050. Who Were Behind The Abandoned Health Observatory Surveillance Project Of Kerala?

Who Were Behind The Abandoned Health Observatory Surveillance Project Of Kerala?

By Special Correspondent
Kerala Health Research Online

The first news report to mention Kerala Health Observatory And Basic Surveillance Project was by The Hindu National Daily published on 23 January 2013 which involved Health Secretary Rajeev Sadanandan saying: ‘The State Health Department is putting in place a Health Observatory formulated by the department to track the morbidity and mortality pattern in the State through a survey, covering 2.3 lakh households or a population of 10 lakh covering all panchayats. It is one of the largest armies in the world to track all health-related data. The project is taken up by the Health Department, with technical support from the Population Health Research Institute of McMaster University, Canada under formal technical collaboration, supervised and supported academically by the Achutha Menon Centre for Health Science Studies, Health Action by People, and the Department of Community Medicine at the Medical College. McMaster University will assist in data management and analysis as the State has little experience in handling such mammoth studies. The proposal is to pilot the project in April, by surveying data from two clusters of 55 households each in urban and rural areas in all districts. Health workers will visit the designated areas and administer the questionnaires prepared by a team of experts. The questionnaire will be pre-loaded in a tablet PC so that the health workers need not spend more than 20 minutes in a household for data collection. Personal information on all members in a family will be collected. The tablet is GPRS-enabled so that the supervisors can determine if the health workers are entering the data from the field. The data will be uploaded in a server to be maintained here, ‘a Health official’ said. The training for health workers for administering the questionnaire through tablets will begin in February. The pilot is expected to be completed in a month after which the project will be formally launched. The 28 tablet PCs to be used for the pilot study will be provided by McMaster University. A proposal for supplying tablet PCs to health workers for their field work is being taken up with the IT Department.’

The second news article to come up was what the Times of India published on 18 March 2013, ‘Canadian Expertise To Create Database Of Diseases’, which further revealed that NRHM would fund the survey and the diseases caused due to extensive use of alcohol and tobacco, the food habits of the people, the rate of obesity and its reasons, the rate of prevalence of diabetes and blood pressure, the diseases caused due to lack of exercises and the reasons behind the deaths occurring in the state, would be investigated.

For one full year nothing was heard of this project in news media though everything was happening with the project. It was on 23 March 2014 that Times of India printed Kerala’s Opposition Leader Mr. V. S. Achuthanandan’s allegations on this project, under the heading ‘V S Says Govt. Clarification On Drug Tests Misleading.’ We must note that, by this time, the words Basic and Surveillance had dropped out of the title of the project and we know why. They are dreadful words, attracting the attention of vigilant inquisitors. The news article said, according to Mr. Achuthanandan, ‘the government’s clarification on allegations of drug experiments on citizens was misleading, health minister had not denied receiving money for the survey conducted among 1,540 families across the state for a Canadian organization, the minister had only said that the health department has not accepted any remuneration for the survey and the minister has yet to clarify how an NGO received money instead and why such an initiative was undertaken without the permission of the Government of India or the Indian Council of Medical Research. The Opposition Leader also alleged that a memorandum of understanding signed between Kerala Health Observatory and Population Health Research Institute of Canada had led to handing over of lifestyle and health details of people of the state to the Canadian organization, the health minister and former health secretary Rajeev Sadanandan were involved in the matter, and that the Head of the Department of Community Medicine, Mr. Vijaya Kumar, was receiving the remuneration through a non-government organization of which he is the secretary.’

The New Indian Express also on 21 March 2014 reiterated this allegation of the Opposition Leader that ‘the State Government is conducting dangerous drug trials on people in collaboration with the Canadian Government, people were being treated like guinea pigs by the State Government project Kerala Health Observatory and the Population Health Research Institute in Canada and that under the guise of this experiment, the Canadian Government was being gifted details about the lifestyle and health of the people of Kerala. He also alleged that the Health Department assigned five health inspectors and nurses for this job for over the past one year. Under the agreement signed between the Kerala Government and the PHRI, this is not merely an observation programme, but a scheme to intervene in the health status. This means, drug tests could also be a part of it. It is understood that data collected from 1,540 households in the 14 districts have been transferred to the Canadian Government. He said this is not just illegal and immoral, but also a source of corruption and demanded the State Government to clarify as to what exactly the Kerala Health Observatory Project is. The government should explain whether the subjects were informed that the data would be handed over to Canada and whether the scheme had the clearance of the Union Health Ministry. It should be explained as to how the remuneration is being paid to the organization ‘Health Action by People’. The government should also explain whether drug tests have been conducted on people, he said. 

The Hindu National Daily, on 31 March 2014 reported, in a different tone, that ‘the Opposition Leader’s recent criticism of the so-called drug trials conducted as part of the Kerala Health Observatory Project has caught many public health activists by surprise. Many officials in the health department wonder what caused the octogenarian leader to suddenly raise the issue’ when Health Minister had announced in the Assembly sometime ago that the project, which never involved any drug trial, had been shelved, the minister having had also clarified that the project, sought to be conducted in association with the Canada-based Population Health Research Institute, involved only collecting details on the morbidity and mortality patterns with regard to the high prevalence non-communicable diseases in the Kerala population and advisory body comprising of top health officials and well-known academics and public health activists having overseen the entire exercise, the findings of which having not handed over to any foreign entity.’ According to this news paper, ‘many officials wondered privately whether the Leader of the Opposition had been briefed wrongly about the project by sections not disposed well towards such Health Department initiatives, since allegations regarding drug trials have always been a politically sensitive topic in Kerala.’

We, readers of all these news articles, will now have a few questions of our own in our minds which will have to be answered by the government and a few names printed on our conscience which we ourselves have to clear. The most relevant questions which spring up in our minds have already been asked by the Opposition Leader. The names which trouble us, which we ourselves have to clear, are Kerala Health Observatory Project, Government of Kerala Health Department, National Rural Health Mission, Medical College Department of Community Medicine, Population Health Research Institute Canada and McMaster University Canada, Health Action by People, Achutha Menon Centre for Health Science Studies, Trivandrum and a few names which come up when we search internet for Kerala Health Observatory Project. 

Kerala Health Observatory and Basic Surveillance Project

To tell the truth, the name Kerala Health Observatory Project does not come up anywhere, associated with any credible research institutions. Only news is there, cultivated, planted or officially released. It exists nowhere. It has left behind only paper trails- vouchers, letters, cheques- all conveniently shelved now, to be opened only when an investigation starts or a judicial court summons. It left no electronic trail. Searching the internet with the key words kerala-health-observatory-project leads to nowhere, or to whatever is only there (See the picture below). It leads to the names of only two ladies. Everyone escaped clean, except two young ladies whose names are left there alone on the broad sky of internet for all to view. One is a consultant whose Linked In profile shows she is engaged by Health Action by People since April 2010 as Consultant, holding the responsibility of coordinating their international study funded by McMaster University and other responsibilities including searching out funding options for their research projects. The website of Health Action by People also shows her name. The other is that of a Computer Assistant in the Medical College Hospital, Trivandrum whose Linked In profile also claims she has been associated with Kerala Health Observatory Project. Medical College Authorities do not have Computer Assistants on their pay rolls except those, if any, appointed on daily wages basis by Hospital Development Committee. None of the other governmental and non-governmental organizations’ digital fronts mention anything about this project. Even after questions having been raised by prominent legislators, health minister having answered questions and reputed news papers having reported grave allegations, it is inconceivable that electronic searches for this project lead only to two young women who did not think it prudent and wise to keep back from publicly associating their names to a project which was doomed to be abandoned and hushed up later.

Health Action by People

Health Action by People started near Mutharamman Kovil, Pettah and then moved to near Medical College, Trivandrum. It was founded by the prominent Dr. C.R.Soman of Trivandrum, the late health visionary of Kerala. He was a professor at Medical College, Trivandrum, noted as a trainer of health workers in the state. After his demise, Dr. Raman Kutty, a professor at Achutha Menon Rsearch Centre became its Chairman. Dr. K.Vijayakumar, Professor of Community Medicine at Medical College, Trivandrum is its Secretary. They have two professors from the Achutha Menon Centre in their Executive Council, including the Chairman, and four professors from the Medical College, Trivandrum, including the Secretary. They do have a Dr. Rajasree Gopinath as Consultant. When they say they are committed to serving the people in the field of health and that their organization is led by a group of professionals sharing a common vision and ideal, why should we unbelieve?

Government of Kerala, Health Department and National Rural Health Mission

Government of Kerala through its health minister has admitted that an agreement was signed between the Canadian Organization and the Government which along with everything else was shelved after a time. It has not yet revealed who in Kerala were involved and how much money was spent on this project before its shelving. Also it has yet to answer the specific questions raised by the Opposition Leader of Kerala. The Health Department did involve itself in this project by deputing staff, if they did depute. This department has to answer who were deputed to do what, when and where and what their financial commitments were and who gave them the authority to depute personnel, spend money, collect people’s data and hand over it. The people of Kerala know well about the activities of NRHM. It is a central agency housed in the state, working with a lot of money, living a lavish life like kings and accounting to no one. The central government directed NRHM to create websites and post every activity including daily expenditure so that people can evaluate how they spend public money, following continuous allegations of misappropriation of money were reported from all states. They were even directed to post the names of who work where on which day so that people may check. They totally disobeyed this for fear of peoples’ interfering and public comments in websites. That is why it is said they account to no one and live like kings. Their websites have a few photos of persons, a few telephone numbers, a few links here and there and no information. Whatever is there is available in any government diary. Every dubious project which springs up in Kerala in the name of health is financed by this agency, if it has ‘considerations’. Every ambitious educated entrepreneur set out to make quick money come up with projects for this agency, for they do not provide links in their website to projects undertaken or amounts spent on each. If they are funded by the government of Kerala in any project, the government will not have details of this money once it leaves government coffers. If someone asks details from the government under the Right To Information Act about the money they gave, the government will say details are available only with the NRHM and not with them! In this particular case of Kerala Health Observation and Surveillance Project too, as reported, it was NRHM who was to finance (or distribute money to?) this survey, no wonder. Every unaccountable spending is now delegated to NRHM. Man, even defense establishments are now accountable to people! 

Achutha Menon Centre for Health Science Studies, Trivandrum

The Achutha Menon Centre for Health Science Studies is the Health Sciences wing of the Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum. They train professionals in health research and health policies. Government of India recognized this wing of Sree Chithra as a Centre of Excellence for public health training.  The AMCHSS does have an ongoing research project, the Principal Investigator of which being Dr.V.Ramankutty: Prevalence Of Type II Diabetes In A Rural Community. The path to this project is: Home > About SCTIMST > Organisation > AMCHSS > Projects > List of Ongoing Projects- 12. Apart from this, they mention nothing about any research project undertaken with Canadian partnership or assistance. They do have visiting faculties from abroad and an affiliated WHO Fellowship Programme and there might be Canadian citizens among the scholars who have come and gone, but their official website has zero information on Kerala Health Observatory Project. Perhaps, their name was unnecessarily dragged into this by those who came up with this project. One of their professors, Dr.V.Raman Kutty, is also the chairman of Health Action by People in Trivandrum, incidentally. And another of their professors is in their Executive Council also.

Population Health Research Institute in Canada

The Population Health Research Institute (PHRI) was founded in 1999 as a joint Institute of Hamilton Health Sciences Corporation and McMaster University. Their declared research programs include studying the causes and prevention of cardiovascular diseases, diabetes, obesity, vascular complications, and stroke. They have a global team of collaborators with researchers from eighty countries in six continents, including North America, Africa, Asia Pacific, Europe, Middle East and Latin/South America, according to their public relations. Their Lead Investigators are noted as Dr. Salim Yusuf, D.Phil, FRCP, Canada, Professor of Medicine at McMaster University, Director of the Population Health Research Institute, and Vice-President of Research and Chief Scientific Officer at Hamilton Health Sciences and Dr. Clara Chow, a post-doctoral research fellow.

But their official website does not have information on any projects undertaken in Kerala. In European standards, with the strict European Information Commissioners, if they do not have anything to display on Kerala, it clearly means they do not have any official deal with Kerala. If there does exist a connection, it is personal and out of office. It is very easy nowadays for someone to sign Memorandums of Understanding and mislead institutions, if there is someone in that institution who is prepared to turn head the other way in return for favours once received or offered. 

So, we have to assume that the name of the PHRI was either unnecessarily dragged into this project to boost project profile and secure government support and finance, or the PHRI withdrew from partnering with the project, on wise second thoughts. News reports say that they only intended to provide guidance and expertise, not finance. The PHRI which has undertaken so many research studies in so many countries is unlikely to sign genuine agreements officially and withdraw from them if the projects are feasible, viable, legal and righteous in their evaluation. Then who did sign the agreement for them? Did they sign it with Health Action by People or with the Government of Kerala? What were the terms of this agreement?

We know whoever approved, promoted and travelled along with this project and claimed it as their own has now disowned it, like they do to a leper. The involved establishments did spend money, depute personnel, collect data, hand it over and everything else associated with carrying out a project like this. It was, we can guess, brought forward by private persons, who got eminent institutions and scientific personalities involved, got politicians to speak for them and get favour from government, until it became a government project with government funding. We can also guess it violated so many principles inviolable where two countries, a state government, and sensitive data of people are involved. It all started in 2013 and ended in 2014 within just one year, the same period when people with guts in Kerala were playing with state politicians and bureaucrats and technocrats like playing with dolls and puppets and got projects approved and purses un-stringed. We have seen so many scams not to wonder. Why did the Kerala Government actually abandon this project and shelf it suddenly?

Note: 

This is not the end of the article. We know more things will become public in near future. We will certainly report them here. This article will be updated. Please bookmark this page.

Links To News Articles:

The Hindu News Article Dated 23 January 2013

Times of India News Article Dated 18 March 2013

Times of India News Article Dated 23 March 2014  

New Indian Express News Article Dated 21 March 2014

The Hindu National Daily News Article Dated 31 March 2014