[The
state’s health infrastructure remains abysmal, and officials say they now
suspect that the murders resulted from a virulent combination of fast money,
scant oversight and a notoriously graft-addled state political leadership. The
last doctor to die, relatives say, was preparing to name names in a widening
scandal. The central government has stepped in to investigate.]
 |
Daniel Etter for The New York Times
An effort to improve maternal health care in Uttar Pradesh,
India's most populous state, has been plagued
by a host of problems.
|
LUCKNOW, India — The first doctor to die, a senior government
health administrator, was shot on his morning walk last October by two men on a
motorbike. Six months later, his successor, a cardiologist, was shot to death
while out on a predawn stroll. A third government doctor, accused of conspiring
to murder the first two, was found dead in jail in June, lying in a pool of
blood with deep cuts all over his body.
The one
thing the doctors had in common? All three had at one point been in charge of
spending this city’s portion of the nearly $2 billion that has flowed to Uttar Pradesh, India’s most populous state, as
part of a nationwide push to improve the health of India’s poorest citizens.
The
state’s health infrastructure remains abysmal, and officials say they now
suspect that the murders resulted from a virulent combination of fast money,
scant oversight and a notoriously graft-addled state political leadership. The
last doctor to die, relatives say, was preparing to name names in a widening
scandal. The central government has stepped in to investigate.
“When
this much money is given to a government that is basically a criminal
enterprise, violence cannot be ruled out,” said Kamini Jaiswal, a prominent
lawyer who has filed several lawsuits in the case.
The recent hunger strike by the
social activist Anna Hazare has drawn attention to the everyday corruption that
has infuriated India’s middle class — the large and small bribes people must
pay to evade the annoyances and harassments of an overbearing and inept state.
But in
places like Uttar Pradesh, the price of corruption can be far higher, witnessed
not just in the deaths of the doctors but in the toll it takes on the health of
India’s most vulnerable people.
Uttar
Pradesh is by almost any measure one of the most corrupt states in the nation.
It also has some of the worst health statistics anywhere, including rates of
infant and child mortality and malnutrition to rival sub-Saharan Africa. If Uttar Pradesh were
independent, its 200 million people would make it the world’s fifth-largest
nation, more populous than Brazil, a country with 35 times the land mass.
In
2005, the government, led by the Congress Party, created the National Rural Health Mission, which sought to
overhaul the delivery of health care to the rural poor by building hundreds of
thousands of new clinics and hiring millions of health workers.
Because
of India’s federal structure, most of the work was carried out by state
governments like the one here, run by a lower-caste leader, Mayawati, who once
accepted a garland of 1,000-rupee notes from supporters worth about $36,000.
Not all of the states were prepared to handle it, and here, at least, much of
the money never fulfilled its promise.
Some
states fared much better, using the money effectively. Supporters of Mr. Hazare
say that his demand for the
creation of an ombudsman in
every state could help stem corruption and protect whistle-blowers.
The
central government handed over the cash to Uttar Pradesh with virtually no
oversight.
Only
after the doctors were killed did a review by the central government’s
investigators find that contracts worth millions of dollars were granted
without competitive bidding, and millions more was paid in full to contractors
who did not complete the work they were required to do, leaving health centers
in ruins and without vital equipment. The government failed to make its
investigative report public; The New York Times acquired a copy from The Indian
Express, a leading newspaper that broke the story about the
scandal.
Naseemuddin
Siddiqui, Uttar Pradesh’s health minister, said that the state had asked for
the central government’s inquiry. Asked for more details, he hung up the phone.
Two state ministers have been forced to resign.
It is
hard to see where the money went. Two years ago state officials approved a plan
to build a 30-bed health clinic in the village of Kurebhar, a three-hour drive
from Lucknow. The new clinic would replace a four-bed site, which was straining
to provide decent health services for 74 villages. More than $700,000 was
budgeted for the project.
The
building was supposed to be ready last December. Nearly eight months past that
deadline, the health center was still a skeleton of red brick.
“We are
trying to push them to do the work faster,” said J. L. Mishra, the chief
medical officer in the Sultanpur district. But the government had already paid
all the construction fees in advance, leaving almost no leverage.
There
is little evidence of the influx of cash in the health center. “We sometimes
don’t even have soap for our hands,” said P. N. Tiwari, the center’s
vaccination officer. “Meanwhile, they are looting like monkeys,” a reference,
he said, to politicians, bureaucrats and contractors.
Half a
dozen babies are born in the clinic daily, but the water tank is broken, so
deliveries are performed without running water. The center has an ambulance,
but it, too, is broken. Repairs would cost only about $30, but there is no cash
to pay for it.
Crucial
medical supplies, like oral rehydration salts for children with diarrhea, have been out of stock for months.
Mr. Tiwari said that the money to fuel the generator ran out, leaving workers
scrambling to keep vaccines cold.
Mr.
Tiwari, a 30-year veteran of the government health system, said he was among
those who believed that the vast increase in health funds with so little
oversight had led to murder.
“Because
of this money two doctors were killed,” he said. “A huge amount of money is
involved, so a huge amount of crime is taking place.”
Doctors
started dying in Lucknow last October. When the first to die, Vinod
Kumar Arya, was shot, the case was treated as a puzzling mystery:
why would anyone kill a mild-mannered government doctor?
The
government did not immediately replace Dr. Arya, who had been the chief medical
officer for the city, installing as interim chief a more junior officer, Dr. Y.
S. Sachan. It was an important position that included responsibility for
spending millions of dollars in rural health money from the central government.
In
February, a cardiologist, B. P. Singh, was named chief medical officer. He had
accepted the job in March under pressure, relatives said, and felt a great deal
of strain in the post.
“He
used to say there was a lot of corruption,” said a cousin, Inder Pratap Singh,
a lawyer at Lucknow’s high court. Dr. Singh had begun keeping a diary of
improprieties, Mr. Singh said, and complained that he was being pressured to
approve false expenditures worth hundreds of thousands of dollars.
On
April 2, Dr. Singh was killed by two gunmen. A police investigation later
concluded that the same weapon had been used in the killing of Dr. Arya.
Suspicion
fell on Dr. Sachan, a politically connected bureaucrat who had worked in the
city’s health department for years. He was an associate of the minister who
managed the health funds, Babu Singh Kushwaha, a close ally of Ms. Mayawati,
the state’s chief minister. Dr. Sachan was arrested, but few people believed that
a relatively junior bureaucrat would have carried out the murders on his own.
Dr.
Sachan’s wife, Malti, who is also a physician, said that her husband had been
sacrificed to protect more powerful people.
“He
told me, ‘I am being framed in this case,’ ” she said.
Dr.
Sachan had told his wife that he feared someone would kill him and felt safer
in jail. He had decided to reveal who had directed him to steal money from the
health department, relatives said, in a court appearance.
But the
day before he was to appear he was found dead. Initially, officials ruled his
death a suicide, but an autopsy revealed that he had bled to death from deep
wounds that could not have been self-inflicted.
“The
intention was very clear,” said R. K. Sachan, Dr. Sachan’s brother. “He was
going to disclose the involvement of senior politicians in the scam. That is
why he was silenced.”
The
families of the dead doctors hope for justice, but they have kept their
expectations low.
“If he
had been corrupt, he would have survived,” said Mr. Singh, Dr. Singh’s cousin.
“Never will a senior bureaucrat or politician be convicted. Some small fish
will suffer, but never the big ones.”
Hari Kumar contributed
reporting.
