is ‘mismanagement’ for ADB, where world calls it ‘fraud’. The ADB was not even willing to recover this money. Funds earmarked for renewable energy, healthcare, and livestock development which were to be made available to non-governmental organizations like the Agha Khan Foundation never reached them but were siphoned out using fabricated and bogus documents.
The management consultant submitted evidence of fraud to the Integrity Division of ADB in 2006 in fair belief which the ADB suppressed and did not make available to auditors. He was yet to see how dreadful this Division was in silencing whistle blowers. His report accompanied with affidavits never came to auditor’s attention till the anonymous management consultant turned a whistle blower and the whistle blowers’ group challenged the findings in their audit report and refuted the work progress data posted by ADB in their website in 2008. At last the auditors after a revised audit admitted that 21 of the 26 allegations made by the management consultant were true, and the remaining 5 could not be verified due to ADB not making available documentation. The angry ADB demoted, terminated and blacklisted the management consultant and protected all its corrupt officials and was not willing to recover the amounts lost to fraud. People laughed when ADB told the world that these ‘sums are puny compared to the $200 million ADB aid to Afghanistan that is in the works. The people laughed because they thought how lucky the ADB officials in Afghanistan and the Head Office were to steal from such huge funds!
We have heard about swamps reclaimed as land and made fit for human habitation and cultivation. But ADB created endless miles swamp when their Khulna Jessore Drainage Rehabilitation project in Bangladesh was completed. Miles and miles of cultivated land submerged with settlements, homes and schools in them but they decreed all compensation claims non-eligible since the date of completion was declared and the period for filing complaints was over. Who will know the project would submerge homes and lands and schools before the project was completed and water ran in? They pushed a whole community into a gigantic swamp, to rot there with the guilty Bangladesh government watching like a traitor. They sent a whole community of small scale farmers bankrupt in Sumatra in 2002 when their Rubber and Tea Planting Project yielded no rubber or tea. They declined to initiate stop-recovery proceedings against farmers, claiming their project had already declared to be closed in 2000. Their failed projects abound in Asia, leaving their skeletons creating havoc in economy and eco-system in all countries in Asia. Not even the Supreme Court of Bangladesh, or even the International Court of Justice, or even the International Human Rights Council of the UN can interfere, because it is ‘written’ in their ‘Chapter’! According to this rotten Chapter of theirs, they needn’t disclose information on any of their projects, and if they release any such information ever, it cannot be made public. As a concession to the low class world, out of pity, they will make public their Board decisions, after 10 years have passed!
ADB would grant aid to developing countries only if they privatize everything. In return, ADB will keep its source of funds always open among large private corporations which would go and gorge down large government services in these countries including their health services and sanitation and clean water services. The large corporations get the projects and the big officers and directors in ADB will get ‘heavy compensations’ for the time and effort they put in. Environmental damage caused by these corporations is not their concern. Not only do their projects destroy nature in a large scale but the people displaced are left with no compensation. Hospital charges, water charges and electricity charges skyrocket after these projects are in place and the investors want quick returns. Many of their projects gone awry in Japan, Nepal, The Netherlands, Australia, Indonesia, Thailand and Papua New Guinea and even the Philippines are under severe protests from ecological preservation groups and the affected and displaced people there.
It is important to note that corruption, bribery and human rights violations are not a concern for ADB because they are not so for the hundreds of big corporations which fund them and benefits from their worldwide projects. The three are just routine practices considered not sin in these corporations. They even earmark money in their budgets for bribes and financial compensations and softening up of human rights violation charges, of course under acceptable sub heads. If a corruption is reported, they wonder why it is reported at all, instead of being taken for granted. So, now, the culture of ADB also is the same, i.e., the culture of the main donors. Regardless of whether the recipient of the loan remains a democratic country or a despot, this culture of ADB remains the same.
The Asian Development Bank (ADB) is skilled in evading transparency and accountability since its beginning in 1966 with just 31 countries in membership, ‘for the objective of driving poverty out from Asia’. Their Charter is such autocratic and anti-democratic that their staff, projects or project-related documents can’t be questioned in any national or international jurisdiction. They are accountable only to them! But if any borrowing country defaults or refuses to repay loan they would be entitled to approach any national or international jurisdiction!! No decent country would accept their terms and conditions for loan unless it is democratic in profile and despotic in function.
In 2003, in an earlier primitive form of a forum for redressal of grievances of the affected, they received 42 letters of complaints and none were addressed. Forced by the furor of the world against them, they formulated an Accountability Mechanism Policy in 2012 and created a new forum for posting complaints. Within 2013, there were 23 letters of complaint against 23 specific projects! Since almost all letters of complaints were ignored or rejected, it was proved this Forum was a farce to appease the anger of the world against ADB. The fact is no one shall complaint against them except to them. And the complaint should also be to review a project, not to stop it for any reason. And also the complaint should be before the declaration of the date of closing of a project. In this graciously allowed period of time for submitting complaints, the closing date of the project does not include the 20 to 30 years the project is open for the borrowing country for repaying the loan but is the date of the actual completion of the work and the team moves on. In every way, it is the most aggressive blade financier in the world, the most fascist monetary organization in the planet, excelling even the Nazis’ in dubious financing!
IV. HUMAN RIGHTS VIOLATIONS
Human rights violations in health occur both in government hospitals and private hospitals, three times more in private hospitals because they cater to three quarters of the population in India. We will give here examples of gross human rights violations and corruption, in all cases the culprits going unpunished. Some are cases of corruption; some are cases of human rights violations, and some of both. Incidents from the early 1980s to the late 2010s are documented and the nature of the outcomes of their investigations underlines one thing- that the nature and behaviour of the Kerala State Health Services Department won’t change. Because the Directors of Health Services and the Health Secretaries of the Government are committed to protecting the culprits in the department, human rights violations go on, without anyone asking why compensations are not given. When one incident happens in an institution, gauging from the uproar in the press, investigations by the police, statements of ministers in the legislative assembly and proceeding of the cases in the law courts, we will assume that human rights violations in the health department are going to stop. We will expect that hospital staff and authorities will become alert from then onwards and such incidents will not happen for a long time at least in the same institution. That is not so. Because it is guaranteed that no one will loose jobs and no one will go to jail, it may happen in the same institution in the same week. The deaths of the medical student Shamna Tasneem (22) and the engineering student Jerin Michael (25) on 25 March 2017 at the Medical College Hospital Ernakulam Kerala.
What next are the Human Rights Commissions in the state and the centre. The State Human Rights Commission and the National Human Rights Commission do take cases occasionally, for publicity. After the initial press releases and the three internal rejoinders the interests of the bureaucrats and officials involved in the case are protected in the end. The outcomes of these cases are never disclosed and the websites of these Commissions do not permit examinations of the proceedings and outcomes of their cases even though they are public records. Besides, the judges and members of these Commissions are not saints beyond prejudice. Some of them are even famously prejudiced, as alleged by even their colleagues in the bench. Most of the judges in these establishments may have served in courts in the concerned state as judges or as lawyers and would be reachable, or their staff who prepare the draft proceedings. Remember here that almost all judges in India have been blotted by their colleagues publicly at least once, even those in the Supreme Court. Judges in the Supreme Court have even held press conferences raising allegations against their Chief Justice. Being judges, we believe their words, we are bound to. This is, it has to be said, is the power, strength and transparency of Indian judiciary today. India tolerates. The politicians appointed as members in these Commissions also would have at least one blot on their scutcheon from their politician’s life. Even if they punish someone, they do not have the claws and teeth to enforce it. For that they have to hand over it to the lowest court in the hierarchy- the Magistrate Court- where the fight will begin for endless years. They will most often advise the parties to seek remedy and justice through a regular law court, which is a good advice.
Instrument breaking into pieces, falling into the abdominal cavity and patient returning home not knowing anything.
The Taluk Headquarters Hospital, Nedumangad is recognized and upgraded as a District Hospital and assigned the rank of Model Hospital. A patient was done hysterectomy in this institution in August 2016 and there was complication where it was not to be. An instrument broke into pieces and one piece fell into the abdominal cavity. It could not be retrieved through the incision made during the hysterectomy. This was just a repetition of what had been happening in this hospital for years during simple PPS operations. She was referred to the Medical College Hospital, Trivandrum. She had to undergo a second surgery. Whether the piece was retrieved or not in the second surgery remained a mystery. It was reported in the media and the Kerala State Human Rights Commission took a suo moto case. The Commission declared the doctors to be guilty of medical negligence and ordered the government to pay a compensation of Rs. 50,000 and to recover it from the doctors. The health department’s enquiry found that the incident was not a case of medical negligence but an ‘unexpected event’. Perhaps they will call it machinery failure! On appeal by doctors, the High Court of Kerala ruled that ‘there was no medical negligence and the State Human Rights Commission’s order was grossest violation of principles of natural justice! As the Hon’ble High Court frequently gets from the Supreme Court of India what it gave to the State Human Rights Commission, the government sanctioned Rs. 50,000 from the Chief Minister’s relief fund as compensation to the patient, fearing the patient might file an appeal with the Supreme Court of India. Where is the judiciary going in cases of human rights violations?
Murugan: the migrated worker from Tamilnadu.
Murugan, a native of Tirunelveli in Tamilnadu was working as a milkman at Kottiyam in Kollam district in Kerala. His was a poor family consisting of his wife Murugammal and two minor sons of six and four years age studying in standard 2 and LKG. He was the sole bread-winner of the family. He met with an accident on the night of 6 August 2017 on NH 66 at Kottiyam, Kollam while riding pillion on a motorcycle. The onlookers called for an ambulance and one from the privately owned Life Save Ambulance Service arrived. The police took him to the KIMS hospital at Kottiyam. They diagnosed him to be with brain hemorrhage but said they had no ventilator facility. Unbelievable though it was for one of the finest chain hospitals in the world, those were their words. They referred him to Meditrina and Medicity Medical College Hospitals, Kollam. He was rushed to Meditrina Hospital, Kollam where they said they had no neurosurgeon. So he was rushed to another hospital in Kollam, the Medicity Medical College Hospital which asked if he had a bystander and when informed none said there was no ventilator available to admit him. Medicity said all its fifteen ventilators were engaged. Remember that the victim was stable when he reached Medicity Medical College.
The first 24 hours after the accident is crucial for victims. The police cops and the ambulance service personnel who were desperate by now had the only option of ferrying the victim to the Medical College Hospital, Trivandrum 65 kilometers distant. They conferred and the owner of Life Save ICU Ambulance Service, Near Holly Cross Hospital Kottiyam, Kollam - 691001, Phone: 7559992222, Mr. Rahul, was quite willing to take the responsibility for getting treatment to Murugan and to bear the cost of the treatment also as a humane gesture.
So, by night, he was journeyed 65 kilometers to Trivandrum Medical College Hospital. A Neuro Post Graduate resident checked on him and said there was no vacant ventilator available, so wait. No senior Neuro Surgeon came near him. Doctors were not willing to cooperate and won’t tell the accompanying police details about ventilator occupancy. This hospital being notoriously famous for making ventilators available to only those who will pay, it was suspected ventilators were available but would not be connected until someone pays which they knew no one will for the victim was a poor migrating worker from Tamilnadu. The police specifically asked which patients were using ventilators at that time but doctors won’t give details. In fact, as found out and admitted later, they have 54 ventilators of which half they keep out of condition always and the other half idling, waiting for rich patients. The Health Department actually had to admit later that they had a VVIP ventilator and 16 stand-by ventilators vacant at the time.
From Medical College Hospital he was taken to the nearby SUT Royal Hospital Trivandrum which also denied admission, claiming they had no neurosurgeon. So he was journeyed all the way back to Kollam Azeezia Medical College Hospital, which also refused admission for having no neurosurgeon. His condition worsened, and he breathed his last on the way to the District Hospital, Kollam, the last measure. He died around 6:30 in the morning, after spending seven hours in the ambulance.
In all these hospitals they inspected him, if they ever inspected him, by going to the ambulance parked in their casualty bay. The victim was not taken out from the ambulance at any of these hospitals. He stayed in it for seven hours after the accident. Do you know how he sustained through these seven long hours? He was connected to the small ventilator in the ambulance resuscitating him continuously. Not once was he disconnected from it. His last seven hours owes to the owner of this small private ambulance service.
‘To save his life, this private firm's ambulance, whose owner was quite willing to take the responsibility for getting treatment to Murugan and bear the cost of the treatment, traveled around 120 kms from Kollam to Trivandrum and back, but couldn't find one single hospital that was willing to offer him treatment’. The great rich hospitals in Kerala- private and government- which claim they have excellent facilities for treatment of trauma patients and whose owners must probably be dining with health ministers and health secretaries did not have the magnanimity and generosity of a small private ambulance service in a little town. Their address is ‘Life Save ICU Ambulance Service, Near Holly Cross Hospital Kottiyam, Kollam-691001, Phone: 7559992222. Owner: Mr. R. Rahul.’ Someone someday will reward them.
The timid press did not enquire whether the only available ventilator and Neuro Surgeon in the two vast districts of Trivandrum and Kollam were only at the Medical College, Trivandrum at the time. More over the question of why ambu bags were not used if ventilators were unavailable was not asked by press, or police. Had Murugan been rich, every hospital would have summoned neuron surgeons from outside who were always on call. A case was registered against all hospitals except KIMS because it is the pet of the government, and of all ministers, legislative assembly members, top bureaucrats, all political leaders and the press. It claims 903 doctors and 6602 employees in 16 hospitals in 6 countries. Take the example of their one at Kumarapuram, Trivandrum. Nowhere in this world will a government allow an overpass between two buildings built over a public road but KIMS did construct at Kumarapuram, Trivandrum, Kerala. Every one of the above mentioned people, including the Chief Minister and the Roads Minister see it and pass below it often but pretend there is not such an illegal obscenity there. It is this bunch of people who deal with international organizations and seek monetary assistance. It is definite they will bribe fund managers of these organizations to get hold of the amounts. They do not feel any shame or anger while passing under this overpass which ought to have been built as an underpass below ground. It was not at all impossible for this hospital to build it blow ground; it is rumoured that they have built an underground passage which opens up somewhere below some establishment near the Medical College Hospital there to bring and return expert surgeons, a closely guarded secret mutually profitable. Who will know who is inside those operation room masks, gowns and scrubs? This hospital which is very near to the Trivandrum Airport built their behemoth violating every rule regarding height of buildings near airports, and their upper stories do nothing but housing rich clients on pleasure tourism. It was no wonder when a young female nursing student jumped from these upper stories (?) and died, there was no action from the Kerala Government.
The internal report of the Medical College, Trivandrum said that there was no negligence on the part of the duty doctors on that night and also alleged that the Director of Health Services had no qualification to submit a report as her team had no doctor trained in trauma care. Remember that their department Kerala Medical Education Department was bifurcated years earlier from the Kerala Health Services Department to create more chairs and double and trible promotion opportunities for doctors, nurses and office superintendents.
Doctors’ organization Kerala Medical Post Graduate Association (KMPGA) threatened a strike if any doctor was arrested for the death of the accident victim. The Kerala Government Medical College Teachers’ Association (KGMCTA) asked how the police can put the blame on the government hospital alone when four private hospitals also denied treatment to the patient and threatened to strike if government doctors were to be made ‘scapegoats’.
In an anticipatory bail petition filed by three doctors the High Court of Kerala directed the police to submit a report. The police on 19 October 2017, Thursday submitted that ‘the hospitals failed to ascertain the suspected head injuries and give basic treatment, the doctors knew that the failure to treat a patient suspected to have suffered head injuries could lead to loss of his life, had refused treatment on account of non-availability of vacant ventilators or neuron surgeons, the post-mortem examination had revealed that he died of head injuries which contributed to the death, leading to incorporation of an offence under Section 304 of the IPC, and that action had been taken for constituting a medical board ‘for evaluating the entire circumstances against the backdrop of the treatment protocol’ for reaching a final conclusion’.
The State Human Rights Commission Kerala, in an order issued on 20 October 2017 Friday, flayed the health secretary for the undue delay caused in submitting the inquiry report on the death of Murugan and stated that the delay in submission of the report was also an act of violation of human rights. The secretary had not only failed to file his report of enquiry but also failed to file a report in response to the accusatory findings of the police that ventilators were available, the victims life could have been saved if the Trivandrum Medical College Doctors had attended him, and that the hospital was not cooperating with the enquiry.
The medical board constituted by the health department, after seven months after the incident, on 04 March 2018 Sunday as everyone knew, absolved all doctors of any lapses and softly slapped all the hospitals for ‘erring in not registering admission’ regardless of having or not having neurosurgeon or ventilator. What absurd observation to be made by the supposedly highest qualified medical board in the state on the death of a human being which their Chief Minister publicly apologized in the state assembly for the crimes of these doctors and their hospitals! They found no negligence on the part of doctors in any of these hospitals!!
Shamna Thasneem: The medical student who died at the hands of her professors and teachers.
Shamna Thasneem, a second-year MBBS student at Government Medical College, Ernakulam died of severe allergic reaction to ceftriaxone injection on July 18, 2016 while she was under the care of her own professors and teachers. An investigating panel of doctors of the medical education department found that callous attitude, casual and indifferent dealing and severe medical negligence were the reasons for her untimely demise. After she developed respiratory distress, there was delay in shifting her to ICU, another delay in administering life-saving medicines adrenaline and atropine, she was not ventilated even during critical stages, suction apparatus malfunctioned and basic life support systems were not available at the nurses’ station.
A bronchial asthmatic patient, she reported fever, body pain, dizziness and breathlessness on January 18 at 1.30 PM. She was given ceftriaxone injection at 2.30 PM, the universal medicine for respiratory infection in internal medicine, on the doctor’s assumption that there was presence of water and infection on the left chest, even before taking a chest x-ray for diagnosis and even without taking into consideration her allergic history. Other doctors were of the opinion that the girl only had a viral influenza and an antibiotic injection was completely unnecessary. In their opinion the infection was viral and the unnecessary and careless administration of the antibiotic injection led to her collapse. After her collapse she was not immediately administered adrenaline injection for resuscitating her. Though she died at 3.45 PM, she was shifted to the private Rajagiri Hospital at 6 PM under the façade of better treatment, to confuse where the victim actually died. The relatives were even asked to pay this hospital’s bill amounting to Rs. 9,000. She was the first medical student from her village. Her life could have been saved if timely medical care was given after she collapsed.
Later, at a press meet, the victim’s father would release a phone clip of a conversation between the duty doctor and another hospital staff, confirming his daughter had died at the Government Medical College Hospital Ernakulam before she was shifted to this private hospital for suppressing evidence. They must have been doing this for a long time- a government medical college hospital and a private hospital in the same city joining hands to suppress evidence.
Her virology lab tests conducted at TD Medical College Alappuzha confirmed influenza A sub-type H3N2. Her histo-pathological test result in the post-mortem report from the forensic department of the Medical College Alappuzha stated that ‘Shamna’s viral infection of H3N2 did not lead to her sudden death. The virus did not cause the death by causing sudden failure of vital organs like lungs, heart or brain and the death was not due to pneumonitis, myocarditis or encephalitis hitting these organs respectively. Under such circumstances it can only be reasonably concluded that the death was as a result of the drug allergic reaction.’
The doctor, who administered the injection, the professor and head of the department of general medicine, was suspended first in October 2016, and then reinstated based on the report of the DMO’s medical board. He was suspended again in April 2017 based on the report of the DHS’ medical board. The principal of the Medical College Ernakulam was very reluctant to hand over the details of the staff who treated Shamna to the investigating police. The health department was very much reluctant to dismiss the doctor who ‘referred’ Shamna to a private hospital after her death and allowed her body to be removed to another institution before a pathology surgeon took over. Six months after the death, the affidavit filed by the Joint Secretary of Health and Family Welfare before the State Human Rights Commission of Kerala admitted that there had been lapse on the part of the doctors in treatment and also lapse on the part of the local police in investigation. But by that time the local police investigation had been derailed and the departmental investigation rigged.
The state health department refused to cooperate with the Crime Branch investigation. Instead they offered a compensation of 3 lakhs rupees which the victim’s father rejected. Kalamasseri Police informed Mr. Abootty that they were closing the case on recommendations from the medical board headed by the Ernakulam District Medical Officer Dr. Kuttappan ruling out medical negligence in this case. The forensic expert in the board, Dr. Lisa John from Alappuzha Medical College, recorded disagreement note with the proceedings of this board and even issued her counter statement to the public. Mr Abootty complained to the Director General of Police, Kerala that the local police were misleading the case and the DGP wound up the local police investigation and handed over the case to the Crime Branch police. They crime branch police investigated and their report on 17 July 2017 named 15 staff of the hospital including 2 doctors as responsible for death due to medical negligence. So the crime branch case came into being.
The experienced District Medical Officer, Dr. Kuttapan, knew how to save one of them and the District Level Expert Committee constituted by him merely recorded their views and suggestions and did not attribute medical negligence on anyone or name anyone as responsible. The Kerala Administrative Tribunal (KAT) on 18 October 2017 Thursday quashed the suspension of the professor directed the State government to reinstate him and regularize his absence from duty, citing the expert committee had only recorded their views and suggestions and had not attributed medical negligence on anyone or named anyone as responsible and the suspension of the doctor was premature.
The equally ‘experienced’ Director of Health Services, Dr. Saritha, who constituted the Kerala State Medical Board, the State Level Apex Body which second investigated the death also knew how to provide loopholes to save a doctor like her. Her Board consisted of herself the DHS, a paediatrician, the Director of Medical Education, a radiologist and the Additional Director of Health Services (Vigilance), a mere medical graduate with no specialization in medicine or vigilance. The High Court of Kerala on 2 August 2017 Thursday stayed the crime branch police investigation, saying the Apex Medical Board had no experts or specialists in the Board and did not state in their report why they arrived at a different finding from that of the District Level Expert Committee, and so the investigating officer cannot proceed on the basis of this report.
The victim’s father who continued this fight for justice and pioneered bringing this human rights violation to the fore of public attention, Mr. Abootty, passed away in Muscat following a cardiac arrest on 28 October 2918 noon. Now there is no one there to carry on this fight. The Kerala Health would have been forced to pay a compensation of at least 2 crore rupees, imprison the culprits and get the doctor’s name removed from the Medical Council of India’s rolls, had he could have continued this fight. The government would have happily paid the compensation had the coffers been full with foreign funds, and human rights violations in health would have continued. Had there been no foreign funds and only the bare minimum in the government coffers, the government would have asked the doctor to pay the amount, and then all human rights violations in health in the state would have stopped then and there. That is how foreign funds help and promote human rights violations in health.
Jerin Michael: The engineering student who succumbed to hospital neglect and delinquency.
Jerin Michael, a Thevakkal-native sound engineering student at Goodness Institute of Film and Television at Pachalam, his parents predeceased and living with his grandmother, was suffering from severe stomach ache and visited the Government Medical College Hospital around 6.30 AM on 25 March 2017 Saturday. He was denied proper medical care and left unattended till 1 PM when his bystander and friend Vyshakh pointed out this and complained. What his friends thought was a case of food poisoning, turned out to be a case of appendicitis and the hospital staff told that he must undergo a surgery. Then the nursing staff administered some injection on him at 1 pm and informed him that the surgeon was on leave and a free surgery could be performed on him if he waited for a few days, or he could get it done immediately using a doctor from the outside if he was willing to pay. He was also asked to get a few blood tests done from a lab outside the hospital, and left unattended again. He developed seizures multiple times at night- fits three times around 9:30 PM but no one bothered- and when the fourth fits developed the hospital staff asked his friend to shake him until the seizure stopped, which did not stop. When his condition worsened, the staff wrapped him in a bed sheet and took him to the ICU, carrying him by stairs as the lift was not working. Some say the lift worked but the lift operator was absent. By the time they reached the ICU, Jerin had died around 11.20 PM, less than 16 hours after admission. The Medical College principal Dr. Sreekala told that he was not lying neglected but ‘under observation’! She even told they were perplexed as to why he developed seizures which must have been due to an unknown cause!!
The body was taken to the Alappuzha Medical College for postmortem which they did only on the next day Sunday and the histo-pathological lab report stated septic shock following acute appendicitis as leading to the death which means he could have been saved with timely medical intervention. Edathala police registered a case for unnatural death, citing medical negligence, not getting the consultation of the call surgeon on duty, not referring to other hospitals for better care, not scanning and operating at the right time and not getting timely care leading to death.
It was also revealed that following the aftermath of the Shamna’s death the same year the Government of Kerala had allotted 1 crore rupees to this medical college for purchasing basic equipments they said they lacked but the principal was sitting idle on the file for the next incident of death to occur. That it is the second time within a year that negligence leading to the death of patients at this medical college was noted by press and people but not by government and health department.
When each case occurs there will be rigging of investigations, digging of loopholes in charges and finally letting go free the culprits, for favours received or as favours repaid. No one notices the end results of individual cases, but when accumulated through the years their numbers are astounding and everyone is found to be let go free. How could the world pay these thugs foreign funds for continuing this?
(Will be updated; please check)
I. WHO
WHO used to get its funding from Member States’ (MSs) Assessed Contributions based on their wealth and population and their Voluntary Contributions. Assessed Contributions are committed, predictable, and flexible and the country cannot question how WHO spends it. The other source of funding is Voluntary Contributions from Non-State Actors (NSA). Voluntary Contributions can be part-flexible and not category-specific, or not at flexible and category-specific or issue-specific. 80% of WHO’s funding is from voluntary contributions. WHO has twenty four programme areas and they cannot use voluntary contributions in these areas as needed or as they choose. All needed programme areas won’t be able to attract sufficient voluntary contributions and as a result these needed areas receive less funding than needed. Ten areas receive 80% of all voluntary contributions and fourteen areas receive less than 2% of the voluntary contributions. So the WHO tries to balance the budget by appropriating the fourteen areas against assessed contributions and non category-specific voluntary contributions, and then ten against category and issue-specific voluntary contributions. The budget always remains unbalanced. Some areas become lavishly funded and some remain neglected.
Through the years the inevitable happened. WHO began to focus on the favourite areas and began to neglect others. If they cannot raise funds for these areas, what else can they do unless member states voluntarily raise non category and issue-specific contributions? Gradually the contributor preferences became the norm for WHO funding. And the Non State Actors began to influence, and even force, WHO in policy-making and decision-making. The member states, especially the poor states, lost their importance and their much-needed projects and the rich states and the richer Non State contributors took over WHO.
In the past the world countries looked up to the WHO for guidance and help. No more do they. Its influence and hold have steadily been waning through the years and now its place is being taken by multi national health financing organizations which lend money for an interest. Today the WHO no more standards in health matters but is giving way to these multi nationals to decide how developments in the health sector should go and what standards to be set. Today they decide what the WHO’s policies should be and in which areas it should work. Today the WHO’s policies and areas of work always supplement theirs as they have become the biggest fund-givers to the WHO. The member states which originally made WHO possible and funded it through decades are gradually made to suffocate for the single reason that they have the same single vote power like the major fund-givers like the USA who back these multi nationals and neo liberals. All member states having only one vote make many attempts by these multinationals to totally commercialize the health sector fail and soon they will be forcing the World Health Assembly to change the voting system to being based on the amount of contribution. These are the powers behind the World Bank also- the many foundations, consultancies and corporations. They are the greatest investors in the health-damaging industries also- the liquor, the tobacco, the chemicals. They are one and the same. The meaning: they are buying out the World Health Organization. If there are no-profit players in the health sector, especially health financing, they are pushed out by WHO now. Their initiatives do not receive their due respect with WHO.
Many saints in this field are just fronts for cut-throat for-profit health organizations. The ultimate goal of even some famous charity foundations is nothing but legitimizing the multi nationals’ greed.
So what happens when health financing goes from member states to corporate sector? They have a policy for corruption and a provision for bribes. Their officers and even board members are prone to corruption and bribes. They are famous for oiling the wheels of bureaucracy with money. Corruption and bribes which were rampant under member state financing have their field day under corporate health financing. The member state financing had at least a commitment at least in papers against corruption and bribery. Corporate health financing does not have any such commitments. For profit, it is legitimate for them to give bribes and ignore corruption. They will still have their profit.
Since when World Bank emerged as the major-most player in health financing, i.e. the major-most financier who gives loans to countries for interest, the WHO who gave grants-in-aid instead of loans with interest was pushed to the back. The gradual and steady work of neo-liberal financing consortiums that are on the back of World Bank made this happen successfully. The power and push of neo-liberal financiers are such that developing countries which depended solely on WHO for interest-free and repayment-free health financing turned to World Bank in spite of the future burden of repayment and interest. Why did this happen? And how did this happen? Private foundations which made their fortunes from cut-throat free market enterprises and global trade agreements began to shift their sympathy from WHO to World Bank for pure financial reasons and began to cut contributions to WHO and to flow more money to World Bank coffers. Sure they began to get more say in international health policy-making and decision-making. No wonder WHO though the years have been loosing its chieftain’s role in international health policy-making and decision-making.
The WHO succumbing to the methods of these neo liberal organizations also meant WHO succumbing to corruption also in a global scale.
Since 2000, more than 100 Global Public Private Initiatives were formed in the health sector, heavily backed and promoted through legislation by countries like the USA. Soon they took over global health control and gulped down in some cases and replaced in mosrcases WHO in the field. It became clear to the world that if these private initiatives guised for the time as public-private partnership ventures were not given a free hand in health care in all countries, WHO will be wiped out along with all non-profit health care financiers it associates itself with. The terrified WHO had no other way but to cut relations with not-for-much-profit initiatives like the Global Fund for AIDS, TB, and Malaria (Global Fund) and the Global Vaccine Alliance (GAVI). Remember that GAVI had heavily financed several health projects in India. What place once occupied by the Global Fund and GAVI was shamelessly taken over by the more-private-than-public initiative Gates Foundation. India Government celebrated their coming to India Health like ….. The contribution to India Health on account of this change was weakening the famous Free Hospital System of India and strengthening the Pay Hospital System which these ‘philanthropic foundations’ want.
Up to 2010 the WHO and its general body World Health Assembly kept themselves away from organizations functioning in the health sector for making profits. In 2010 the united effort of these for-profit organizations succeeded in sabotaging this decades-long policy of the WHO and moved the World Health Assembly to adopt a new framework for health governance, named FENSA (Framework for Engagement with Non-State Actors), which came into effect in 2016 and took into its policy and decision making process ‘the strong opinions and views’ of for-profit organizations. Gradually the ‘strong opinions and views’ of these for-profit organizations began to shape the opinions and views of the WHO.
The United States is a stubborn criticizer of all WHO programmes except those funded by them for specific projects of their or their country’s corporations’ interest. All their contributions are towards specific projects. They do not like to contribute to the core budget of the WHO as a member state. When they stop funding a specific programme but the programme has to go on, the funding has to come out of its core budget which has been crippling the WHO resources for thirty years. For thirty long years, the US has been trying to cripple the WHO this way by freezing contributions. During these thirty years it has been spending a million times more money on foreign soil on wars for political reasons. It is like the US literally forcing the WHO to become a polio victim who won’t be able to stand or walk on its own anymore. Even its Polio Eradication Programme is making it a polio victim. This programme is funded slightly through Voluntary Contributions and mostly through issue-specific contributions, the biggest contributors being the US and the US-based Microsoft’s owner’s Gates Foundation for a time. In fact they flooded the WHO with funds for polio and hijacked the programme for their corporations’ benefit: the US alone delivered a total of US$ 902 million hitherto through the Global Polio Eradication Initiative; the Gates Foundation delivered US$ 682m in 2008, 134m in 2011, 204m in 2013 and 95m in 2017. These funds are drying up through years and now have come to only a trickle. Soon it would eat into the WHO’s core budget because the programme has to be carried on as polio has not gone away completely. And at this junction, the US will not increase its member state contribution or the Gates Foundation its non-member state contribution towards polio eradication. They are working in unison to wreck the WHO’s core budget so that that charade of a World Health Assembly could bring more reforms favouring Private Initiatives and allowing the private sector to take over global health policy-making and decision-making.
The WHO’s budget to run its core projects and also its headquarters in Geneva, 5 regional offices and 180 country offices comes to just US$ 2.2 billion which is a moderate figure, compared to the fact that it is only 30 percent of India’s annual spending on National Health Mission. Many drug companies have 300 times higher turns over. Clearly many developing countries like India and China could easily have enhanced their voluntary contributions and saved the WHO’s socially important programmes without having yielding to imperialist countries and non-state actors, but US diplomacy won’t allow them. India has actually become a partner of US in obstructing WHO initiating meaningful discussions on key issues of social importance which happen to be against the business interests of many over-developed countries and multi nationals. For example, both share the same interest for protecting US trade agreements and patent rights and ignoring how detrimental most of them are to the interests of health.
II. IBRD
The five constituents of the 189 member states-strong World Bank Group which offers flexible loans with maturities as long as 30 years are International Bank for Reconstruction and Development (IBRD), International Development Association (IDA), International Finance Corporation (IFC) and Multilateral Investment Guarantee Agency (MIGA) and International Centre for Settlement of Investment Disputes (ICSID). India is one of the founder members of IBRD, IDA and IFC and a member of MIGA. She did not join ICSID. India has US$ 6098.3 million worth of shares in IBRD and is the 7th largest shareholder. In IDA, IFC and MIGA also India has considerable worth of shares and proportionate percentage of votes.
India has been drawing funds from the World Bank mainly through IBRD and IDA. As on 31 December, 2011, India has drawn total assistance of US$ 42124.96 million from IBRD. Of this amount, part of assistance for the sector of urban infrastructure (water & sanitation) reached health. As on 31 December 2011, the total assistance from IDA to India was US$ 39,506.5 million, the bulk of which went to the sector of health. IFC made available about US$3.6 billion to India till now, almost all of which went to health and education. In addition, the World Bank assistance programmes guided by Country Partnership Strategy lent $3 billion to $5 billion each year to India over the five years of 2013-17. Sixty percent of this financing went to state government-backed projects, most of which in the health, sanitation and transportation sectors.
World Bank supported US $ 1500 million of the US $ 22,000 million Clean India Mission Project approved on 15 December 2015 with closing date on 31 January 2021, US $ 106 million of the US $ 151.50 million Integrated Child Development Services (ICDS) Project approved on 6 September 2012 with expiry date on 30 August 2022 and US $ 255 Million of the US $ 510 million National AIDS Control Support Project approved on 1 May 2013 with expiry date on December 31, 2019. All these projects drowned in corruption. The money was squandered in procurement and administrative spending by bureaucrats, politicians, supervisory personnel and supply companies. And then more money from the rest was pilfered by way of bogus vouchers. Items supplied inferior in quality and performance and further worsened public health conditions. ‘Immunization of children from one year to two years age remained below 54 percent and despite the largest child-nutrition program funding in the world, 48% of children below five years age remained low height for age, 43% low weight for age, and 20% low weight for height. Pregnant women could not be guaranteed at least three antenatal hospital visits during pregnancy. Maternal and infant mortality became the highest in Asia and childhood diseases and infectious diseases common.’
Though the World Bank invested US$ 2.6 billion in India Health during thirty years, the development in the health and nutrition sectors were very poor. Compared to other countries, this amount did not bring the development it ought to have brought. The World Bank mistook this failure to be due to lack of education and poverty instead of intelligently assessing this failure to be due to corruption. What amounts actually reached people through projects after deducting the amounts pilfered as corruption from this enormous assistance did indeed bring its share of development. Only that, had there been no corruption the development would have been dramatic. =The World Bank was too slow and hesitant in accepting that corruption in India was unexpectedly heavy to withdraw from further financing. Foolishly and blindly it continued to be the largest financier in the health sector in India. Why they did not accept this failure was because it would be construed as a failure in policy. It was they who were the main players in advising India on national health policies. They further erred in beginning to employ those very ‘experts’ in India who were the master minds behind this corruption to advise on how to rectify mistakes of the past. This happened in the early 1990s and that was when serious corruption in health sector began in India. They identified population growth putting a strain on government resulting in progress being not as rapid as expected as an important factor, forgetting the fact that for three decades it was they who were financing and advising India Health on population control, and their earlier projects were emphasizing on sterilization. They forget that even in the late 1960s, even before the World Bank came to India with its 3.6 percent of total program funding for family planning services, the Female Loop Insertion had been picking up speed, among educated Indians of course. The above said amount of US$2.6 billion was spent not limited to the health and nutrition sectors but in the population control sector also. They also admitted that ‘80 percent of this health spending was for private health services on the belief that the poor would frequently bypass public facilities to seek private care’. Totally wrong: the Indian poor always go first to government hospitals. So, that was what the ‘Indian Experts’ were advising them: to neglect government hospitals and spend 80 percent of the resources for the development of the private hospitals! The last they were to admit was that the projects had flaws which their experts could not foresee. They themselves say ‘support has evolved slowly, in phases, from simple beginnings, learning all the way. Then what to say when world talents help prepare, scrutinize and approve projects after tedious and time-consuming processes and find flaws?
It took another 30 years and needed Wall Street Journal to bring out the heavy corruption in World Bank projects in India Health and the World Bank to admit they misjudged and corruption gulped down the lion’s share of the project money they flowed to India. Why the blacklisting of scores of companies every year who were entrusted with World Bank tenders in India did not open the eyes of the World Bank personnel to corruption implies the Indians were not alone in corruption.
Till the 1990s, development in the health sector in India was mostly centred on public hospitals and free services. The World Bank, in their own words, ‘made use of a change of leadership in the Ministry of Health and Family Welfare at that time’ to self-assume the role of policy advisor and to turn the government to focusing project spending on development of private hospitals and payment services by beginning to fund Disease Control Projects and State-Level Health Reform Projects. It covered leprosy, tuberculosis, malaria, cancer, mental illness and whatever was in the book. By the time they finished with these projects, the famous free public hospital system of India had deteriorated and the large private hospitals system deep-rooted. When it came up with financing the National AIDS Control Project, the Golden Gate of Corruption in India was opened. Of course ‘one-third of a million cases may have been prevented’ in their estimate, but this project opened up a million new avenues for corruption in diverse fields.
An Indian doctor, Dr. Kunal Saha first reported to INT, the anti-corruption unit of the World Bank in May 2007 that the use of faulty HIV/AIDS test kits mass purchased for the World Bank-funded First National AIDS Control programme and supplied by the Government of India to hospitals and blood banks in the country gave false negative results and did not reliably detect HIV-contaminated blood which could therefore be accepted for use in blood transfusions. The US Center for Disease Control (CDC) certified the kits’ accuracy and tried to cover up the fraud and World Bank officials began a series of misleading public press releases to discredit Dr. Saha in India and abroad. The WB criticized his findings as just personal opinions and the India government accused Dr. Saha, who worked as a senior HIV/AIDS researcher at the Columbia University in New York and Ohio State University in Columbus and Ohio for more than 12 years and who is a recognized expert in the field of HIV/AIDS research with two decades of research and clinical experience, of having no credibility.
Soon the compelling evidence collected by Dr. Saha appeared in the Indian press and the CDC assembled their own experts and refuted the allegations as baseless. He proved that though there had been several earlier complaints against the kits distributed by Monozyme, Ltd. as October 2004, the agency or the government had not withdrawn the kits, the kits had caused danger to public health in West Bengal in 2006 and Chhattisgarh in 2007 and since then in many other states and that these faulty diagnostic kits may have been transmitting HIV in India.
No one knew how high in the hierarchy of officials in the World Bank the India Health Corruption has reached. The frightened World Bank engaged more experts and flooded the world press with more misleading information. But the United States legislation on the disbursement of funds stopped everything and the World Bank was forced to release their anti-corruption unit INT’s report on Indian health projects which revealed not a few skeletons.
Seven months later World Bank’s Detailed Implementation Review confessed to using the CDC to conceal the fraud, not acting immediately to arrest the potential spread of HIV through the project and admitted Dr. Saha’s report was a real red alert. The same year, the World Bank’s Anti-Corruption Unit took him into the six-member team reviewing the Second National HIV/AIDS Control Programme financed by the World Bank with US$ 191 million.
Two years of test results by one hospital showed that the Monozyme-supplied SD Bioline kits were yielding a high false negative rate.
Five Voluntary Counseling and Testing Centers had complained to Municipal/ District AIDS Control Societies that Monzyme-supplied S.D. Bioline HIV ½ Rapid Test Kits were producing invalid/false negative/discordant results.
Procurement of diagnostic test kits and blood bank equipment was riddled with fraudulence and corruption, which were markedly pronounced where they were decentralized procurements.
The World Bank knew from the beginning that these kits had serious problems, allegations were correct and an unknown number of Indian citizens may have contracted HIV through these kits used for testing.
Despite the public release of the INT report in January, the World Bank continued to tell the world that the HIV test kits were not faulty.
Accelerating Universal Access to Early and Effective Tuberculosis Care
Accelerating Universal Access to Early and Effective Tuberculosis Care was another programme in 2016 which followed the DOTS programme of the 1990s and aimed at funding quality diagnosis and treatment services for people who were affected with TB-affected. The foreign supervisors and the Indian collaborators did not accept the simple fact that medicine is more important in this disease than care and later restructured and reduced the funds for procurement of drugs from 85 percent to 40 and increased the funds for consultancies and services from 15 percent to 60. Why should there be another evidence to prove that the World Bank’s personnel and their Indian counterparts were more eager to divide the money among consultants and support staff than procuring drugs for curing and preventing TB?
The general consensus is that if the bank spends $25 billion on projects, $5 billion will vanish in corruption. 10 percent of the amount is standard in corruption. In Nigerian projects, it was found to be 40 percent. In Indian health projects it must be more than half. Not only in health projects but in other projects also this is what is happening in India. In the Lucknow-Muzaffarpur National Highway Project the INT which investigated the allegations found that huge amounts of money were stolen through forged and falsified invoices in exchange for cash payment as bribes to officials. Bank had to disbar the supervision consultant for five years and took no action against the Bank personnel involved.
III. ADB
Asian Development Bank headquartered at Manila in Philippines finances 7 projects in the health sector in India. India has 6.359% of subscribed capital and 5.386% of total voting power in the ADB and ranks number 4 among the 20 largest countries in subscription.
Out of the total 3.4 billion Ordinary Capital Resources (OCR) for Water and Other Urban Infrastructure and Services laid out in the Country Operations Business Plan 2016-2018 for India, Urban Health Care gets a handsome amount of 315.5 million Dollars out of which it supports National Urban Health Mission 2017 and 2018 for a total amount of 0.8 million US Dollars. These missions include projects in Kerala also and a considerable portion of this amount is sent to Kerala. These are figures for just the two years of 2017 and 2018. In addition, there are co-financing and re-financing of projects, and there are other years.
Project No: 47354-002 Supporting National Urban Health Mission, Approved on 16 Dec 2013 was US$ 225,000 as Technical Assistance Special Fund and US$ 600,000 as Technical Assistance Special Fund (Supplementary). This project has been closed now. Project No: 47354-003 Supporting National Urban Health Mission, Approved on 28 May 2015 was US$ 300 million as Ordinary Capital Resources, US$ 2 million as Japan Fund for Poverty Reduction and US$ 500,000 as Technical Assistance Special Fund. This project is running now. More than equal funds earmarked for sanitation and clean water heads also reached Kerala Health in other years. Think how much amount from these may have reached Kerala from the Asian Development Bank alone.
‘Beyond their medical significance, hospitals are a product both of culture and technology.’
The Asian Development Bank’s conception of hospitals while extending sustenance money to Kerala’s hospitals is, ‘Hospitals are places for help and healing. Though going to hospitals is seldom an enjoyable experience they, like health problems, are here to stay. Beyond their medical significance, hospitals are a product both of culture and technology, and they should prepare themselves for today’s challenges and those of tomorrow, and be able to tap into the latest technologies and knowledge. To deliver sustainable, inclusive, and resilient healthcare in Asia for decades to come, they should be people-centered, and put people’s needs, values, and experiences at the heart of their design, construction, and operation. Build hassle-free hospitals, which do not create negative healthcare experiences. Even their environments should be therapeutic and salutary.’ (From ADB’S Blog 15 May 2018 Tuesday). The World Health Organization, the heaviest financier to Kerala’s hospitals, holds the same view.
Corruption In ADB India Health Projects.
If we look for news of corruption in the ADB, we will not see any. Why? It is because it is not accountable to anyone in the world, except to the presidents of their member countries. It self-declared immunity and enjoys diplomatic privilege everywhere. How will people find out if there is corruption if that International Financing Institution does not publish its project funding details and investigation reports. That is why it is headquartered in Philippines, not in the United States, to escape from making financial dealings and data sheets public. After blocking every avenue for people to check corruption inside an institution, and making project details inviolately private records, ADB claim their anti-corruption procedures are the world’s best, the thief guarding records efficiently.
Even while claiming ADB is totally corruption-free, every year there are hundreds of allegations, reports and investigations on corruption and fraud in ADB projects. In 2012, ADB banned 42 companies and 38 individuals with 240 investigations. In 2013, it was 31 companies and 30 individuals and 250 investigations. It is general estimate that 30 per cent of development money in any project in the world is lost to fraud and corruption. Still ADB claims it is an angel, a saint, after its Office of Anticorruption and Integrity debarring a total of 499 firms and 474 individuals for corruption or fraud. Half of the complaints and allegations were from staff against unscrupulous and corrupt other staff, following an inevitable new policy formulated by the OAI encouraging the whistle blowers among staff. ADB never makes public their project procurement-related reviews. Though is loud about its anti-corruption policies ADB does not like accountability. It hates accountability. If a country wants to take ownership of the anti-corruption activities related to a project in their country, they will be given that ownership readily: one burden less. The most corrupt countries in the world, for example India, will naturally want to own the anti-corruption efforts related to the ADB projects in their country and sure, they will be given that ownership, so that they can rig their anti-corruption activities associated with a project against their own corruption in the project. Where have we heard about more absurd a vigilance policy than in ADB?
The environmental impact of several ADB projects in many countries has been well documented because those permanent damages are there for all to see, document and evaluate. That is not the case with corruption in ADB projects. It is a well guarded secret, known only to its president, board of directors and investigating officers. It is doubted if even the president of the country where the project is carried out would ever know about the corruption in that project. Their executives are not answerable to anyone, including the parliament and law court in that country, of any country. Such is the set up. If you want loan, accept the set up and accept the conditions. Ask no questions and reveal nothing to anyone, including the president and parliament of your country.
The mismanagement, incompetence, deception of donors, and fraud in ADB’s projects in Afghanistan which were reported audited by Price Waterhouse Coopers of UK was brought to light by the Whistleblowers’ Protection Group in the US- Government Accountability Project (GAP). The leaked report showed that ‘reports to donor countries were exaggerated and project achievements were fabricated, technical assistances were politicized favoring select constituencies, and the ADB rented lavish, unneeded project offices in the capital while urgent poverty reduction programmes were dropped for want of funds’. These Afghan projects funded by the donor agencies Poverty Reduction Cooperation Fund of UK and the Danish Aid Agency DANIDA, would have brought grander follow up funds from other donors, if successful.
An infant and maternal health programme which only needed less than $100,000 was dropped from the project stating there was no money for the programme. Another programme, which was a milking cow for corrupt ADB officials, had no invoices, competitive quotations, purchase orders or receipts amounting to $455,000, almost 60 percent of total equipment expenses for that programme. These frauds by officials were portrayed by ADB in their website as mere mismanagement and shortcomings. Money diverted for an unauthorized purpose but shown in records as having given to a Non-Governmental Organization for purchasing a mobile clinic for Northern Afghanistan were maternal mortality rates were the highest in the world is ‘mismanagement’ for ADB, where world calls it ‘fraud’. The ADB was not even willing to recover this money. Funds earmarked for renewable energy, healthcare, and livestock development which were to be made available to non-governmental organizations like the Agha Khan Foundation never reached them but were siphoned out using fabricated and bogus documents.
The management consultant submitted evidence of fraud to the Integrity Division of ADB in 2006 in fair belief which the ADB suppressed and did not make available to auditors. He was yet to see how dreadful this Division was in silencing whistle blowers. His report accompanied with affidavits never came to auditor’s attention till the anonymous management consultant turned a whistle blower and the whistle blowers’ group challenged the findings in their audit report and refuted the work progress data posted by ADB in their website in 2008. At last the auditors after a revised audit admitted that 21 of the 26 allegations made by the management consultant were true, and the remaining 5 could not be verified due to ADB not making available documentation. The angry ADB demoted, terminated and blacklisted the management consultant and protected all its corrupt officials and was not willing to recover the amounts lost to fraud. People laughed when ADB told the world that these ‘sums are puny compared to the $200 million ADB aid to Afghanistan that is in the works. The people laughed because they thought how lucky the ADB officials in Afghanistan and the Head Office were to steal from such huge funds!
We have heard about swamps reclaimed as land and made fit for human habitation and cultivation. But ADB created endless miles swamp when their Khulna Jessore Drainage Rehabilitation project in Bangladesh was completed. Miles and miles of cultivated land submerged with settlements, homes and schools in them but they decreed all compensation claims non-eligible since the date of completion was declared and the period for filing complaints was over. Who will know the project would submerge homes and lands and schools before the project was completed and water ran in? They pushed a whole community into a gigantic swamp, to rot there with the guilty Bangladesh government watching like a traitor. They sent a whole community of small scale farmers bankrupt in Sumatra in 2002 when their Rubber and Tea Planting Project yielded no rubber or tea. They declined to initiate stop-recovery proceedings against farmers, claiming their project had already declared to be closed in 2000. Their failed projects abound in Asia, leaving their skeletons creating havoc in economy and eco-system in all countries in Asia. Not even the Supreme Court of Bangladesh, or even the International Court of Justice, or even the International Human Rights Council of the UN can interfere, because it is ‘written’ in their ‘Chapter’! According to this rotten Chapter of theirs, they needn’t disclose information on any of their projects, and if they release any such information ever, it cannot be made public. As a concession to the low class world, out of pity, they will make public their Board decisions, after 10 years have passed!
ADB would grant aid to developing countries only if they privatize everything. In return, ADB will keep its source of funds always open among large private corporations which would go and gorge down large government services in these countries including their health services and sanitation and clean water services. The large corporations get the projects and the big officers and directors in ADB will get ‘heavy compensations’ for the time and effort they put in. Environmental damage caused by these corporations is not their concern. Not only do their projects destroy nature in a large scale but the people displaced are left with no compensation. Hospital charges, water charges and electricity charges skyrocket after these projects are in place and the investors want quick returns. Many of their projects gone awry in Japan, Nepal, The Netherlands, Australia, Indonesia, Thailand and Papua New Guinea and even the Philippines are under severe protests from ecological preservation groups and the affected and displaced people there.
It is important to note that corruption, bribery and human rights violations are not a concern for ADB because they are not so for the hundreds of big corporations which fund them and benefits from their worldwide projects. The three are just routine practices considered not sin in these corporations. They even earmark money in their budgets for bribes and financial compensations and softening up of human rights violation charges, of course under acceptable sub heads. If a corruption is reported, they wonder why it is reported at all, instead of being taken for granted. So, now, the culture of ADB also is the same, i.e., the culture of the main donors. Regardless of whether the recipient of the loan remains a democratic country or a despot, this culture of ADB remains the same.
The Asian Development Bank (ADB) is skilled in evading transparency and accountability since its beginning in 1966 with just 31 countries in membership, ‘for the objective of driving poverty out from Asia’. Their Charter is such autocratic and anti-democratic that their staff, projects or project-related documents can’t be questioned in any national or international jurisdiction. They are accountable only to them! But if any borrowing country defaults or refuses to repay loan they would be entitled to approach any national or international jurisdiction!! No decent country would accept their terms and conditions for loan unless it is democratic in profile and despotic in function.
In 2003, in an earlier primitive form of a forum for redressal of grievances of the affected, they received 42 letters of complaints and none were addressed. Forced by the furor of the world against them, they formulated an Accountability Mechanism Policy in 2012 and created a new forum for posting complaints. Within 2013, there were 23 letters of complaint against 23 specific projects! Since almost all letters of complaints were ignored or rejected, it was proved this Forum was a farce to appease the anger of the world against ADB. The fact is no one shall complaint against them except to them. And the complaint should also be to review a project, not to stop it for any reason. And also the complaint should be before the declaration of the date of closing of a project. In this graciously allowed period of time for submitting complaints, the closing date of the project does not include the 20 to 30 years the project is open for the borrowing country for repaying the loan but is the date of the actual completion of the work and the team moves on. In every way, it is the most aggressive blade financier in the world, the most fascist monetary organization in the planet, excelling even the Nazis’ in dubious financing!
IV. HUMAN RIGHTS VIOLATIONS
Human rights violations in health occur both in government hospitals and private hospitals, three times more in private hospitals because they cater to three quarters of the population in India. We will give here examples of gross human rights violations and corruption, in all cases the culprits going unpunished. Some are cases of corruption; some are cases of human rights violations, and some of both. Incidents from the early 1980s to the late 2010s are documented and the nature of the outcomes of their investigations underlines one thing- that the nature and behaviour of the Kerala State Health Services Department won’t change. Because the Directors of Health Services and the Health Secretaries of the Government are committed to protecting the culprits in the department, human rights violations go on, without anyone asking why compensations are not given. When one incident happens in an institution, gauging from the uproar in the press, investigations by the police, statements of ministers in the legislative assembly and proceeding of the cases in the law courts, we will assume that human rights violations in the health department are going to stop. We will expect that hospital staff and authorities will become alert from then onwards and such incidents will not happen for a long time at least in the same institution. That is not so. Because it is guaranteed that no one will loose jobs and no one will go to jail, it may happen in the same institution in the same week. The deaths of the medical student Shamna Tasneem (22) and the engineering student Jerin Michael (25) on 25 March 2017 at the Medical College Hospital Ernakulam Kerala.
What next are the Human Rights Commissions in the state and the centre. The State Human Rights Commission and the National Human Rights Commission do take cases occasionally, for publicity. After the initial press releases and the three internal rejoinders the interests of the bureaucrats and officials involved in the case are protected in the end. The outcomes of these cases are never disclosed and the websites of these Commissions do not permit examinations of the proceedings and outcomes of their cases even though they are public records. Besides, the judges and members of these Commissions are not saints beyond prejudice. Some of them are even famously prejudiced, as alleged by even their colleagues in the bench. Most of the judges in these establishments may have served in courts in the concerned state as judges or as lawyers and would be reachable, or their staff who prepare the draft proceedings. Remember here that almost all judges in India have been blotted by their colleagues publicly at least once, even those in the Supreme Court. Judges in the Supreme Court have even held press conferences raising allegations against their Chief Justice. Being judges, we believe their words, we are bound to. This is, it has to be said, is the power, strength and transparency of Indian judiciary today. India tolerates. The politicians appointed as members in these Commissions also would have at least one blot on their scutcheon from their politician’s life. Even if they punish someone, they do not have the claws and teeth to enforce it. For that they have to hand over it to the lowest court in the hierarchy- the Magistrate Court- where the fight will begin for endless years. They will most often advise the parties to seek remedy and justice through a regular law court, which is a good advice.
Instrument breaking into pieces, falling into the abdominal cavity and patient returning home not knowing anything.
The Taluk Headquarters Hospital, Nedumangad is recognized and upgraded as a District Hospital and assigned the rank of Model Hospital. A patient was done hysterectomy in this institution in August 2016 and there was complication where it was not to be. An instrument broke into pieces and one piece fell into the abdominal cavity. It could not be retrieved through the incision made during the hysterectomy. This was just a repetition of what had been happening in this hospital for years during simple PPS operations. She was referred to the Medical College Hospital, Trivandrum. She had to undergo a second surgery. Whether the piece was retrieved or not in the second surgery remained a mystery. It was reported in the media and the Kerala State Human Rights Commission took a suo moto case. The Commission declared the doctors to be guilty of medical negligence and ordered the government to pay a compensation of Rs. 50,000 and to recover it from the doctors. The health department’s enquiry found that the incident was not a case of medical negligence but an ‘unexpected event’. Perhaps they will call it machinery failure! On appeal by doctors, the High Court of Kerala ruled that ‘there was no medical negligence and the State Human Rights Commission’s order was grossest violation of principles of natural justice! As the Hon’ble High Court frequently gets from the Supreme Court of India what it gave to the State Human Rights Commission, the government sanctioned Rs. 50,000 from the Chief Minister’s relief fund as compensation to the patient, fearing the patient might file an appeal with the Supreme Court of India. Where is the judiciary going in cases of human rights violations?
Murugan: the migrated worker from Tamilnadu.
Murugan, a native of Tirunelveli in Tamilnadu was working as a milkman at Kottiyam in Kollam district in Kerala. His was a poor family consisting of his wife Murugammal and two minor sons of six and four years age studying in standard 2 and LKG. He was the sole bread-winner of the family. He met with an accident on the night of 6 August 2017 on NH 66 at Kottiyam, Kollam while riding pillion on a motorcycle. The onlookers called for an ambulance and one from the privately owned Life Save Ambulance Service arrived. The police took him to the KIMS hospital at Kottiyam. They diagnosed him to be with brain hemorrhage but said they had no ventilator facility. Unbelievable though it was for one of the finest chain hospitals in the world, those were their words. They referred him to Meditrina and Medicity Medical College Hospitals, Kollam. He was rushed to Meditrina Hospital, Kollam where they said they had no neurosurgeon. So he was rushed to another hospital in Kollam, the Medicity Medical College Hospital which asked if he had a bystander and when informed none said there was no ventilator available to admit him. Medicity said all its fifteen ventilators were engaged. Remember that the victim was stable when he reached Medicity Medical College.
The first 24 hours after the accident is crucial for victims. The police cops and the ambulance service personnel who were desperate by now had the only option of ferrying the victim to the Medical College Hospital, Trivandrum 65 kilometers distant. They conferred and the owner of Life Save ICU Ambulance Service, Near Holly Cross Hospital Kottiyam, Kollam - 691001, Phone: 7559992222, Mr. Rahul, was quite willing to take the responsibility for getting treatment to Murugan and to bear the cost of the treatment also as a humane gesture.
So, by night, he was journeyed 65 kilometers to Trivandrum Medical College Hospital. A Neuro Post Graduate resident checked on him and said there was no vacant ventilator available, so wait. No senior Neuro Surgeon came near him. Doctors were not willing to cooperate and won’t tell the accompanying police details about ventilator occupancy. This hospital being notoriously famous for making ventilators available to only those who will pay, it was suspected ventilators were available but would not be connected until someone pays which they knew no one will for the victim was a poor migrating worker from Tamilnadu. The police specifically asked which patients were using ventilators at that time but doctors won’t give details. In fact, as found out and admitted later, they have 54 ventilators of which half they keep out of condition always and the other half idling, waiting for rich patients. The Health Department actually had to admit later that they had a VVIP ventilator and 16 stand-by ventilators vacant at the time.
From Medical College Hospital he was taken to the nearby SUT Royal Hospital Trivandrum which also denied admission, claiming they had no neurosurgeon. So he was journeyed all the way back to Kollam Azeezia Medical College Hospital, which also refused admission for having no neurosurgeon. His condition worsened, and he breathed his last on the way to the District Hospital, Kollam, the last measure. He died around 6:30 in the morning, after spending seven hours in the ambulance.
In all these hospitals they inspected him, if they ever inspected him, by going to the ambulance parked in their casualty bay. The victim was not taken out from the ambulance at any of these hospitals. He stayed in it for seven hours after the accident. Do you know how he sustained through these seven long hours? He was connected to the small ventilator in the ambulance resuscitating him continuously. Not once was he disconnected from it. His last seven hours owes to the owner of this small private ambulance service.
‘To save his life, this private firm's ambulance, whose owner was quite willing to take the responsibility for getting treatment to Murugan and bear the cost of the treatment, traveled around 120 kms from Kollam to Trivandrum and back, but couldn't find one single hospital that was willing to offer him treatment’. The great rich hospitals in Kerala- private and government- which claim they have excellent facilities for treatment of trauma patients and whose owners must probably be dining with health ministers and health secretaries did not have the magnanimity and generosity of a small private ambulance service in a little town. Their address is ‘Life Save ICU Ambulance Service, Near Holly Cross Hospital Kottiyam, Kollam-691001, Phone: 7559992222. Owner: Mr. R. Rahul.’ Someone someday will reward them.
The timid press did not enquire whether the only available ventilator and Neuro Surgeon in the two vast districts of Trivandrum and Kollam were only at the Medical College, Trivandrum at the time. More over the question of why ambu bags were not used if ventilators were unavailable was not asked by press, or police. Had Murugan been rich, every hospital would have summoned neuron surgeons from outside who were always on call. A case was registered against all hospitals except KIMS because it is the pet of the government, and of all ministers, legislative assembly members, top bureaucrats, all political leaders and the press. It claims 903 doctors and 6602 employees in 16 hospitals in 6 countries. Take the example of their one at Kumarapuram, Trivandrum. Nowhere in this world will a government allow an overpass between two buildings built over a public road but KIMS did construct at Kumarapuram, Trivandrum, Kerala. Every one of the above mentioned people, including the Chief Minister and the Roads Minister see it and pass below it often but pretend there is not such an illegal obscenity there. It is this bunch of people who deal with international organizations and seek monetary assistance. It is definite they will bribe fund managers of these organizations to get hold of the amounts. They do not feel any shame or anger while passing under this overpass which ought to have been built as an underpass below ground. It was not at all impossible for this hospital to build it blow ground; it is rumoured that they have built an underground passage which opens up somewhere below some establishment near the Medical College Hospital there to bring and return expert surgeons, a closely guarded secret mutually profitable. Who will know who is inside those operation room masks, gowns and scrubs? This hospital which is very near to the Trivandrum Airport built their behemoth violating every rule regarding height of buildings near airports, and their upper stories do nothing but housing rich clients on pleasure tourism. It was no wonder when a young female nursing student jumped from these upper stories (?) and died, there was no action from the Kerala Government.
The internal report of the Medical College, Trivandrum said that there was no negligence on the part of the duty doctors on that night and also alleged that the Director of Health Services had no qualification to submit a report as her team had no doctor trained in trauma care. Remember that their department Kerala Medical Education Department was bifurcated years earlier from the Kerala Health Services Department to create more chairs and double and trible promotion opportunities for doctors, nurses and office superintendents.
Doctors’ organization Kerala Medical Post Graduate Association (KMPGA) threatened a strike if any doctor was arrested for the death of the accident victim. The Kerala Government Medical College Teachers’ Association (KGMCTA) asked how the police can put the blame on the government hospital alone when four private hospitals also denied treatment to the patient and threatened to strike if government doctors were to be made ‘scapegoats’.
In an anticipatory bail petition filed by three doctors the High Court of Kerala directed the police to submit a report. The police on 19 October 2017, Thursday submitted that ‘the hospitals failed to ascertain the suspected head injuries and give basic treatment, the doctors knew that the failure to treat a patient suspected to have suffered head injuries could lead to loss of his life, had refused treatment on account of non-availability of vacant ventilators or neuron surgeons, the post-mortem examination had revealed that he died of head injuries which contributed to the death, leading to incorporation of an offence under Section 304 of the IPC, and that action had been taken for constituting a medical board ‘for evaluating the entire circumstances against the backdrop of the treatment protocol’ for reaching a final conclusion’.
The State Human Rights Commission Kerala, in an order issued on 20 October 2017 Friday, flayed the health secretary for the undue delay caused in submitting the inquiry report on the death of Murugan and stated that the delay in submission of the report was also an act of violation of human rights. The secretary had not only failed to file his report of enquiry but also failed to file a report in response to the accusatory findings of the police that ventilators were available, the victims life could have been saved if the Trivandrum Medical College Doctors had attended him, and that the hospital was not cooperating with the enquiry.
The medical board constituted by the health department, after seven months after the incident, on 04 March 2018 Sunday as everyone knew, absolved all doctors of any lapses and softly slapped all the hospitals for ‘erring in not registering admission’ regardless of having or not having neurosurgeon or ventilator. What absurd observation to be made by the supposedly highest qualified medical board in the state on the death of a human being which their Chief Minister publicly apologized in the state assembly for the crimes of these doctors and their hospitals! They found no negligence on the part of doctors in any of these hospitals!!
Shamna Thasneem: The medical student who died at the hands of her professors and teachers.
Shamna Thasneem, a second-year MBBS student at Government Medical College, Ernakulam died of severe allergic reaction to ceftriaxone injection on July 18, 2016 while she was under the care of her own professors and teachers. An investigating panel of doctors of the medical education department found that callous attitude, casual and indifferent dealing and severe medical negligence were the reasons for her untimely demise. After she developed respiratory distress, there was delay in shifting her to ICU, another delay in administering life-saving medicines adrenaline and atropine, she was not ventilated even during critical stages, suction apparatus malfunctioned and basic life support systems were not available at the nurses’ station.
A bronchial asthmatic patient, she reported fever, body pain, dizziness and breathlessness on January 18 at 1.30 PM. She was given ceftriaxone injection at 2.30 PM, the universal medicine for respiratory infection in internal medicine, on the doctor’s assumption that there was presence of water and infection on the left chest, even before taking a chest x-ray for diagnosis and even without taking into consideration her allergic history. Other doctors were of the opinion that the girl only had a viral influenza and an antibiotic injection was completely unnecessary. In their opinion the infection was viral and the unnecessary and careless administration of the antibiotic injection led to her collapse. After her collapse she was not immediately administered adrenaline injection for resuscitating her. Though she died at 3.45 PM, she was shifted to the private Rajagiri Hospital at 6 PM under the façade of better treatment, to confuse where the victim actually died. The relatives were even asked to pay this hospital’s bill amounting to Rs. 9,000. She was the first medical student from her village. Her life could have been saved if timely medical care was given after she collapsed.
Later, at a press meet, the victim’s father would release a phone clip of a conversation between the duty doctor and another hospital staff, confirming his daughter had died at the Government Medical College Hospital Ernakulam before she was shifted to this private hospital for suppressing evidence. They must have been doing this for a long time- a government medical college hospital and a private hospital in the same city joining hands to suppress evidence.
Her virology lab tests conducted at TD Medical College Alappuzha confirmed influenza A sub-type H3N2. Her histo-pathological test result in the post-mortem report from the forensic department of the Medical College Alappuzha stated that ‘Shamna’s viral infection of H3N2 did not lead to her sudden death. The virus did not cause the death by causing sudden failure of vital organs like lungs, heart or brain and the death was not due to pneumonitis, myocarditis or encephalitis hitting these organs respectively. Under such circumstances it can only be reasonably concluded that the death was as a result of the drug allergic reaction.’
The doctor, who administered the injection, the professor and head of the department of general medicine, was suspended first in October 2016, and then reinstated based on the report of the DMO’s medical board. He was suspended again in April 2017 based on the report of the DHS’ medical board. The principal of the Medical College Ernakulam was very reluctant to hand over the details of the staff who treated Shamna to the investigating police. The health department was very much reluctant to dismiss the doctor who ‘referred’ Shamna to a private hospital after her death and allowed her body to be removed to another institution before a pathology surgeon took over. Six months after the death, the affidavit filed by the Joint Secretary of Health and Family Welfare before the State Human Rights Commission of Kerala admitted that there had been lapse on the part of the doctors in treatment and also lapse on the part of the local police in investigation. But by that time the local police investigation had been derailed and the departmental investigation rigged.
The state health department refused to cooperate with the Crime Branch investigation. Instead they offered a compensation of 3 lakhs rupees which the victim’s father rejected. Kalamasseri Police informed Mr. Abootty that they were closing the case on recommendations from the medical board headed by the Ernakulam District Medical Officer Dr. Kuttappan ruling out medical negligence in this case. The forensic expert in the board, Dr. Lisa John from Alappuzha Medical College, recorded disagreement note with the proceedings of this board and even issued her counter statement to the public. Mr Abootty complained to the Director General of Police, Kerala that the local police were misleading the case and the DGP wound up the local police investigation and handed over the case to the Crime Branch police. They crime branch police investigated and their report on 17 July 2017 named 15 staff of the hospital including 2 doctors as responsible for death due to medical negligence. So the crime branch case came into being.
The experienced District Medical Officer, Dr. Kuttapan, knew how to save one of them and the District Level Expert Committee constituted by him merely recorded their views and suggestions and did not attribute medical negligence on anyone or name anyone as responsible. The Kerala Administrative Tribunal (KAT) on 18 October 2017 Thursday quashed the suspension of the professor directed the State government to reinstate him and regularize his absence from duty, citing the expert committee had only recorded their views and suggestions and had not attributed medical negligence on anyone or named anyone as responsible and the suspension of the doctor was premature.
The equally ‘experienced’ Director of Health Services, Dr. Saritha, who constituted the Kerala State Medical Board, the State Level Apex Body which second investigated the death also knew how to provide loopholes to save a doctor like her. Her Board consisted of herself the DHS, a paediatrician, the Director of Medical Education, a radiologist and the Additional Director of Health Services (Vigilance), a mere medical graduate with no specialization in medicine or vigilance. The High Court of Kerala on 2 August 2017 Thursday stayed the crime branch police investigation, saying the Apex Medical Board had no experts or specialists in the Board and did not state in their report why they arrived at a different finding from that of the District Level Expert Committee, and so the investigating officer cannot proceed on the basis of this report.
The victim’s father who continued this fight for justice and pioneered bringing this human rights violation to the fore of public attention, Mr. Abootty, passed away in Muscat following a cardiac arrest on 28 October 2918 noon. Now there is no one there to carry on this fight. The Kerala Health would have been forced to pay a compensation of at least 2 crore rupees, imprison the culprits and get the doctor’s name removed from the Medical Council of India’s rolls, had he could have continued this fight. The government would have happily paid the compensation had the coffers been full with foreign funds, and human rights violations in health would have continued. Had there been no foreign funds and only the bare minimum in the government coffers, the government would have asked the doctor to pay the amount, and then all human rights violations in health in the state would have stopped then and there. That is how foreign funds help and promote human rights violations in health.
Jerin Michael: The engineering student who succumbed to hospital neglect and delinquency.
Jerin Michael, a Thevakkal-native sound engineering student at Goodness Institute of Film and Television at Pachalam, his parents predeceased and living with his grandmother, was suffering from severe stomach ache and visited the Government Medical College Hospital around 6.30 AM on 25 March 2017 Saturday. He was denied proper medical care and left unattended till 1 PM when his bystander and friend Vyshakh pointed out this and complained. What his friends thought was a case of food poisoning, turned out to be a case of appendicitis and the hospital staff told that he must undergo a surgery. Then the nursing staff administered some injection on him at 1 pm and informed him that the surgeon was on leave and a free surgery could be performed on him if he waited for a few days, or he could get it done immediately using a doctor from the outside if he was willing to pay. He was also asked to get a few blood tests done from a lab outside the hospital, and left unattended again. He developed seizures multiple times at night- fits three times around 9:30 PM but no one bothered- and when the fourth fits developed the hospital staff asked his friend to shake him until the seizure stopped, which did not stop. When his condition worsened, the staff wrapped him in a bed sheet and took him to the ICU, carrying him by stairs as the lift was not working. Some say the lift worked but the lift operator was absent. By the time they reached the ICU, Jerin had died around 11.20 PM, less than 16 hours after admission. The Medical College principal Dr. Sreekala told that he was not lying neglected but ‘under observation’! She even told they were perplexed as to why he developed seizures which must have been due to an unknown cause!!
The body was taken to the Alappuzha Medical College for postmortem which they did only on the next day Sunday and the histo-pathological lab report stated septic shock following acute appendicitis as leading to the death which means he could have been saved with timely medical intervention. Edathala police registered a case for unnatural death, citing medical negligence, not getting the consultation of the call surgeon on duty, not referring to other hospitals for better care, not scanning and operating at the right time and not getting timely care leading to death.
It was also revealed that following the aftermath of the Shamna’s death the same year the Government of Kerala had allotted 1 crore rupees to this medical college for purchasing basic equipments they said they lacked but the principal was sitting idle on the file for the next incident of death to occur. That it is the second time within a year that negligence leading to the death of patients at this medical college was noted by press and people but not by government and health department.
When each case occurs there will be rigging of investigations, digging of loopholes in charges and finally letting go free the culprits, for favours received or as favours repaid. No one notices the end results of individual cases, but when accumulated through the years their numbers are astounding and everyone is found to be let go free. How could the world pay these thugs foreign funds for continuing this?
(Will be updated; please check)
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