EDITORIAL : THE HINDU, INDIA

Widen the investigation

Given the central government's conspicuous lack of enthusiasm to act against those responsible for the string of financial irregularities related to the Commonwealth Games 2010, the arrest of Suresh Kalmadi is certainly a step forward. The former Chairman of the Organising Committee — who has been arrested on corruption charges in a case relating to a contract for Timing, Scoring and Result (TSR) devices awarded to a Swiss firm at a scandalously high rate — has a lot to answer for. The Central Bureau of Investigation is investigating his role in another case relating to the Queen's Baton Relay, a traditional precursor to the Commonwealth Games (CWG) that was launched in London in October 2009. But there is no ignoring the fact that many of the scandals in CWG 2010 were the result of either the commission or omission of authorities belonging to a clutch of government bodies, which include the Union Sports Ministry, the Delhi government, and the Delhi Development Authority. The V.K. Shunglu Committee, which was set up to probe “the weaknesses in management, alleged misappropriation, irregularities, wasteful expenditure and wrongdoing in the conduct of the Games,” stresses in its report that the extravagance of the Organising Committee of the Games was coupled with a reckless lack of budgetary control on the part of government authorities. The report records the “galactic jump” of the original budget estimate — placed at somewhere between Rs.300 crore and Rs.400 crore — to an actual expenditure of over Rs.28,000 crore, of which Rs.16,560 crore was spent by the Delhi government.

The Shunglu Committee report implies that there were bigger fish than Mr. Kalmadi in the sea of corrupt CWG-related deals and projects. The CBI must keep the findings of the report in mind while broadening its investigation. The fortunes of Mr. Kalmadi, a Lok Sabha MP and former Union Minister, dipped rapidly after the conclusion of the Commonwealth Games. He was dismissed as the chief of the Organising Committee of the CWG, forced to resign as Secretary of the Congress Parliamentary Party and, following his arrest, suspended from the party's primary membership. Now Mr. Kalmadi is fighting to hold on to the position of the President of the Indian Olympic Association, his role having been taken over by the body's senior vice-president as a result of the former's “indisposition.” Rather than allow him unbridled power as chief of the Organising Committee, a firm check should have been put on Mr. Kalmadi once the first suspicions about financial irregularities emerged. The chaos today is a result of the failure of the central government and the Congress to act against him when they should have.

What ails public health research?

Why has the incidence of tuberculosis in India remained around 170 per 100,000 people for the last 20 years despite DOTS, the directly observed treatment strategy, being in place? Answer: DOTS is a passive system that kicks in only after a person takes the initiative and gets tested for the disease. Despite the high prevalence and mortality rate, researchers are yet to figure out a system that works proactively, identifying all people with active TB and treating them. The compulsion to identify and treat people with active pulmonary TB as early as possible arises from the fact these patients stop infecting others only at the end of two months of treatment. The reason for the overall failure to identify an efficient and effective system for tracking down people with tuberculosis boils down to a grievous lack of public health research originating from India. India has the greatest total disease burden in the world, and is plagued by both communicable and non-communicable diseases. Yet the total number of research reports and journal papers on public health is small. This, despite the fact that public health research plays a pivotal role in understanding disease distribution in the population and reducing the burden through effective intervention strategies.

A paper recently published online in The Lancet (“Research to achieve health care for all in India,” by Lalit Dandona et al.) reported that though the proportion of health papers published from India increased from 0.4 per cent of the global total in 1988 to 1.8 per cent in 2008, the papers on public health constituted a measly 5 per cent of the total health research papers published. While there has rightly been increasing representation of diabetes and cardiovascular disease in recent times, many of the leading causes of the disease burden such as lower respiratory infections and mental illness continue to be under-represented. The skew in the focus of health research reflects funding priorities. For instance, HIV/AIDS is better covered than chronic diseases and injuries that have much greater weightage in India's disease burden. Of what use are public health programmes and policies if the evaluation research to understand their effectiveness and deficiencies is weak? It is time these shortcomings were addressed by the national health policy, which promises to strengthen public health research. Increasing funding for evaluation research in addition to research on high burden diseases and the health system must be taken up as a life-saving priority. Now is the time for the government to put its money and political will where its mouth is.