Empty Beds, Emptier Coffers

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Unhealthy state The PHC at Kimipfuphe is empty because it lacks even basic facilities
Unhealthy state The PHC at Kimipfuphe is empty because it lacks even basic facilities Photo: Luit Chaliha

Helen* gave birth to a boy at a Primary Health Centre (PHC) near Kohima, the capital of Nagaland. She was given Rs 500 under the Janani Suraksha Yojana (JSY), a scheme launched in 2005 with the aim of decreasing neonatal and maternal deaths by promoting institutional delivery of babies. A few days ago, her sister-in-law gave birth to a girl, but she received only Rs 300.

Intrigued by the disparity, Helen questioned the hospital authorities. Little did she know that she was going to expose a scam that has blighted the state Health Department and runs into crores of rupees. Helen reported her findings to the Naga Mothers Association (NMA), the powerful apex body of Naga women.

“In 2009, we got the first hint that something was amiss,” recalls Rosemary Dzuvichu, a noted social activist and an NMA adviser. “We asked our district units to check if there are any discrepancies in the implementation of the National Rural Health Mission (NRHM). Within a month, complaints started pouring in from different parts. We could smell a bigger scam.”

Soon, the NMA sent fact-finding teams across the state and also filed RTI applications to seek information about the utilisation of funds under the NRHM. “We discovered that the claims made by the state officials on the NRHM and the actual state of affairs were as different as day and night,” says Dzuvichu. “That’s when the Naga mothers decided to take up the matter with bureaucrats and lawmakers.”

NRHM guidelines stipulate that mothers who deliver babies at PHCs should be paid Rs 700 within 48 hours. But RTI documents reveal that hundreds of mothers in Nagaland were given the money more than one year after delivery, while many others didn’t get the money at all.

“I came across many mothers who didn’t even know that they were supposed to get cash if they give birth at PHCs,” says Helen. “Those who knew were told to collect it later. But many did not go back. When we sought information through RTI, we found that crores were siphoned off by issuing false receipts.”

Officials of the Health Department, where Helen’s husband works, put pressure on the couple to back out. “But I didn’t give up,” says Helen. “I requested the NMA to take the issue further.”

A 2005 state government notification said that the NMA chief should be one of the nominated public representatives in the state health mission, but the decision was never conveyed to the NMA. “This shows that they wanted to keep the civil society out so that they can loot without fear,” says Dzuvichu. “We found out that there are no ambulances for picking up expecting mothers and dropping them off after deliveries, as mandated under the NRHM. The NRHM annual report indicated that there are 1,700 ASHA workers, but we found out that they were not getting paid on time. We also found that doctors and NRHM officials had appointed their kin as health workers in violation of all norms. All in all, it was a free-for-all loot between 2009 and 2011 before we stepped in.”

RTI documents reveal that senior NRHM officials took Rs 5 lakh as travel advance while touring Mon, Mokokchung and Tuensang districts in 2010 even though they were entitled to only Rs 50,000. “This came to light during a special audit of the health department but due to political pressure the discrepancies were kept under cover,” says a senior accountant with the Health Department on the condition of anonymity.

The engineering division of the Directorate of Health and Family Welfare was given advances that run into crores of rupees for building infrastructure under NHRM. RTI documents show that money was spent on rewiring the directorate building and repairing the director’s official residence — none of these fall under the approved infrastructure under NRHM, indicating how funds were diverted.

“We also came to know that 15 percent of the total allocated funds went as kickbacks to officials,” says Dzuvichu.

Between 2008 and 2011, the Health Department bought 108 vehicles; almost half of them were meant to be used as ambulances. But officials used the NRHM funds to buy SUVs such as Scorpios, Boleros and Maruti Gypsys. “Most of the time, we refer patients to bigger hospitals,” says a doctor posted at a remote PHC in Wokha district. “However, many PHCs don’t have ambulances because the vehicles bought for the purpose are Gypsys, which hardly has any space to carry patients. Doctors use them as their personal vehicles.”

The Centre sanctioned Rs 52 crore for upgrading the districts hospitals at Phek and Kiphire. In 2010, the first tranche of Rs 26 crore was released and the state government’s utilisation certificate shows that every paisa was spent. But RTI documents show that only Rs 5.33 crore was released to the contractors. It’s anybody’s guess where the rest of the money went.

Another RTI document reveals that Rs 4 crore was released to a bogus private company for the procurement of pre-fabricated structures to be used at 50 PHCs without observing any formalities.

On 21 March 2011, the NMA wrote to the then Nagaland governor, Nikhil Kumar, requesting for an independent probe. “We knew that the state government would hush up matters because this kind of blatant corruption cannot take place without the political class’ help,” says NMA member Vilanuo Angela Yhome. “We requested that the inquiry committee must include at least two expert members nominated by the NMA. To our dismay, the governor’s office did not take up the matter proactively and ended up passing the buck to the state government.”

NMA members allege that government officials started to harass them. “We keep getting threats but we won’t back down,” says Yhome. “Our idea is not only to clean up one department but the whole society. Corruption has reached such a level that government officials now feel that misusing public money is their right. Everyone who comes to power in Nagaland does it. But if we allow them to misuse money meant for mothers and babies, it will kill all the social values that we are proud of.”

To verify the NMA’s claims, TEHELKA visited a PHC at Kimipfuphe near Kohima. Established in 1994, it caters to more than 5,000 people. However, there was not a single patient at the PHC on that day. “We cannot keep patients because we lack even basic facilities,” says a nurse. “Whenever patients come, we examine them and refer them to a Kohima hospital.”

Her litany of complaints was endless. There was no power supply most of the time and the back-up generators were of no use. Storing life-saving drugs was impossible because the refrigerators don’t work. There was no running water. Even in delivery rooms, the nurses had to collect water from unhygienic toilets, which are never cleaned due to a lack of sweepers. To make matters worse, this PHC does not have an ambulance either.

On 2 June 2012, Dzuvichu and Yhome lodged an FIR against the NRHM authorities alleging rampant corruption. “It has been over a year and our FIR was never registered. This goes to show how the entire state machinery is actually trying to save the kingpins,” says Dzuvichu. They estimate that around Rs 40 crore have been siphoned off since 2009, and resents that even the top brass of the Nagaland Police chose to turn a blind eye on the FIR.

Finally, Dzuvichu petitioned the Kohima Bench of the Gauhati High Court to initiate a probe into the scam. “We know that it will be a long-drawn battle against a corrupt system,” says human rights lawyer Zhevi Swu. “The mothers would like to lead the change. Unless this happens, there will be no development.”

Even though Nagaland boasts of low infant and maternal mortality rates, the fact remains that the state also has equally low institutional delivery rates. In villages, women still prefer to give birth at home. Perhaps, the state is taking advantage of this and misusing funds meant for keeping mothers and babies healthy.

*Names changed to protect identities

ratnadip@tehelka.com

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