New Delhi: Should a government ministry’s response to an unprecedented health emergency go through the loops of rules and bureaucracy? Even if it means the response could be slowed down and risk lives?
Or should a battle against the pandemic of the century cast standard norms aside, step around guidelines, and just rush the system to act? Even if it means working with select private players and giving them access to vast amounts of valuable public health data?
These were contentious questions that roiled the Union health ministry in the early days of Covid in India, as it was putting together a ‘war room’ to compile and analyse critical data from around the country to help combat coronavirus, and needed to partner with seven private organisations.
The argument was eventually settled in favour of urgency, government documents and communication accessed by ThePrint under the RTI Act show.
The health ministry, the documents show, went ahead and got the seven private organisations on board without going through the standard process of inviting expressions of interest from companies interested in doing the work and evaluating them. This was done citing the state of “battle” and using the “special provisions under the Disaster Management Act 2005”.
The seven companies — Cisco Systems India, KPMG Advisory Services, Red Swan Labs, Urban Clap Technologies India, Boston Consulting Group, Primus Partners and UChicago — were picked from among several individuals and organisations who had contacted the ministry and volunteered their services.
No time to be clerical
The Covid war room on the first floor of Nirman Bhawan in New Delhi is the nerve centre of the analysis and projections being done on the daily, weekly and monthly status of the pandemic in the country. It has access to state, district and facility-level data, and results of its analyses are periodically shared with states through written and oral communications — it was from here that some of the lists of hotspot districts emanated in the early days.
A note, moved by the under-secretary, e-health, on 23 April, spoke about getting the seven companies to help with “latest tools and technologies for analytics, visualisation, forecasting methodology and documentation”, and also laid down the procedure that would need to be followed according to the General Financial Rules.
The rules state that once the health secretary has approved the move, a request for expression of interest would have to be put out on the ministry website, following which a committee formed for the purpose would evaluate the proposal. Once the agencies had been finalised, contracts and non-disclosure agreements etc. could be signed.
“The committee may perhaps play the same role, which in normal circumstances would have been done by committees doing EOI, pre-bid meetings, technical and financial evaluations,” the note said.
However, in this case, because of the pandemic, the emergency procurement and accounting guidelines under the Disaster Management Act were invoked, to allow waiving of standard procedure for inviting tenders. This was also done because of a “no-cost liability” to the ministry for these services.
In his notings on this document, health ministry joint secretary Lav Agarwal wrote that this was no time to be ‘clerical’. “We are dealing with a battle here and forming committees implies we are still working in a clerical mode & not even understanding the magnitude of the battle we are dealing with. As already directed, instead of wasting my time on these issues, please obtain signed agreement from them and put up,” he wrote.
A senior ministry official involved in the functioning of the war room, said on the condition of anonymity: “Everything, the moving of the note, the deliberations, happened subsequently. The war room was already functional because that was the need of the hour at that point. If we didn’t do it right then, the health ministry would have been talking out of thin air. We and they (in the war room) worked past 1 am and were back in office at 6 am to get it up and going. And they were doing all of this pro bono.”
Agarwal’s notings too mentioned that the companies were working pro bono. “All organisations are working pro bono and have already signed the nondisclosure agreement. They are all providing valuable support already to Covid-19 support in managing of control rooms, and attending to IT platform development,” he wrote.
Concerns over giving data to healthcare businesses
The war room has access to data that can, among other things, help predict future hotspots — information that can be valuable for healthcare businesses looking to expand.
According to the note, the proposed committee would have worked at the same time as the companies were helping out the war room, to prepare the guidelines for data-sharing based on the National Data Sharing and Accessibility Policy, 2012.
The note said: “After due approval of the competent authority and shortlisting of the agencies, a nondisclosure agreement will be signed between the agency and MOHFW with all the necessary terms and conditions to maintain confidentiality and security of the patient data in accordance with all the relevant acts of government. In addition, the committee so constituted for the examination of proposals will also prepare the guidelines for data sharing based on the National Data Sharing and Accessibility Policy (NDSAP) —2012.”
Agarwal’s notings on the document in April clearly stated: “There is no data sharing with any of the organisations.”
However, the ministry’s RTI reply said the data related to the Covid app is being shared with KPMG, CISCO and BCG, all of whom have already signed non-disclosure agreements. It declined to share the agreements on the grounds that it is third party information.
A detailed questionnaire sent by ThePrint to the ministry remained unanswered for a week, despite multiple reminders.