India's Health Policy Driven by Foreign Funded Consultants
Many health ministry consultants paid by foreign aid agenciesReplying to an RTI application, the health ministry said 363 consultants worked with it.
The salaries of a large number of these consultants are being paid by external aid agencies such as the US Agency for International Development (USAID), the UK's Department for International Development (DFID) and the United Nations Population Fund (UNFPA). These organizations hire consultants and pay them through agencies such as Deloitte, a US-based financial company, IPE Global, which describes itself as a development consultancy, or SPC Management, a consulting company. Health-related international agencies such as UNICEF and the WHO too have consultants in the ministry.
Former health secretaries and senior public health experts admitted that having a large number of external consultants has become the practice in recent years. Many of them added that this not only raised serious issues of conflict of interest, security and sovereignty, but also led to the erosion of in-house technical expertise, making the government permanently dependent on external consultants. There was no response from the ministry to questions TOI mailed to them on the issue. Reetika Khera, associate professor of economics in IIT-Delhi, said, "The consultants are in effect employees of various consulting firms like Deloitte, which is essentially a financial company whose consulting pages include life sciences and healthcare as an industry, raising clear conflict of interest issues."
"For a country with aspirations of being a great power to be dependent on DFID and USAID for the regular running of a national ministry is absolutely shameful," said a person who worked with the ministry for over a decade on public health policy. "A consultant paid by an agency has dual loyalties and when asked to work on guidelines or policy, being more loyal to his paymaster, is bound to check with the agency. The agency will then insert whatever it wants into the guidelines," a person who has worked with the ministry and multilateral organisations on health legislation explained.
He cited the example of how the technical secretariat for the national immunisation programme was shifted out of the ministry into the Public Health Foundation of India (PHFI), which received $100 million from the Bill and Melinda Gates Foundation, whose avowed goal is to influence government policy on health programmes such as immunisation.
Many of those TOI spoke to felt that bureaucrats were reluctant to do away with the system of consultants, though such recommendations have been made many times, because they liked to keep foreign aid agencies happy. Many looked forward to deputation abroad or the frequent foreign jaunts these agencies could swing, they pointed out.