Wary of their influence, India limits foreigners in its health system

NEW DELHI — Expressing concern about foreign influence on its policies, India is turning away from a decades-old practice of filling gaps within its health system with consultants hired by foreign aid agencies and non-governmental organisations (NGOs).

Under the new rules, consultants who have worked within India’s health system for foreign aid agencies for more than three years, a total of about 100 people, will be terminated, said Mr Manoj Jhalani, Joint Secretary in the Ministry of Health. The roughly 100 who remain will need to be approved by a new screening committee.

Fifty employees of the National AIDS Control Organisation were given notice this month, though supervisors said they hoped to retain them as government employees.

Experts warned that if vacancies went unfilled, major health initiatives, such as those aimed at fighting the spread of AIDS and tuberculosis, could suffer serious setbacks.

“Every one of these jobs is a necessary one,” said Dr Bobby John, a specialist in infectious disease and maternal health who previously worked for the Bill and Melinda Gates Foundation. “These people are doing something the country needs. It is not something that is superfluous and imposed on.”

“If this is a transition to hiring them on government of India rolls, brilliant.”

Beginning in the early 1990s, when its health system was chronically short of funds, India began to employ specialists provided by the World Health Organization, the United States Agency for International Development, Britain’s Department for International Development and, more recently, the Gates Foundation.

Nearly all Indian citizens, they typically earn somewhat more than government employees, said Dr John, who worked for years on tuberculosis control.

Prime Minister Narendra Modi’s government, however, has taken a wary view of NGOs, in some cases accusing them of acting against national interest.

Last year, the government suspended the registration for Greenpeace and placed the Ford Foundation on a national security watch list for nearly a year, barring it from making grants in India without specific permission.

Similar concerns have arisen around the work of foreign-funded consultants in the health system. A report last year in The Times of India said the practice “raised serious issues of conflict of interest, security and sovereignty”.

Dr Sita Naik, a former official of the Medical Council of India, said the government “has been drawing criticism for some time now that they have been supporting foreign NGOs”.

Dr C V Dharma Rao, a top official at the National AIDS Control Organisation, whose headquarters are almost entirely staffed by consultants, said that for some workers, the practice had led to split loyalties.

“When yesterday all these consultants met, they were saying ‘Sir, we have lost loyalties with our donor partners, because we kept on arguing for the government of India,’” he said.

“The donor country might have told the consultant to probably tweak something,” he said. “But they did not! They said, ‘No, we are loyal to the government of India’ — thereby rubbing wrong shoulders with the donor.”

But others said the consultants rarely waded into sensitive policy matters.

Mr Keshav Desiraju, who served as health secretary under the previous, Congress Party-led government, said they “were doing a lot of detailed work that nobody else had the time to do”, assisting senior bureaucrats who “simply had no time to handle the volume of paperwork”.

“To say policy decisions are being influenced is completely far-fetched,” he said. “Decisions are made at a more senior level.”

Dr John, who is now the managing director of Aequitas Consulting, a London-based public health group, described the health consultants as “the backbone of a successfully running program”, and said they mainly filled managerial and technical roles.

The policy change was first reported by Reuters.

A government notice released in December laid out stringent new regulations for foreign-hired consultants.

They will now be required to sign a confidentiality clause with the Indian government, “will report only to the ministry”, and will be barred from sharing any data or information with the foreign agency without specific approval from top Indian bureaucrats.

Any foreign-hired consultant must wait for a one-year “cooling-off period” before taking another, similar job. And foreign citizens must submit to a security clearance.

Mr Jhalani, of the Ministry of Health, said the aim of the order was to ensure that “no consultant should be permanently replacing a government employee”.

Officials from United Nations Children’s Fund (UNICEF), the World Health Organization and the Gates Foundation said it was too early to comment on the effect of the decision. THE NEW YORK TIMES