People's Democracy

Corporatisation of AIIMS on the Agenda

Amit Sen Gupta

IN 2006, in the wake of an ugly public display of acrimony between the then director of AIIMS, DrVenugopal, and the then health minister, Ambumani Ramadoss, the government had set up a four-member expert committee headed by Professor M S  Valiathan. The committee�s mandate was to propose recommendations to turn the premier institution �into a centre of excellence and a leader in public health�. While the committee�s report was submitted during the tenure of the previous government, it had been lying in cold storage for some time. However the report has now been resurrected and there are serious attempts to get the governing council of AIIMS to endorse the report.

RECOMMENDATIONS OF

VALIATHAN COMMITTEE

The committee, has made far reaching recommendations to restructure India�s premier medical institution in the public sector. If accepted, the restructuring would result in AIIMS becoming an autonomous institution with freedom to involve the pharmaceutical industry and industry associations such as FICCI, CII and ASSOCHAM in its research council and other decision making bodies. Specifically suggested is the inclusion in the governing body of AIIMS of �an Industrialist with interest in education/ sciences to be nominated by the central government in consultation with CII, NASSCOM or FICCI.� It is further suggested that the institute�s research council should include �two representatives of industry representing pharma and biotech industries and a scientist nominee from the R & D labs of Pharma Research industry�.

The Valiathan Committee also suggests means by which partnership with industry could help generate revenue. The report says: ��the institute should adopt a clear strategy for reducing the dependence on government grants significantly over a 10 year period by diversifying sources of income; by making growth plans sustainable; and by professionalising the management of the institution with no room for adhocism..�. It suggests setting up a self financing body called the �AIIMS International�, whose activities should include, �consultancy by AIIMS faculty for specific projects, setting up new institutions for medical education or research in other countries, conduct of entrance examinations in other countries, etc.�

The committee�s recommendations have also called for �research incentives� in the form of Rs 10,000 awarded for papers published by AIIMS faculty in peer reviewed journals. The faculty is also encouraged to undertake consultancy for industry. Even closer links with industry is suggested in the form of opportunities to faculty members to be taken on lien by industry. It also proposes setting up a new research facility as per USFDA (United States Food and Drugs Administration) guidelines that would promote research that is of �great interest to industry�. The recommendations are not limited to the medical faculty, and also calls for contract recruitment in Class C and posts through �professional agencies in the public/private sectors�.

NEOLIBERAL POLICIES AND

CORPORATISATION OF RESEARCH

The Valiathan Committee�s recommendations and the government�s eagerness to adopt them raise some broader issues of critical importance. The fact that the recommendations are being welcomed by the government points to its complete capitulation to the needs of a neoliberal economic order. Today, the demands of global capital, mediated through the market, are increasingly driving the trajectory of advances in science. The needs of a neo-liberal economic order valorises immediate gain as the principal driver of science. Science as an open system is giving away to the logic of the capitalist enterprise, where it is driven by the demands of a private research system, increasingly embedded within the heart of the educational system. This is clearly what the Valiathan Committee wants enshrined in the functioning of the AIIMS.

Classically, development of scientific knowledge in all fields, resided within the structures of higher education. As these were relatively autonomous of both the state and the market, the system of generating new knowledge was not closely bound by the immediate needs of the dominant classes in society. The university system, thus, was able to retain a sense of independence and self-regulation. Education was seen to have a larger purpose than merely serving capital or the needs of the state. The Valiathan Committee imbroglio is a reflection of the fact that the present Indian state seeks transformation of research institutions into profit making commercial enterprises. In the neoliberal order, science is no longer seen as a way to advance knowledge and the well-being of society but as a means for generating profits for corporations. The impact of such a shift is already visible in different sectors in India. Over the past decade the research culture in CSIR institutions has been vitiated as they have been forced to tie up with industry to generate resources. 

The trajectory towards private appropriation of knowledge is typified by the Bayh Dole Act in the US. The Act, enforced in 1980, reversed the almost universal assumption that public funded research should not be protected by private rights in the form of intellectual property protection. The Act allowed universities and other non-profit entities to patent research that was funded from public sources. The Act created the conditions for the university system in the US to work much more closely with largely corporations. Fortune Magazine held the Bayh Dole Act responsible for pushing up the cost of medicine in the US. �Americans spent $179 billion on prescription drugs in 2003, up from $12 billion in 1980.� The Bayh Dole Act, many now believe, had actually retarded the progress in science instead of helping it. The discovery of new molecules, a measure of innovation in the pharmaceutical industry, has actually come down. It helped a few companies, universities and scientists to become fabulously rich, at the expense of scientific development and the common people. Unfortunately, the market fundamentalists world-over are pushing ideas similar to the Bayh Dole Act, including in India in the form of the �Protection and Utilisation of Public Funded Intellectual Property Bill�.  

REVERSING THE SPIRIT BEHIND

SETTING UP OF AIIMS

It may be recalled that the AIIMS was set up through the All India Institute of Medical Sciences Act, 1956. The Act outlined the objectives of the institute as follows:

�        To develop patterns of teaching in under-graduate and post-graduate medical education in all its branches so as to demonstrate a high standard of medical education to all medical colleges and other allied institutions in India;

�        to bring together in one place educational facilities of the highest order for the training of personnel in all important branches of health activity; and

�        to attain self-sufficiency in post-graduate medical education.

Since then the institute has had a chequered career. On one hand, it has produced some of the best medical minds in the country, many of whom have gone on to lead other centres of excellence. It has also been a pioneer in the introduction of many medical technologies in the country. However, particularly in the last two decades, the institute has fallen into growing disarray. This has been fuelled principally by two forces. First, the increasing interference of the government in the institute�s day to day working (which culminated in the ugly public exchange of words between Dr Venugopal and Dr Ramadoss). But, perhaps more importantly, AIIMS has also become a victim of the erosion of �public ethos� in the country. In the last two decades the institute has failed to cope with the challenge posed by a burgeoning, corporate controlled, private medical sector. The faculty has been denuded by migration to the private sector and to foreign locations. This has been helped along by the vitiated work environment in the institute, a result of ham-handed government interference.

The institute today is in urgent need for resuscitation. Its demise would signal the demise of public funded excellence in the field of medicine in India. The primary need is to bring back the ideas of public funded science and medical education into the functioning of the institute. Tragically, the Valaithan Committee does exactly the reverse. The creeping loss of the public ethos in AIIMS is now sought to be provided official sanction. The institute has been rightly criticised for training, at substantial public cost, medical professionals who migrate abroad or into the private sector. The answer to that does not lie in formalising the institute�s links with the private sector and with foreign universities. It lies in making available opportunities and work environments that can absorb some of the best talent produced in the medical field. Mere exhortations to doctors to serve the poor will not work, they need enabling conditions to be able to do so. India has one of the poorest records for public spending on health � at 1per cent of GDP spent by the government on health, India is securely in the bottom 5-10 nations of the world. The Valiathans of this world are clearly engaged in further encouraging this race to the bottom.

Press reports suggest that the report has been well received and got an �in-principle approval from the governing body�. They also suggest that a strong pressure is being mounted by the prime minister�s office on the governing body to have the recommendations accepted. This is a matter of grave concern and it is imperative that parliament takes stock of the attempt to completely reverse the spirit behind setting up of the institute.