How They Made The NRHM Sick

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With the Mayawati government now out of power, will the NRHM scam probe be taken to its logical conclusion, asks Abhishek Bhalla

Behind bars Former family welfare minister Kushwaha
Behind bars: Former family welfare minister Kushwaha, Photo: Indian Express Archive

MINUTES AFTER polling concluded in the Uttar Pradesh Assembly election on 3 March, Babu Singh Kushwaha was arrested in connection with the multi-crore National Rural Health Mission (NRHM) scam. Standing with folded hands in a Ghaziabad courtroom, the former family welfare minister told the judge he was innocent.

In court, Kushwaha pinned the entire blame on former chief minister Mayawati, claiming she took all crucial decisions relating to NRHM, whereas he did not have much say. “I was just a minister, not the supervisor of the scheme. All major decisions were taken either by the chief minister or the chief secretary,” he said.

The CBI is probing whether the money trail reaches the top. Along with Kushwaha, BSP leader Ram Prakash Jaiswal was arrested. The agency alleges that Jaiswal, a close aide of Kushwaha, helped him invest the spoils of the crime.

It’s not just the CBI. In a scathing attack, the Comptroller and Auditor General (CAG) has strongly indicted the State Health Mission, saying it was responsible for the NRHM scam. The audit done by the CAG pertains to the period April 2005 to March 2011, and was conducted between August and November 2011.

According to the CAG report, the State Health Mission did not discharge its responsibilities adequately, resulting in Rs 5,754 crore going unaccounted for. The total amount spent on NRHM by the state is Rs 8,657 crore.

Some of Mayawati’s decisions are being closely scrutinised as part of the criminal investigation. Among them is the creation of a new post — that of Chief Medical Officer (CMO), Family Welfare. So every district now had two CMOs. The move, carried out in a hurry, was not only opposed by CMOs but also upset the top brass in the state, including some ministers.

The creation of this new power centre, reporting directly to the family welfare minister, completely changed the dynamics of the health sector. Kushwaha, already a powerful political figure, now had 72 CMOs in the state under his control, responsible for almost Rs 3,000 crore on average every year. “The move to have a CMO to handle NRHM funds is definitely under the scanner,” reveals a CBI officer on condition of anonymity. How the new posts were filled in an unseemly hurry also violated all procedural guidelines.

The separation of health from family welfare for NRHM funds was a move that was against the guidelines laid down by the Union health ministry, which had specified in a circular that the two should not be separated.

The CAG report, yet to be made public but accessed by TEHELKA, says, “There was absence of structural integration and convergence within the health department.”

‘I was just a minister. All major decisions were taken by the CM or the chief secretary,’ says Kushwaha

The CAG report blames the state government’s decision to appoint two ministers for family welfare and health as a move away from integration. “Consequently, two parallel posts of CMOs became operational in districts. However, the government had to withdraw the earlier orders due to institutional problems arising out of the two posts. This indicated that the issue of integration of funds, functions and functionaries even within the department was not resolved as of March, 2011,” the CAG report states.

It is interesting to note that the state government recalled its order of two CMOs after the murder of two CMOs from Lucknow, Dr Vinod Arya and Dr BP Singh.

It is in this backdrop that the CBI carried out a series of searches and questioned CMOs across the state. Investigators believe the new bunch of CMOs were instrumental in siphoning off huge amounts at Kushwaha’s behest, as it was the minister himself who took interest in appointing of many of them.

“The freedom that Kushwaha enjoyed under Mayawati at one point of time cannot be ignored in the probe. Most of the people posted as CMOs were close to Kushwaha,” says a CBI officer.

However, so far, there is little material evidence to establish the exact money trail. The system of having two CMOs itself does not establish criminal culpability.

The CBI is also inquiring into records of middlemen and contractors who might have paid kickbacks to get people of their choice posted as CMOs in their district to benefit from contracts related to NRHM projects.

But one handicap for the investigators is gathering material evidence. Account books, details of transactions are all tampered with.

The CAG report mentions that a lot of information required for the audit was not made available. “The audit has been constrained due to non-productivity of records at different tiers of the government. At many units, it was informed that records are either not available at all or are not available in full. In quite a few instances, original records had not been maintained, particularly relating to accounts,” the CAG report says.

Another reason why BSP supremo Mayawati’s role cannot be ignored is the fact that the goals of NRHM were to be achieved by the State Health Mission, which was directly under the former CM.

Even the CAG report directly blames the State Health Mission for various anomalies in the mega health project. The report states, “The management of the mission, especially financial and accounts procedures, suffered from systemic weaknesses. The improper and deficient maintenance of books of accounts resulted in accounts not reflecting the true and fair picture of NRHM in the state, apart from resulting in serious financial irregularities.”

THE CAG has also found anomalies in releasing of funds; the method adopted was once again in complete violation of the NRHM guidelines. “The State Health Mission, instead of directly releasing funds to the executing agencies, released more than Rs 1,500 crore through the programme management society, an unregistered society introduced by state government,” says the report.

These are not the only violations of the guidelines by the state government. According to the CAG, the selection and awards of construction works to agencies on nomination basis is not only a violation of NRHM guidelines but also rules laid down by the Supreme Court and Central Vigilance Commission. The CAG points out that agencies were paid money for construction without even ensuring the availability of land resulting in money lying with the agencies without work starting and benefiting them as interest.

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Fatal fallout of a scam

Even the CBI is struggling to solve the mystery of the NRHM-related deaths

Crime scene Police examine the body of slain CMO BP Singh
Crime scene: Police examine the body of slain CMO BP Singh, Photo: Pramod Adhikari

AS THE CBI tightens the noose in the NRHM scam, the crime scene has been bloodied by a handful of suspicious deaths. After the murders of two CMOs, Dr Vinod Arya and Dr BP Singh, and the mysterious death of deputy CMO Dr YS Sachan in jail, two more government employees have died in mysterious circumstances.

The last such death took place on 12 February in Lakhimpur district. The body of Mahendra Sharma, a clerk with the community health centre, was found 10 days after he reportedly went missing from home. The post-mortem report revealed that the death was caused due to smothering leading to asphyxia — a clear indicator that it was a murder. But the police came up with a suicide theory claiming they recovered a suicide note.

Sharma’s family is not buying the police theory. “We have not even been shown the original suicide note. I saw a photocopy and it’s not too clear,” says Sharma’s 23-year-old son Neeraj.

The family claims that Sharma, who handled accounts at the health centre, was constantly under pressure from his bosses to fudge account details of NRHM projects. “When my father did not succumb to the pressure, he was transferred,” claims Neeraj.

Although the case has been transferred to the CBI, sleuths have not been able to establish the family’s claims.

In another mysterious death, Sunil Verma, a project engineer with the Jal Nigam, allegedly shot himself on 23 January. A suicide note was found saying the CBI was harassing Verma by constant questioning on the NRHM scam. It is not clear whether he was a suspect or a witness for the agency.

“We have been questioning many people, especially employees who were part of NRHM and understood its functioning to get leads. He was just one of them,” says a CBI officer.

However, Lucknow-based lawyer Prince Lenin, who filed a PIL in the high court asking for a CBI probe in the murders of the two CMOs, says none of the deaths should be seen in isolation. “It appears to be an attempt to silence whoever wants to raise a voice. Even if it’s a suicide, it must be probed what led to it. It’s possible that the person was forced to kill himself,” he says.

While probes are at a nascent stage, the CBI has not got any major leads in the earlier cases. In Sachan’s case, it is working on the suicide theory despite a judicial probe indicating otherwise. On 22 June 2011, his body was found hanging in the jail premises. This was a day before he was to be produced in court for further remand. The police declared it a case of suicide.

The police, who claimed to have solved the murders of Singh and Arya, implicated Sachan in the murders and arrested three shooters. The chargesheet filed by the police was found to be unreliable and the high court stayed any proceedings on it.

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The CBI is closely following all these findings of the CAG in their probe. According to the CBI, largescale bungling took place in the implementation of NRHM. The modus operandi for siphoning off state wealth included overpricing, fake supply of medicines and hospital equipment by fictitious firms as well as huge kickbacks in construction activity to improve health services in government-run primary health centres in rural areas.

The CBI also discovered how some persons acted as middlemen between contractors and influential bureaucrats and ministers to supply medicines and equipment under the programme.

The NRHM scam surfaced just ahead of the Assembly election in Uttar Pradesh and along with the subsequent mysterious deaths of three CMOs and two other state employees associated with NRHM became a major political flashpoint.

In her defence, Mayawati maintained during her election meetings that she had nothing to hide and it was her government that recommended a CBI probe in the multi-crore scam and the five killings that are seen as direct fallout of the scam. But her political opponents attack her directly, saying that since the former chief minister was at the helm of affairs of NRHM, she should be answerable.

ACCORDING TO Samajwadi Party chief Mulayam Singh Yadav’s brother Shivpal Singh, not only is Mayawati responsible for all the wrongdoings, she has also managed to delay the investigation. “It’s been more than a year when the first murder took place and the scam surfaced. By not allowing a CBI probe immediately they have ensured that by now a lot of evidence has been destroyed,” Yadav told TEHELKA.

The politics over NRHM will not end with the elections. Now with the arrest of Kushwaha on the concluding day of polling in Uttar Pradesh, political clamour over NRHM has again started raising doubts on the timing of the arrest.

‘By not allowing a CBI probe immediately, a lot of evidence has been destroyed,’ says Shivpal Yadav of the SP

Not surprisingly, the BJP has come out in support of Kushwaha, who joined the party after being expelled from the BSP. “It appears they were waiting for elections to get over. Why did the CBI have to wait all through the elections if they had evidence against him? It seems CBI is working under pressure,” says BJP leader Kalraj Mishra.

On the other hand, the CBI has made it clear that this arrest relates only to one case. It is alleged that Kushwaha allotted work of upgradation of 134 hospitals to a company without any bidding. There are 12 cases registered in the NRHM scam till date and the investigating agency says there might be more cases registered soon and more arrests are likely.

Abhishek Bhalla is a Senior Special Correspondent with Tehelka.
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