Thursday, 19 March 2015

Kerala's E-Health In Dark Shadows

E Health is new to Kerala State in India and, considering the strange avenues into which massive corruption has penetrated into, we have decided to closely follow the state’s activities in this field from the very beginning to as far as we can follow in time and space such that when something happens good or bad, no one will have to wonder. When corruption occurs in large scale in this field which surely will and e-health in Kerala reported to be in shambles and disarray, there will certainly be investigations but within that time, millions of rupees will have gone. We wish to report things from the beginning so that we can pinpoint persons who were responsible when considerable amounts money are lost from public funds. We certainly will have repercussions, oppositions and even retaliation from those involved, which we do expect, which also we hope to report through these pages.

The centres of activities in implementing this project in Kerala are the Health Secretary’s office in Government of Kerala in the Secretariate, the Directorate of Health Services and the Mission Directorate of the National Rural Health Mission, all situated in Trivandrum. The first thing which was got done by those involved was getting prepared a report on the possibilities and scope of implementing e-health in Kerala which, we believe, was commissioned out to persons not in this field. This report got approved and then what we heard was media news about some funds being brought to Kerala, allocated by the Government of India. (We, in these columns earlier have reported the same). Some reported it to be 97 crores and some said it was only 92 crores but all wondered in secret where the balance did go, considering the usual rate of ten percent realized by political agents in India for getting a project approved and financed. Government of India usually allots 100 crores. It is inconceivable that the full amount reached Kerala, if it did, in contradiction to North Indian standards. Or has our country progressed beyond being a puritan state?

All digital health activities in a state will have to be controlled and monitored from a single centre, to minimize theft of confidential patient data which is costly and which would be beneficial to a multitude of commercial organizations from insurance companies to health psychic predictors. We will be startled at the incompetence and lack of imagination with which the Directorate of Health Services operates its own simple website, let alone the massive and complicated encrypted data flow in connection with e-health governance. It is a crude website where people cannot interact; data are scanty, incomplete and unreliable, what shall be there is not there and what shall not be there is there, data never updated since inception and pages will not open and if they open will have only a few irrelevant sentences. We enquired and learned that there was no one there to do these things except temporary hands lent by peripheral institutions. No one can believe that such gross neglect and ignorance can be engaged to monitor the digital clinical maneuvers in the whole state, unless the same is outsourced-something feared in even England, United States, France and Germany. Insurance companies alone will spend a million dollars to see central stores of people’s health data established. Let us take the example of the E-Health Link in the DHS’ web site:

Since the starting of this digital front of the state’s health in 2013, the E-Health link remains skeletally maintained and laughable; it has no important data or information to display. See a snap-shot of this page as on 19 March 2014 which is self-revealing. There is not mention of the important things in the field that have happened! The importance is laid not in enlightening people on this new subject which even these ‘authorities’ know nothing about and which is going to affect people’s lives every way, but on how the 92 crores could be spent safely without public interference.

An Expression of Interest in May 2013, an inevitable corrigendum six days after, four ridiculous queries the same month- this was all. And it was the month of the greatest digital activity in this Directorate- or that was what they wished to make public. Five Months later, in October 2013, there was application invited for the post of Manager but no mention of who applied for and who was selected. 

The Expression of Interest was posted on 3 May 2013 with a deadline on 18 October 2013 with no mention after the deadline of who expressed interest and who were approved and short-listed. Note that this was a period in Kerala when the greatest number of fraudulent people and organizations submitted bids and took part or collaborated in heavily-funded government projects, with Solar Scam in the lead. No wonder the names of people who expressed interest in government’s e-health project could not be publicized!

Things are dubious and large amounts of public money are involved. Why permit them to steal away people’s money in leisure instead of going after them and following every move? We know that there is a Vigilance Wing in the Directorate of Health Services, administered by an Additional Director of Health Services who does nothing but hunt petty lowly employees like Hospital Attendants, Nursing Assistants, Nurses and Clerks. How many doctors and officers of authority did they found out guilty and charged in the past 25 years? Their main duty is to hand over the names of those who report corruption and misdeeds to reported culprits, their actual subordinates! Never did they detect something in their own initiative without someone reporting or complaining. That is the same situation with the government’s vigilance department. No one in vigilance detects something on their own account. Everything has to be detected by people or newspaper reporters and details conveyed to them. Then they will investigate, reluctantly.

So it is now our own duty to detect and report, which we shall do; let us see what they do to charge-sheet and punish them, if there happens to be something punishable. We, decided to follow two routes- private investigation and the broad route of the Right to Information Act. What our private investigations revealed shall be reported to you readers later in its time but we find it nothing inappropriate to publish in time to time what we found out via the broad path.

Here is our original Registered Letter to the concerned Public Information Officers on 20 March 2014. We think these questions we asked are pertinent, which everybody may wish to ask:

Application for information under the Right to Information Act


The Public Information Officer,
Government of Kerala, Secretariate, Trivandrum.
Department of Health and Family Welfare,
Government of Kerala, Secretariate, Trivandrum.
Directorate of Health Services, Trivandrum.
Directorate of National Rural Health Mission, Trivandrum.

Dear Sir,

I request you to kindly make available to me under the Right to Information Act, in writing, the following information which is not classified, within the prescribed time limit. I have affixed Rs.10/ worth of Court Fee Stamps as fees.

Does Kerala State Government wish to implement E Health in Kerala?

If yes, which are the agencies/offices through which it is to be implemented? Have the Government of Kerala Collaborators/ Nodal Agencies for formulating/implementing this project?

Did Government of Kerala or any of its departments/offices/collaborators receive any funds from anywhere for formulating, developing or implementing E Health project, and if so, who is the custodian of this fund? Please give name and full official and postal address.

If funds were received or offered, which were the sources of such funds? Please give specific details of communications allowing/releasing/offering of such funds.

Were any amounts from the funds transferred to any individuals/ establishments/ organizations on account of fees, services, salaries, honorarium and/or allowances? If so, please give the mode of payment, their names and full postal addresses and reasons for transfer of money, along with details of cheques, demand drafts and acquittances.

Were any advertisements given in any media inviting Expression of Interest on this project, and if so, where? What were the dead lines and who were the persons/institutions/organizations who expressed their interest? Please give full postal addresses.

Did the names and addresses of those who expressed interest in the project published in media where the original invitation for EOI was advertised, and if not, why? Where else was it published?

Which are the posts created for implementing this project? Please give full pay scales, incentives and other perks.

Where were advertisements inviting applications to these posts published? Please give specific links and dead lines.

Who were selected for each post? Please give their names, full postal addresses and the last institutions where they served with name of designation and period of service there. Were their names and posts published anywhere?

Which posts are yet/proposed to be created in connection with this project and when and where are they going to be advertised?

Please include names and addresses of Appealing Authorities also in your reply.

Sincerely Yours,
Dated: 20 March 2014.

We sent these requests by registered post, and they have 30 days time to give us their answer, if they give in time which is unusual. We will wait and post their replies here, along with papers of appeal if it goes up to there. Meanwhile we will see what other things happen in this field.

The RTI Letter we sent to The Public Information Officer, Government of Kerala, Secretariate, Trivandrum was returned by the Indian Postal Department, with the endorsement, ‘Not Sufficient Address’ and not with ‘There Is No Such Addressee’. We know government functions through its various departments, but why as a single entity government did not appoint a Public Information Officer? It is dubious. A delivery postman, as per rules, cannot determine in his office whether the designation exists or not or whether the concerned officer would accept it or not, provided the name of the government office and the place where it functions is printed in the address. He certainly has to take the letter to that office. So we shall assume the postman did take the letter to the office but the officer-in-charge declined to accept the letter. What right has a government officer to reject a letter from a citizen addressed to government, on the basis of whatever technical grounds? Even if a citizen does not mention the Right to Information Act in his letter, is not the government liable to convey the information he requested?

The Department of Health and Family Welfare sent a reply signed by one Mr. Sudarsanan, Additional Secretary, which stated that ‘the Government of Kerala implemented the e-health through the National Rural Health Mission and details are available with them’. Does not this department have a Public Relation Officer to reply to RTI letters and why is that designation absent in this reply? He did convey information on point number 1 but omitted point numbers 2 to 10. If government is implementing E-Health in Kerala, why are not details available with Government of Kerala but only with NRHM which is not Kerala Government’s? What kind of a government and what kind of an administration is that? Why are details not available in Secretariate, the seat of government? Are details of E Health available in Secretariate or not? Or is this dubiousness to hide facts or prevent contradictory information from being released from two sources, i.e. from Government and NRHM? These are the usual questions which rise in the minds of common man. We are certainly raising these issues of discrepancy with this department’s Appellate Authority. We are credibly informed that the bids mentioned in the beginning are being finalized on the extended date and things are being kept secret till then.

Shady Recruitment Procedures Adopted For Several E Health Posts.

Dubious advertisements appeared in equally dubious places, inviting applications to these posts. In one place, the How to Apply link leads to admissions section of the Manipal University and the CLICK HERE MORE DETAILS FOR THIS JOB link leads to where there is nothing about these posts. The DHS, NRHM and Arogya Keralam have nothing to show on these posts in their websites. It is an old trick- to advertise in places where no one will look and even if someone looks there, the links shall lead to nowhere. It is clear these posts are reserved for favourites, to be recruited through shadow agencies. And the posts do have handsome salary packages, in Kerala standards.

1. Finance Manager 50,000
2. Administration Manager 50,000
3. Technical Manager 50,000
4. Manager (Change Management) 50,000
5. Asst. Manager (Finance) 30,000
6. Asst. Manager (Admn) 30,000
7. Office Assistant 15,000

The following was one of the advertisements (or the only advertisement?) for these posts in e-health. It was online and it appeared in one of the shadiest of places:

‘Directorate of Health Services (DHS Kerala) hiring Managers & Office Assistant (CA/ ICWA, B Tech/ MCA, MBBS, B Com, Any Degree holders). Applications are invited for the following posts in the eHealth Project Management Unit (eHealth PMU) on contract/deputation basis. The contract basis appointment will be for a period of two years. Deputation basis appointments will be based on Government rules. Maximum age limit for posts 1 to 6 is 58 years and for post 7 is 40 years as on 01-01-2014. All the postings will be in Thiruvananthapuram.

Company Name: Directorate of Health Services (DHS Kerala)

Position: Managers & Office Assistant
Education: CA/ ICWA, B Tech/ MCA, MBBS, B Com, Any Degree
Experience: 3-10 yrs
Location: Kerala

Applications may be send to State Mission Director, NRHM, General Hospital Junction, Trivandrum – 35 so as to reach the office on or before 12-03-2014.’

Who make money and who use government projects to do favours and repay favours received? So, that's why this great reluctance in conveying information under the right to information act. If what usually happens in Kerala happens in this project also, we will see that the relatives of the very authorities who were bound to give information out were undergoing the recruitment process. 

So, as we feared, government do not know who the custodian of the 92 crores they gave is. The NRHM Directorate also does not know who the custodian of this amount is and how it is spent. See the reply from Smt. Vijayalekshmi P. Nair, Senior Administrative Assistant. We have to wait for months for an information which is available under the roof of a building adjacent to her own office building.

First reported on 19 March 2014

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