Objective="Control of Corruption in Health Services."
Details for Reform Option "Setting up a Vigilance Cell for the health sector, Karnataka"
In order to improve the public health care system in the State of Karnataka, the then Chief Minister set up a “Task Force on Health and Family Welfare” in December 1999. The Task Force was required to make recommendations regarding improvements necessary in the management and administration of the department and to monitor the impact of the recommendations.
One of the major concerns of the Task Force report (published in 2001, see documents and illustrations) was the issue of corruption in the health sector. Corruption was found at various levels of the system and in all aspects and sectors of health care.
The Task Force recommended the setting up of an institutional mechanism in the Directorate of Health. A Vigilance Cell was established in the Department of Health in 2002 to investigate minor complaints on Class II, III and IV group of health staff received by the department directly and also cases referred to it by the Lokayuktha (literally ‘people’s representative’- see comments box for more information). However, since the cell had very limited powers to control corruption, it was found to be not very effective.
When the report was shared with the Lokayuktha, Honourable Justice Venkatachala, he requested the Chairman of the Task Force, Dr H. Sudarshan, to assist him in dealing with corruption in the Health Department.
Dr Sudarshan was appointed Vigilance Director (Health) under the Karnataka Lokayuktha. He was to assist the Lokayuktha and Upalokayuktha (deputy Lokayuktha) in investigations and also accompany them during field visits to various blocks and districts.
(For a list of the Vigilance Director’s purview see documents and illustrations.)
The Vigilance Director under the Karnataka Lokayuktha (KL) stepped up inspections of all institutions, from sub-centres and PHCs to district and State level medical colleges and super speciality hospitals, the Directorate of Health Services, Directorate of Medical Education, Drug Control Department and General Drug Store.
To combat corruption amongst hospital staff, anti-corruption officers employ various methods including grievance redressal for complaints. Accused staff will be publicly asked to pay back bribes, humiliated using press coverage or, in some cases, traps will be set. The Police wing of the KL also operates ‘traps and rides’ where a police team uses chemically-treated currency which when given as a bribe will stain the bribe-taker’s hands and so reveal them. The suspects are then placed in Judicial custody and jailed for 24 to 48 hours pending an investigation.
The media has played an important role in publicising and creating awareness about the Lokayuktha and its role. The media accompanies the Lokayuktha during his visits. Display boards at institutions provide information about corruption along with the Lokayutha address to encourage sending in of complaints.
The following reforms for good governance in health were suggested:
i) Creating a proactive Lokayukta (anti-corruption cell)
ii) Strengthening the Consumer Forum
iii) Implementation of the Transparency Act
iv) Using the Right to Information Bill
v) Training in Health and Hospital management
vi) Leadership training
vii) Health Management Information systems and e-Governance
viii) Hospital and Health Committees
The number of demands for bribes has reportedly dropped. A study conducted by the Public Affairs Centre has shown that the bribes have come down in Bangalore City hospitals.
Awareness among patients of corruption within the health services has increased, as illustrated by an increase in the number of complaints. Between 50 and 70 complaints were received at the initial stage and now more than 425 cases have been received (February 2005). The Lokayutha office receives 10 to15 phone calls and 5 to 7 written complaints every day. There is also a plan to start a helpline with the help of an non-governmental organisation (NGO).
The procurement of both drugs and equipment has improved. The State government has formed the Karnataka Society for Promotion of Rational
Use of Drugs and can now provide good quality essential drugs to all health centres. It is also able to purchase good quality equipment at reasonable market rates, whereas previously it was paying more than double the market rate.
The presence of doctors and paramedical staff in PHCs and Subcentres has reportedly improved and absenteeism has reportedly been significantly reduced.
Most of the suggested reforms for good governance mentioned above have been implemented by the Government but need to be further strengthened.
According to Dr Sudarshan, the intervention of the Karnataka Lokayukta has succeeded in saving at least INR 100 crores (€18,057,178) of the State budget which was being pilfered at various levels.
The total budget of entire Lokayuktha institution is about INR 8 Crores per annum which is less than 0.02% of the total expenditure of Karnataka Government.
The total cost of the Vigilance Director’s office is 0.05% of the total Karnataka Lokayuktha budget of which about 70% is spent on salaries and 30 % on travel. The Vigilance Director works with a token salary of INR 1 per month.
The final report of the Task Force was submitted in April 2001. The Vigilance Director’s post was created in January 2002. It took about a month to create the post and set up the office. (The Honourable Lokayuktha wrote to the Government regarding the appointment and he issued the Order to appoint the Vigilance Director.)
Improved access: Patients who would have stayed away, unable to pay bribes, can now use the facilities with the assurance that if bribes are demanded they can report those concerned.
Strengthens the delivery system: Good quality services, drugs and equipment are ensured in public hospitals.
Public awareness: People learn that bribery is not a prerequisite of healthcare. They also understand the need to register a complaint and how and where to make it.
Reduces misuse of funds.
Fear factor: Some doctors who supplement their salaries with small bribes refuse to conduct operations for fear they will be reported.
Harassment: In a few cases, harassment of doctors by false complaints was observed. However, under the Lokayuktha Act, complainants who give false complaints are liable to punishment.
Strong political will and good leadership in Lokayutha institution and Health Department.
Who needs to be consulted
KL, State Government, Health department of the State.
Sustainable, as long as anti-corruption team remains vigorous and the Health Department implements necessary measures.
Chances of Replication
Replicable, but depends on a progressive Anti-Corruption Act and Lokayukta. Requires strong political will.
Lokayukta is an autonomous institution set up at the State level for redressal of citizen’s grievances by investigating into administrative actions taken by or on behalf of Central or State Government or certain public authorities. It is intended to serve as an institution independent of the Government concerned, to supplement the judicial institutions and is headed by Chief Justices or Judges of Supreme Court of India or High Court of the State. 19 States of India have Lokayukta institutions. The Karnataka Lokayuktha was established in 1986.
The Vigilance Director (formerly Chairman of the Taskforce) is a person from an NGO background. In fact, 6 of the 12 members of the task force were from NGOs.