In the third part of a four-part series on the functioning of the Public Health Foundation of India, newly appointed chairman NR Narayana Murthy has answered some of the queries about the organisation, while the PHFI has replied to the other issues that have been raised in the first two articles

In the first two articles, I had raised several questions for NR Narayana Murthy, the new chairman of the Public Health Foundation of India (PHFI). Mr Murthy responded on the 18th and 23rd July to the questions raised and also got the PHFI to respond to some of the questions. I present them here.

I also discover that Mr Murthy himself may potentially face some direct conflict of interest situations between his private funding and his job as chairman of PHFI, which is a public policy institution. Mr Murthy's $129 million venture capital firm, Catamaran, is set to invest $44 million (Rs200 crore) in Manipal Universal Learning, which is best known as a private medical education provider, and it has also invested a relatively modest amount in Wellspring Healthcare, a private healthcare provider. Won't Mr Murthy be in a conflicted situation since his fund invests in health?

Here are the answers to the questions.

1. Did you find serious conflicts of interest in the fact that PHFI, a publicly-funded, public policy body is dominated by wealthy owners of private businesses like Mukesh Ambani, Shiv Nadar, Harpal Singh (and now yourself) -- before you agreed to accept the PHFI chairmanship?

NR Narayana Murthy: I do not see any conflict of interest. This institution is about training, research and policy to improve public health delivery in India.
The institution has highly-respected and accomplished people to guide it to achieve its objectives. The individuals on the board have demonstrated leadership in excellence. Some have expertise in public health delivery, some have managed non-profits, some have been excellent academicians, some have been top quality government bureaucrats, and, in addition, some have contributed to the endowment for the institution.

These people spend their precious time to make this institution a world-class institution. The students who pass out from this institution can join any institution they like and there is no way they will be influenced to join any company founded or financed by any of the board members.

For example, just because I am the chairman of IIITB, no student from there was ever influenced by me to join Infosys.

Similarly, all over the world, high quality educational institutions invite well-known people to be on their board to leverage their expertise.

On the issue of policy research, this institute only recommends policies and it is for the governments to accept or reject it. Further, I have been involved in lots of policy-making bodies in my field in India and never once have I put the interest of my company ahead of the country.

2. By becoming PHFI chairman, will you be conflicted by the fact that Catamaran, your venture capital firm, has invested in Wellspring Healthcare, a private healthcare provider, and Manipal Universal Learning, which is best known as a private medical education provider? And of course, Infosys' healthcare practice.

Mr Murthy: I have already answered this in my answer to question number one.

3. Despite being run on taxpayers' money, PHFI does not disclose basic information, Didn't this worry you when you agreed to become its chairman?

Mr Murthy: I have been invited by the Nominations Committee of PHFI with people that I admire immensely for their honesty, patriotism and excellence in leadership-Dr YV Reddy, Mr Montek Singh Ahluwalia, and other such people.

When you see the kind of people that are on the board of PHFI, like Professor Amartya Sen, I can say that this is one of the few institutes in India with such a quality of global talent.

I have looked at the website and will certainly address any requests from rational, polite and genuine people in due course of time.

Responses by PFHI:

(a) Under which Act is PHFI being run, and is conducting its courses and collecting money from students?

PHFI: We are a registered society under the Societies Registration Act, 1860. This Act provides a legal framework to the societies set up for the purpose of imparting education and diffusing useful knowledge.

The main objective of PHFI, under the Memorandum of Association of the Society, is to open, found, establish, promote, set up, maintain, assist, support and or help in setting up, running and/or maintaining of public health educational institutions for promoting and ensuring capacity building in public health education, training and research.

Presently, PHFI is running diploma programmes which do not require a university affiliation or status. PHFI is now seeking university status, after fulfilling the requirements.

(b) Who gave you the authority to administer diploma courses and conduct consultancy with government agencies?

PHFI: The authority to establish and run an educational institution for imparting academic programmes within the broader regulatory framework of higher education and undertake allied academic activities such as research and consultancy flows from the Society's Memorandum of Association (MoA) and its bye-laws, as registered under the Societies Registration Act, 1860.

Guided by the mandate, and drawing upon its considerable expertise in the area of public health, PHFI announces and conducts post-graduate courses in public health. The Governing Council of PHFI has given the approval for the conduct of these diploma courses.

PHFI is invited, or bids for consultancy assignments, alone or along with other technical partners. It gets selected on the basis of its technical expertise, by the relevant agencies including the government. It has been selected for project grants, which were competitively awarded by several national and international agencies.

PHFI is recognized as a research institution capable of undertaking scientific research and development by the Ministry of Science and Technology, based on the strength of its faculty and researchers, their research credentials and publications, as well as the post-graduate diploma/training programmes that it conducts.
 
(c) Are you accountable to any statutory regulator, the parliament, or any state legislature?

PHFI: Within the legal framework of the Societies Registration Act, 1860, the Governing Council of PHFI is responsible for management of the affairs of the Society and is accountable to its members. The details of the constitution and membership of the Governing Council are available on the PHFI website. PHFI is a registered society and its registration papers are available with the Registrar of Societies. The details on the inception of PHFI are also available on the website.

The Foundation's accounts are audited annually. PHFI has a clearly defined audit system, as approved by its Governing Council. There is an independent audit of PHFI's finances annually, carried out by a reputed external audit firm, approved by the Governing Council.

Financial reports are also prepared for the donors, who are informed on the utilisation of funds by PHFI. Our performance reports and financial audits are ratified by the Governing Council and the Government of India is kept informed. The Government of India is represented in PHFI's Governing Council. In the states where Indian Institutes of Public Health (IIPHs) are located, the state governments are represented on their Advisory Councils.
 
(d) How were you granted the privilege of receiving a steady stream of government-funded students? Was any competitive bidding conducted in granting this privilege?

PHFI: With the roll out of National Rural Health Mission, the Ministry of Health and Family Welfare (MoHFW), Government of India, in 2008, experienced acute shortage of public health specialists in all the states. MoHFW initiated a consultative process leading to a consortium of four institutions, which was charged with the task of providing public health training to serving medical officers in state health services. Initially this consortium comprised the National Institute of Health and Family Welfare (NIHFW), All India Institute of Hygiene and Public Health (AIIH&PH), Mahatma Gandhi Institute of Medical Sciences (MGIMS) and PHFI.

A curriculum for Post Graduate Diploma in Public Health Management (PGDPHM) was evolved by the consortium. Since then, the consortium has been expanded to include nine institutions, approved by MoHFW. PHFI has helped to design this course and was asked by MoHFW to facilitate the coordination among the various institutes offering this course.

Various state governments nominate students to this diploma course. As a 'not for profit' institution, a prescribed fee is charged towards tuition and other utilities. The fee is determined by MoHFW and is paid from NRHM funds, as the trainees are drawn from district and sub-district level medical officers. The fee structure is uniform across all the institutes offering this course as a part of the consortium created by MoHFW. PHFI does not charge any extra fee.

This fee comprises tuition fee, hostel expenses, food, transport and other expenses for the year. The admission of government sponsored candidates for PGDPHM course are jointly finalised between the government and the consortium institutions. PHFI has also awarded full or partial scholarships to 76 students who were self-sponsored. {break}
(e) Do you conduct any merit-based tests in admitting students to your courses? What is the role of "recommendation letters" and "bonds" in admitting students and hiring faculty?

PHFI: The criteria for admission of other students for this course and for other courses offered by PHFI are based upon applications submitted by interested candidates. These comprise curriculum vitae, professional references and a statement of purpose.

The Admissions Committee of the IIPHs, comprising senior members of the faculty, finalises the admissions based upon the eligibility and suitability of the candidates. This process is akin to the process followed by many reputed schools and institutes of public health in other countries. The process is well-documented in the course brochures, available publicly on PHFI's website.

Faculty selection is based upon academic credentials, reference letters and interview by a faculty selection committee.

In view of the shortage of academic faculty in public health in India, PHFI instituted a Future Faculty Development (FFP) programme as a capacity building effort. Candidates with commitment to public health in India are selected, through due process and are sponsored for Master's or PhD Programmes in Public Health with leading partner schools abroad.

The concept is to nurture a cadre of highly motivated and competent public health professionals, who combine a deep understanding of India's public health needs with critical awareness of evolving global knowledge in the precept and practice of public health. Though the future faculty are registered as students in reputed institutions abroad, the practical work for the research related to these PhDs is carried out in India, under joint mentorship.

As a part of this arrangement, the selected and fully-funded Future Faculty Programme (FFP) Fellows, are required to sign an agreement with PHFI in the form of a bond to serve PHFI for a specified period upon their return.

These candidates are recruited as faculty members by PHFI to enable them build their capacity in teaching, research and public health practice during the period of service agreed upon in the contract. This procedure is to ensure that the resources expended for capacity building to meet Indian needs result in the desired outcome.

Other institutions in India, such as the All India Institute of Medical Sciences, follow a similar system for their faculty, who train abroad while in service.

(f) When you are unrecognised and unaccredited yourself, how do you claim the mandate (on your website) to "Establish an independent accreditation body for degrees in public health which are awarded by training institutions across India"?
PHFI: One of the objects of the PHFI MoA reads, "To work towards establishing standards of public health education by enabling the formation of an independent accreditation system".

This is derived from MoHFW's proposal of February 2006, which states that the proposed Public Health Foundation of India would "establish standards of public health education by enabling the formation of an independent accreditation system".
Currently, there are some institutions imparting public health education degree courses in the country. Public health education has emerged, as a multidisciplinary science, and is being imparted in medical colleges, social science institutions and management schools. However, there is presently no system of accreditation for educational programmes in public health.
The role PHFI envisages here is to facilitate the authorities in setting up of an independent system of accreditation. The proposed National Council for Human Resources in Health (NCHRH) is potentially such a mechanism.
In due course of time, PHFI will work with other public health institutions from India to enable establishment of an independent body capable of providing accreditation to such schools.
 
(g) Under what statutory authority does PFHI claim the "power to influence public health policy in India"?

PHFI: We have the capabilities and expertise in diverse disciplines related to public health. We undertake scientific, operational and policy research in the broad arena of public health.

Research conducted and evaluated by PHFI contributes to the evidence base used for policy making by the Government of India and various state governments. When invited by the government, policy makers, health professionals or civil society organisations, PHFI assists in arriving at evidence-based recommendations for policy development. This is a responsible academic contribution to policy development and is not in discharge of any statutory authority.

PHFI does not claim any power to influence public health policy, but plays a legitimate role in assisting the evolution of policies that advance public health. PHFI also undertakes multi-stakeholder consultations to develop evidence-based, context-specific, resource-sensitive, culturally compatible and equity-promoting recommendations for strengthening policies and programmes in public health.

It is pertinent, in this context, to note that MoHFW, which sponsored the creation of PHFI, clearly stated in its proposal (February 2006) that the proposed PHFI would "serve as a think tank to government on key public health issues".
 
(h) Why are the details of your constitution and registration not in the public domain?

PHFI: The details of the constitution and membership of the Governing Council are available on the PHFI website. PHFI is a registered society and its registration papers are available with the Registrar of Societies. All details on the inception of PHFI are also available on the website.
 
(i) Did you undertake competitive bidding to select the 'private partners' in your public-private partnership? Why are the details of the PPP agreement not in the public domain?

PHFI: At the time of PHFI's inception, the Government of India decided on establishing the Foundation on a public private partnership (PPP) mode and on the role and contribution of the private partners to the Foundation. MoHFW's proposal of February, 2006, states "PHFI would be an autonomously governed public private pPartnership with government support".
 
(j) Why does PHFI's website not have a report on its functioning and finances in over five years of its existence?

PHFI: Most information about PHFI is posted on its website or is in various publications. It brings out progress reports twice a year, which are presented to and ratified by the Governing Council, along with the financial audit reports. These progress reports are widely distributed and can be accessed, if desired.
 
(k) Since you have received significant financial grants, parcels of free land and other assistance from central and state governments, why are you not submitting yourself to the RTI Act and the CAG audit?

PHFI: As stated earlier, the Foundation's accounts are audited annually. PHFI has a clearly defined audit system, as approved by its Governing Council. There is an independent audit of PHFI's finances annually, carried out by a reputed external audit firm, approved by the Governing Council. Financial reports are also prepared for the donors, who are informed on the utilisation of funds by PHFI. PHFI's performance reports and financial audits are ratified by the Governing Council and the Government of India is kept informed.
As far as the RTI Act is concerned, PHFI abides by the legal framework of the Act. The Foundation is not a public authority in terms of Section 3(h) of the Right to Information Act, 2005.

(l) Since you work in the area of public health, what would be your stand if Reliance Industries, whose chairman sits on your board, were to be blamed for a case of industrial pollution or industrial accident?

PHFI: PHFI's endeavour is to infuse public health vision, values and practices in all sections of society. PHFI's principled stand will be in the larger interest of people's health. PHFI will guard against any conflict of interest, in situations where there is potential harm to the health of the people. Should any such eventuality arise, the concerned member on the Governing Council will recuse himself/herself from the Governing Council proceedings. The composition of the Governing Council will ensure that, on all occasions, public interest will prevail over any other interest.

(m) How do you propose to resolve the conflict of interest in the fact that Fortis group, a healthcare provider, is represented on your board through Harpal Singh?

PHFI: As stated earlier, PHFI's principled stand will be in the larger interest of people's health. While PHFI benefits from the perspectives provided by its Governing Council members, it carefully avoids any conflict of interest related to their other activities. PHFI has had no dealings with the Fortis group of hospitals and does not in any way espouse the interests of the group.

In the fourth and final part, I shall discuss the replies and how the PHFI case relates to larger issues like who should get to influence public policy; why public-private partnerships allow the involvement of commercial interests in the public policy arena while leaving out the larger sections of society and ordinary citizens; and why these PPPs must be brought under the purview of the RTI.

You may also want to read the first two parts:
Will PHFI be any different under Narayana Murthy?
Will PHFI become transparent and accountable under Narayana Murthy?

(The fourth and concluding part of this series will be published on Thursday. Kapil Bajaj is a freelance journalist and blogger based in Delhi. He has worked for Press Trust of India, Business Today, and other organisations. His interests are democracy and public policy.)