A Course and a Correction

PUBLIC HEALTH FOUNDATION of India (PHFI), the country’s largest public health advocacy group, headed by Dr Srinath Reddy, has a penchant for being in the news for all the wrong reasons. Dr Reddy, who was awarded the Padma Bhushan in 2005, is a renowned cardiologist and former head of the cardiology department at the All India Institute of Medical Sciences. Last year, PHFI attracted the Centre’s wrath over a plethora of reasons including purported diversion of funds, resulting in the cancellation of its licence to receive foreign money. The Government has now relaxed terms and allowed the organisation to receive money from abroad with prior permission. The institute, however, continues to court trouble. As new documents surface, PHFI is likely to land in a soup over an apparent attempt at lobbying—and a successful one at that—to secure permission from the prestigious Thiruvananthapuram-based Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST) to recognise its Master’s of Public Health (MPH) programme. SCTIMST is under the control of the Department of Science and Technology (DST) and is considered a showpiece of medical excellence in the country, thanks to its strict admission and course allotment guidelines.

A DST official confirms a high-level SCTIMST panel had spiked PHFI’s request earlier at the former’s academic committee meeting, where lengthy discussions were held on the subject of recognising new institutes. Documents in possession of Open reveal that the meeting, held on May 5th, 2014, decided the issue needed further deliberations at a higher body of the Kerala-based medical institute, namely the Board of Studies (BoS) of Health Sciences. According to Constitutional provisions, SCTIMST has the powers to grant medical degrees, diplomas and other academic distinctions and titles. The argument then was that any such recognition didn’t fall within the ambit of the institute’s mandate as envisaged in the Institute Act.

PHFI had made its first request to Professor Jagan Mohan Tharakan, then director of the institute, to grant affiliation for its MPH course run by its unit, Indian Institute of Public Health, Delhi (IIPH-Delhi), on February 13th, 2014. Subsequently, the high-level governing body of the institute turned it aside at a meeting on June 28th, 2014. The contention of the decision-makers, among others, was also that they could not allow any dilution of the reputation of SCTIMST and its courses.

SCTIMST’s two-year Master’s of Public Health course, the first of its kind in the country, had been launched with the aim of spurring research and timely interventions in public health, an area of major concern in a country that is home to a large chunk of the world’s sick population. According to the ‘extraordinary gazette’ dated December 22nd, 2011, the Government of India and the Medical Council of India recognised MPH by SCTIMST as a post-graduate degree for medical graduates. This notification was issued on the basis of an approval by the Institute Body (highest decision-making body of SCTIMST) and Department of Science and Technology, Government of India.

The governing body of the institute refused to entertain PHFI’s request once again after comparing it with other institutions whose courses it had recognised earlier, especially ones such as Chennai- based National Institute of Epidemiology and Christian Medical College, Vellore, which is affiliated to MGR Medical University.

An engineer from SCTIMST has, meanwhile, shot off a complaint to the CBI to look into the role of Dr Asha Kishore who took over as director of the institute in July 2015, replacing Tharakan, in ‘bypassing the earlier decisions of the governing body’ to recognise IIPH-Delhi’s MPH course. Open is in possession of the letter that claims that ‘the academic committee of the institute at its meeting held on October 31, 2015, included this item (recognition for IIPH-Delhi’s MPH course) as an additional agenda citing reference of an email dated October 23, 2015, from DST Secretary and a request from IIPH’. Professor Ashutosh Sharma, secretary, Department of Science and Technology, had written a mail to Kishore with a subject line titled, “Strategic Partnership of SCTIMST and PHFI”. He suggested to Kishore that “there may be a good opportunity in it for SCTIMST you may wish to explore”.

Interestingly, in a letter sent to Kishore on October 5th, 2015, PHFI President K Srinath Reddy thanks her for reconsidering the request. In the letter, Reddy writes, ‘At the outset, I am thankful to you for agreeing to reconsider our proposal for affiliation of Indian Institutes of Public Health (IIPHs) to Sree Chitra Tirunal Institute for Medical Sciences & Technology. Prof. Thankappan has spoken to me in this regard…’

In fact, Reddy himself had not requested affiliation for IIPH’s PhD course which it would get from SCTIMST thanks to a memorandum of understanding (MoU). His mail to Kishore goes on: ‘IIPH is keen to enter into a strategic partnership with Sree Chitra Tirunal Institute for Medical Sciences & Technology for the purpose of seeking recognition to its ongoing (post-graduate Diploma in Public Health Management-PGDPHM) and new academic programmes (Master of Public Health – MPH)…’ Dr KR Thankappan (then a professor at SCTIMST) was copied in the mail along with Ashutosh Sharma, Secretary to Government of India, DST. Thankappan was later, through an order by director Kishore on May 9th, 2017, named an emeritus professor at the institute.

THE LETTER TO the CBI sent by the engineer adds, ‘On January 29, 2016, SCTIMST and IIPH-PHFI entered into collaboration for recognising the MPH programme and PhD of IIPH Delhi. Each student has to pay 1.8 lakh per year (as tuition fee alone). It has 50 seats every year. Further the fee for the NRI seats is three times of the normal fees. On the SCTIMST campus, the intake of MPH course is 25 candidates. But the institute has granted approval for taking 50 candidates to the off-campus centre, with a clear view to help the private institute to earn money. In order to make things easy for IIPH, the institute has issued an order dated 2nd September, 2016 allowing candidates from other streams such as engineering, management, economics to also take admission to the MPH course which is a gross violation of the Gazette Notification and this Order was issued without taking necessary approval from Institute Body and DST.’ The letter also reads, ‘One Dr. V. Ayyagiri, a retired DST official and now a part of management team of IIPH Delhi, was instrumental in coordinating the entire episode by liaisoning with DST and SCTIMST.’

A Copy of an MoU between PHFI and SCTIMST suggests PHFI’s Master of Public Health and PhD programmes would be recognised by SCTIMST. In return, PHFI would pay the institute Rs 5 lakh. The figure was written by hand in the MoU

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Last year, the Union Home Ministry had said that PHFI was using the funds it received for HIV control for anti-tobacco activities. According to a Times of India report, the Ministry listed seven ‘undesirable activities’ of the organisation, including declaration of only six of its 151 bank accounts, wrongful declaration of Rs 43 crore received for anti-tobacco lobbying and remittances of Rs 22 crore made to foreign countries from its FCRA account, which is meant for overseas financial transactions. The report added, ‘The seven violations cited by the home ministry against PHFI, which has been receiving a significant chunk of its foreign funding from Bill and Melinda Gates Foundation, include using foreign contributions to lobby media, parliamentarians and government on tobacco control policy issues, ‘which is prohibited under FCRA’. PHFI, according to the home ministry, has bank accounts with credits of Rs 223 crore more than what it had declared to the home ministry.’

Members of the executive committee of the governing body of PHFI include Infosys founder NR Narayana Murthy as its chairman, former deputy chairman of the now-defunct Planning Commission Montek Singh Ahluwalia and other luminaries as members of the council. Dr V Rao Aiyagari is its senior advisor, Science & Technology Initiative. Rajat Gupta, the tainted Indian-origin former managing director of McKinsey & Co, was the chairperson of PHFI until the US Securities and Exchange Commission named him a conspirator in an insider trading scam.

A lengthy response to a mail sent by Open to Kishore about the change in perceptions of PHFI after she took over as director highlight the chronology of various developments in the run-up to PHFI’s courses being awarded affiliation. It read: ‘…PHFI, on 13th February 2014, submitted its application for affiliation for multiple courses, including PhD courses, at multiple locations at Delhi, Hyderabad, Bhubaneswar and Gandhinagar. Academic Committee held on 13.05.2014 decided to have a detailed discussion in the Board of Studies of Health Sciences of the Institute before granting affiliation. The Governing Body meeting on 28.06.2014 noted the decision of the Academic Committee and did not reject the application or future submissions. Academic Committee on 20.02.2015 decided that recognizing and affiliating several institutes may not fall automatically within the ambit of the Institute’s mandate as envisaged in the Institute Act. [The] Governing Body on 06.04.2015 noted the observation of the Academic Committee as such and did not consider any resolution in the matter. Discussions with PHFI and the Achutha Menon Centre for Health Science Studies (AMCHSS is a unit of the Institute) had continued after April 2015, and based on such a discussion between the then Head (of) AMCHSS, Professor Thankappan, and the president of PHFI, the latter submitted a request for affiliation of IIPH only for its MPH programme on 5th October 2015 through the Secretary, Department of Science and Technology. This request was considered by the Academic Committee on 31.10.2015. The Academic Committee examined the application in detail and all information provided on the institute and its facilities. The Academic Committee had considered the proposal and many apprehensions were voiced by few members… Dr Raman Kutty, professor at AMCHSS, had pointed out that the PHFI has strong links not only with the Ministry of Health and other important research donors, but also with the Ministry of Science and Technology, GoI, for public health research. It was also reported that the PHFI has been recognized as a Scientific and Industrial Research Organisation (SIRO) by the Department of Science & Technology, GoI. It was stressed that any such affiliation will open up new opportunities for AMCHSS.’ It adds that apprehensions related to it being a private institute were set aside thanks to clarifications provided by an AMCHSS representative. ‘Many of the apprehensions were further allayed when it was also pointed out that PHFI has been instrumental in bringing together a number of researchers in the field and channelling a number of research projects from international donors and they are already partners for some of SCTIMST projects,’ says the response mail. RTI documents reviewed by Open reveal that there was no SIRO recognition for IIPH-D at the time of the MoU’s signing.

On whether there are the other collaborations between SCTIMST and PHFI, the response mail says, ‘At present, other than the ongoing MPH programme, there is one project, “Non-communicable disease risk factors among working population: An institution based study in Kerala”, with funding from PHFI.’ RTI documents also show that there was no research collaboration between the two organisations at the time MoU was signed.

More lies are getting nailed, too. Information obtained through another RTI request also found as false PHFI’s claim on its official website that secretary, ministry of health & family welfare; director general, Indian Council of Medical Research; and director general of health services, ministry of health & family welfare, are members of the organisation’s general body or executive committee. The Union ministry said in a letter dated February 21st, 2018 that no such order was issued in the ministry naming these high-level bureaucrats in any of these PHFI panels. Another response to an RTI application states that no ministry or department order was issued for the inclusion of Secretary, Department of Science and Technology, in the general body or executive committee of PHFI.

After this story came out on February 23, PHFI has removed the name of Ashutosh Sharma, secretary, Department of Science and Technology, from its website. Secretary, Ministry of Health, whose name continues to be listed as a member of the governing body on PHFI’s website, did not respond to repeated pleas.

A copy of the memorandum of understanding signed between PHFI and SCTIMST that is in possession of Open states that ‘the parties have mutually agreed to come together in respect to the Master of Public Health (MPH) and PhD (Public Health) programme’, suggesting that both courses got recognition from SCTIMST. In return for the affiliation, PHFI would pay Rs 5 lakh to SCTIMST. The ‘Rs 5 lakh’ part was written by hand in the MoU, which was signed in the presence of V Rao Aiyagari.

The response to queries also adds that PHFI’s request letter was placed before the academic committee as an out-of-agenda item because ‘the request for affiliation from PHFI dated 5th October 2015 was received only after distribution of agenda and hence was placed as an additional agenda item, along with two other items’. In fact, an academic committee meeting held on February 20th at the Kerala-based institute had noted that PHFI, which ran MPH courses with a large number of students, will find it difficult to oversee multiple programmes at various sites.

The otherwise two-year MPH course can be completed by a student in three years or extended to four years with the permission of SCTIMST’s director. This was based on a note issued on September 2nd, 2016, by SCTIMST a few months after PHFI launched its MPH course. A DST official says this could be a ruse to help PHFI make money because students who get four years to complete academic course requirements pay fees for those many years.

Meanwhile, an IIPH-Delhi spokesperson tells Open in an email response that ‘we follow the same rules and regulations for the ‘maximum period within which a student enrolled in Masters of Public Health (MPH) may complete requirements towards his/her degree’ as prescribed by Sree Chitra Tirunal Institute of Medical Sciences and Technology’.

As regards the larger number of seats allotted and the costly fee, the spokesperson says the annual enrolment capacity of several public health schools globally is much higher than theirs: ‘Indian Institute of Public Health–Delhi does not receive any recurring grant from the government to run educational programs and we run our programs through rented premises. Hence our fees are higher than institutions receiving recurring grants and having their own infrastructure. Even with this fee, the MPH programme at Indian Institute of Public Health–Delhi is subsidized.’ At SCTIMST, the fee charged per candidate is nominal.

Within SCTIMST, several scientists that Open spoke to state that such ‘misadventures while awarding affiliations’ would dent the status of the institution, formerly Sree Chitra Tirunal Medical Center, set up in 1976 under the aegis of Kerala’s well-regarded late Chief Minister C Achutha Menon. “His dreams shouldn’t go up in flames,” says a scientist at the institute.

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