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Autonomy vs Ministerial Control in AIIMS: A Tussle Born in 1950s

The issue of autonomy in AIIMS is not a new one. It goes back to its formation in the 1950s, when the seeds of the present tussle were sown.

Commantary

Autonomy vs MinisterialControl in AIIMS: A Tussle Born in 1950s

The issue of autonomy in AIIMS is not a new one. It goes back to its formation in the 1950s, when the seeds of the

present tussle were sown.

SHIRISH N KAVADI

T
he acrimonious tussle between the director of the All India Institute of Medical Sciences (AIIMS), P Venugopal and its president, union health minister, Anbumani Ramadoss, has brought into focus once again the issue of institutional autonomy versus political/ bureaucratic control.

The issue of ministerial control/interference in AIIMS affairs is actually as old as its inception. Autonomy has eluded the institute since its creation. The fact is that this premier medical institute conceived as India’s Johns Hopkins has been an appendage of the union health ministry from the time of its establishment. Documents pertaining to its establishment are a testimony to this fact.

The genesis of AIIMS lies in the recommendations of the Health Survey and Development (Bhore) Committee (1946). It materialised from the generous financial grant from the New Zealand government under the Colombo Plan and technical, training and financial assistance from the Rockefeller Foundation (RF). AIIMS was conceived with a view to provide international standards of medical education in the country. It was to determine the future direction of medical education in India, train teachers and develop a research programme. The institute, created through an act of Parliament in 1956, was to be a statutory body with the powers and functions of a university considered important to guarantee its autonomy. However, the special status accorded to the institute seems to have ruffled several feathers. The act, for instance, kept the institute outside the jurisdiction of the Indian Medical Council (IMC). B C Roy, the powerful chief minister of West Bengal and an influential member of the council took serious umbrage at this provision in the act.1 This was viewed with some seriousness by the RF. John Grant, a RF member and former director of the All India Institute of Public Health and Hygiene, Calcutta, sent to review AIIMS in 1957, suggested that all steps should be taken to effect a reconciliation between the institute and the IMC. The explanation given by B B Dikshit, the director of AIIMS, for keeping it out of the purview of the IMC was that the latter did not recognise certain US and Canadian medical qualifications, which would have disqualified several faculty members.

Under the act, AIIMS had its own governing body (GB), which, L R Allen, another RF official, hoped “should be free from interference from political forces desiring to gain special advantage”.2 Rajkumari Amrit Kaur, the union health minister who was actively involved in the setting up of the institute became its first president. From the point of view ensuring the institute’s autonomy Kaur’s holding of dual offices in this manner may be questioned. But what actually appears to have queered the pitch for institutional autonomy was Kaur’s continuing as president even after her resignation from the union cabinet. That one act appears to have sown the seeds for ministerial control and interference in the running of AIIMS. For lack of documentary material, it is difficult to say whether Kaur’s continuation as president happened at her insistence. The most likely explanation is her cordial relations with RF officials and prominent members of India’s medical establishment such as C G Pandit, director of the Indian Council for Medical Research, Jivraj Mehta, finance minister of Bombay, A L Mudaliar, vice chancellor of Madras University, all of whom were on the GB. It was also probably done to placate Kaur after her “ouster” from the cabinet. (Kaur believed Govind Ballabh Pant the then home minister to be responsible for this.)3

Kaur who was deeply involved in the setting up of AIIMS found herself ineffectual in dealing with its affairs after losing membership of the cabinet. The institute had just been set up and faced a myriad of problems that she was unable to sort out without approaching Nehru from time to time. Nehru on his part gave her sympathetic and patience hearing, but declined to intervene directly on her behalf. Kaur, as ex-minister now had powers constrained, especially since, as M C Balfour of the RF, who was based in New Delhi as associate director observed, “the autonomy of the institute’s governing body of which she is president has proved mostly a myth”.4

One expected aspect of the institute’s autonomous status was that it would have freedom from certain government restrictions such as control over appointments. This expectation was belied and all decisions regarding appointments were being made in the ministry of health and the finance department had the final say on most expenditures. When two former members of the Indian Medical Service on the staff of the Safdarjang Hospital began to push for appointments to the institute, Kaur, Dikshit and the GB resisted. Referring to this incident Balfour remarks, “The internal strife of the AIIMS in which several cabinet ministers are involved is the tragic result”.5 Dikshit too for some reason appears to have incurred the displeasure of the minister of finance, T T Krishnamachari. As a result every proposal for new constructions could only be undertaken after TTK’s approval.

Affairs at AIIMS were further affected by the rivalry between the new minister of health Karmarkar and Kaur. The hostility between them was such that Kaur suspected the hand of Karmarkar (and probably Pant) in what were believed to be efforts to oust her and others close to her from the GB. A lady member of the GB, who was also a member of Parliament introduced an amendment to the AIIMS act that would change the government’s right to nominate members to the GB.

Economic and Political Weekly July 8-15, 2006 If the amendment had come into effect it would have eliminated from the GB, apart from Kaur, Jivraj Mehta, A L Mudaliar, C G Pandit, the other government appointees to the GB. The rajkumari had to appeal to Nehru to fight off the amendment.6

Another incident that brought the rajkumari into conflict with the health ministry was the proposal for the construction of a hospital so essential to the training programme being developed at AIIMS. After a great deal of struggle Kaur managed to get 60 beds for clinical work from the Safdarjang Hospital for AIIMS. These were considered inadequate and hence Dikshit requested that the newly constructed but unused nurses’ hostel be made available for a hospital. The government turned down his request. Kaur proposed constructing one, which was not encouraged by either Dikshit or the RF itself. This was probably because as mentioned earlier, with Dikshit falling out of favour with the finance minister and the latter demanding stringency in government spending, there was little hope of getting any money. Kaur chose to approach the RF requesting special aid for the construction of a hospital. The request invited some hard observations from Balfour on the government’s handling of AIIMS affairs. Balfour in his reply remarked, “events of the past six months or more have created uncertainty in my mind as to what the government programme is or will be with respect to the AIIMS” and “I believe it is important to have some assurance regarding government policy and programme with respect to the AIIMS”.

Kaur’s immediate reaction was to send Balfour’s letter to Nehru who while giving her a pacifying response, forwarded copies of the correspondence to the health ministry. This was unfortunate. Balfour believed that Kaur carrying her problems with the ministry to Nehru was unlikely to help out matters. Worse was to follow when the GB met the prime minister. Nehru was reportedly quite irritated by the cold war between the Kaur, GB and the ministry.7 These developments had certain natural but undesired repercussions for AIIMS.

Officials in the ministry of health made clear their irritation and displeasure with the course of developments especially Kaur’s approaching Nehru. They also took particular exceptions to Balfour’s remarks about the slow pace with which the government was working. As far as any proposed aid to AIIMS was concerned Balfour was advised indirectly that the ministry had to be consulted in these matters. The health secretary in a meeting with Balfour and L R Allen, the RF representatives, admitted that it was not improper on the part of the RF officials to negotiate directly with Kaur and Dikshit, as president and director respectively of the institute, but added the ministry had to be kept informed. Thus, as Balfour noted, “Although the AIIMS is an autonomous body which can accept grants from any sources the real fact is that the ministry does control the institute and its governing body in the final analysis”.8

Kaur’s continued functioning as the president it was hoped would ensure the institute’s development along the lines envisaged. But the absence of power placed restrictions on her ability to get things done. For those aware of her commitment to the institute this became a matter of concern. Her holding the office, as R S Morison, a visiting RF official observed, “is not as powerful a position as it should be since virtually all decisions have to be cleared through the ministry of health”. Obviously not happy with this state of affairs he further added, “It would seem as though India is going to have to give a great deal of thought as to how to decentralise its activities in various spheres over the coming decade. Too many decisions are referred up to cabinet level”.9 L R Allen earlier referring to the red tape processes of the government had raised doubts, “as to whether or not the environment will be such as to favour development of an outstanding medical college”. Kaur’s passionate if not obsessive involvement in the setting up of AIIMS may have led to her tussles with the ministry, but there is no doubt that the larger context of systemic flaws and lacunae were at the core of the problem.

In 1959, the faculty at AIIMS recommended that three teaching members be appointed to the academic committee. Since this would require an amendment to the act, Mudaliar feared this would open the way for other less desirable changes. No action was taken. The review committee of 1964 recommended academic control over academic matters.10 Adequate representation to the academic staff on the GB for effective participation in formulation of academic policy and programmes and the management of the institute was suggested. Most importantly it recommended liberalisation of the financial and administrative control along the lines of the University of Delhi. Interestingly, the committee that suggested changes in the constitutional and academic structure was silent on the one issue that really mattered: the relationship between the ministry of health and the GB.

The irony and the paradox as seen in the above narrative is that the erosion of autonomy began when a person other than the minister held the presidentship of the GB. How wise was the decision to make the minister of health also the president of AIIMS? A question that requires looking into the face, but one that in all probability would remain unanswered.

GIRI INSTITUTE OF DEVELOPMENT STUDIES, LUCKNOWGIRI INSTITUTE OF DEVELOPMENT STUDIES, LUCKNOWGIRI INSTITUTE OF DEVELOPMENT STUDIES, LUCKNOWGIRI INSTITUTE OF DEVELOPMENT STUDIES, LUCKNOWGIRI INSTITUTE OF DEVELOPMENT STUDIES, LUCKNOW

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Applications are invited for Institutional Doctoral Fellowships (Ordinary-3 and Salary Protected-1) in Economics, Geography and Sociology for the year 2006-07 at the Institute.

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DIRECTOR

Economic and Political Weekly July 8-15, 2006

Simultaneously, a fact that we may have to live with for times unknown is that our political class will never give up an opportunity, which enables it to extend its patronage. And do we need more evidence as history gets to repeat itself? Even before the AIIMS controversy could settle down reports have appeared that Ramadoss, bypassing the executive committee and board of the Public Health Foundation of India (PHFI), is pushing for a public health school in his own state of Tamil Nadu.

The PHFI, with autonomous status modelled on the National Academy of Science and the Institute of Medicine in the US, is conceived on similar ideas and principles as AIIMS.11 We have been forewarned. Is the death knell for a good idea being sounded? An obituary for an institute before birth? Hopefully not.

ll'

Email: shirishkavadi@hotmail.com

NotesNotesNotesNotesNotes

1 John Grant, ‘Memorandum on AIIMS’, November 6, 1957, Record Group 1.2, Series 464, Box 37, Folder 306, Rockefeller Archive Centre (RAC).

2 L R Allen, ‘Some Thoughts Regarding Four Medical Colleges in India’, September 17, 1957, Record Group 1.2, Series 464, Box 37, Folder 306, RAC.

3 M C Balfour Diary Note, December 5, 1957, Record Group 1.2, Series 464, Box 37, Folder 306, RAC.

4 Ibid. 5 Ibid. 6 Ibid. 7 M C Balfour Diary Note, March 18, 1958,

Record Group 1.2, Series 37, Box No 37, RAC. 8 Ibid. 9 R S Morison Diary Note, February 5, 1958,

Record Group 1.2, Series 464, Box 37, Folder 307, RAC.

10 All India Institute of Medical Sciences, ‘Report of the Review Committee’, December 1964, Record Group 6.7, Series II, Box 141, Folder 1022, RAC.

11 Sunday Times of India, June 25, 2006.

Economic and Political Weekly July 8-15, 2006

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