National Family Health Survey-4

In the early hours of 12 May 2015, four persons died and two others sustained grievous injuries as a result of a head-on collision between a lorry and a Tata Sumo on the NH-13 near Amlapur village in Kudligi taluk in Bellari, Karnataka (Ahiraj 2015)[i]. While this “news” may seem like one of the many road accidents that has come to typify modernising India, it hides a much more sinister story of a series of violations and grievous negligence under the Fourth Round of the National Family Health Survey (NFHS-4) undertaken by the ­Ministry of Health and Family Welfare
(MoHFW), Government of India. Three of those who were killed (all women) and the two who were injured (both men), were workers under the NFHS-4 and died/injured while on fieldwork. The tragic loss of lives and probable permanent disabilities are the culmination of the harsh working conditions imposed on the workers by the Field Agency (FA) operationalising data collection for the NFHS-4 in Karnataka.

Public–Private ‘Partnership’

The NFHS-4, along the lines of the three prior surveys—NFHS 1, 2 and 3—is conducted under the stewardship of the ­MoHFW, with the International Institute for Population Sciences (IIPS), Mumbai, serving as the nodal agency which has further subcontracted to other FAs for field operations. In August 2014, the former director of IIPS, K Srinivasan, in his letter to the then ­Union Health ­Minister, Harsh Vardhan, had “expressed his anguish” at the Population Research Centres (PRC) not being selected for carrying out the NFHS-4 and had warned that the quality of data will be affected because of the involvement of private agencies (Times News Network 2014). Of the 23 PRCs in the country equipped to carry out such surveys, not one was selected by the IIPS for the NFHS-4, despite all of them being eligible in terms of the necessary infrastructure, boarding and lodging ­facilities, transportation, experienced staff and faculty, and extensive experience of implementing such large-scale studies.

In Karnataka, the PRC in Dharwad, established in 1961, is fully funded by the MoHFW for its research activities and has a staff of 23 members, including a director, deputy director, two research officers, four research investigators, four field interviewers, three computers, a tabulator, an assistant librarian, an office superintendent, a stenographer and drivers. The PRC in Bangalore, affiliated to the Institute for Social and Economic Change (ISEC), was involved with the conducting of the previous NFHS-3.

However, the NFHS-4 survey for Karnataka has been contracted out to ­Vimarsh Development Solutions Private Ltd (hereinafter Vimarsh), a Gurgaon-based agency[ii]. It is ironic that the training at Dharwad in Karnataka for NFHS-4 was held in a disreputable lodge by ­Vimarsh, just 1 km away from the sprawling PRC campus which had ample space and resources to do the study but had apparently lost out at the bidding stage because it was not able to compete with the low rates quoted by Vimarsh.

Working Conditions under Vimarsh

Right from the time of training of field investigators, Vimarsh has violated several labour norms. In a letter issued by Vimarsh (dated 8 January 2015) to the field investigators with the subject “Training Selection Letter—National Family Health Survey-4 for Government of India, Coordinated by International Institute of Population Sciences” (hereinafter “Training Selection Letter” 2015), the trainees were informed,

...you are selected to attend the 4 weeks training programme free of cost… however, no additional fee or allowance will be paid for the training duration…In case you drop out mid-way during the training, you will be required to pay the expenses incurred on your boarding and lodging and other expenses related to you for the days you attend the training calculated at the rate of Rupees five hundred per day (“Training Selection Letter” 2015: 1).

When it became clear to the trainees that Vimarsh was not abiding by the contract it had signed with the IIPS, on
4 January 2015, a memorandum was submitted signed by 110 trainees that unless their demands were met, they would not leave for fieldwork. The demands ranged from provision of safe and secure arrangements for accommodation, provision of medical insurance during the course of the survey, payment of the entire monthly salary of Rs 13,500 payable on the 5th of every month together with a dearness allowance (DA) of Rs 200 per day per investigator as mentioned by the MoHFW tender document,[iii] that the onus of the equipment not be placed on the researchers, that the confiscated original marksheets be returned,[iv] signed contracts of employment be issued and a stipend be paid for the period of training.

However, through extreme coercion and verbal assurances the field investigators were made to agree to the terms and conditions set by Vimarsh and sent to the field. The nightmare had begun for the researchers but dire economic necessity placed them at the mercy of an unscrupulous agency and an unresponsive IIPS/MoHFW. Although the training without any form of payment was completed on 4 February 2015, researchers were made to wait another month and a half without any emoluments before the survey was initiated. During this period of “non-work” and non-payment, their original marksheets were retained by ­Vimarsh to prevent them from seeking other employment. After the start of the survey the workers were plagued by non-payment of wages, payment of less than mandated wages and unsafe conditions of work.

As per the MoHFW guidelines, “for effective and efficient implementation of the field operation, every FA must, ­compulsorily provide one vehicle to each survey team (consisting of seven ­members). IIPS reserves the right to stop the fieldwork/cancel the contract any time if any team is not provided with vehicle as per protocol” (International Institute for Population Sciences 2014). Despite this, under “cost-cutting” practices, two– three teams were crammed into single vehicles. “Vimarsh hired white board vehicles for the survey which are not meant for commercial purposes. The drivers were not trained and did not have adequate experience. Then they would ask two or three teams to go in one vehicle,”  said a researcher at the site of the accident on 12 May.

Not just that, the working conditions were such that the fieldworkers were made to work non-stop through the entire period of data collection as per the “Training Selection Letter” which, under the heading of “Responsibilities of Field Investigators” states,

[clause] 5. Travel all over state: You will be required to travel to multiple districts in the state as per fieldwork plan approved by IIPS. Extensive travelling for around five months would be required with no leave/holidays in between… [clause] 11. Continuous work without break: Once appointed you will have to work continuously for the entire duration of fieldwork for the survey with no break. Leaving work mid-way is not permissible. Leaving field work midway shall disentitle you for any payment. (Excerpts from “Training Selection Letter” 2015: 3) (italics added).

The accident in NH-13 took place in the early hours of the morning when the workers were travelling from one site to another under pressure of time because as per Clause 14 of the Vimarsh “Training Selection letter” (2015: 3), “[d]elay in work due to inefficiency or deliberate reasons shall disentitle [them] for any payment.”

Lack of Medical Insurance or Compensation

According to the draft bid document of the IIPS (International Institute for Population Sciences 2014), “FAs must make provision and pay for group insurance to all the field staffs deployed in NFHS-4.” However, in the “Training Selection Letter” (2015: 3) of Vimarsh, clause 19 states, “…VDS [Vimarsh Development Solutions] will not liable [sic] to cover any…costs such as medical treatment,” and while the same clause states, “…VDS will provide group accident insurance to cover any work related eventualities for the duration of the project,” there is no clear provision for compensation for injuries/death during the course of work. The field investigator Mallappa, who is still hospitalised, has sustained extensive facial injuries with loss of teeth, is able to communicate only through SMS and sign language, all indications of potentially serious permanent disability. How will Mallappa, a young active researcher, be able to earn an income in future and support his family if he is unable to speak? And how are the families of the other young investigators who died in the accident to be compensated?

Questions That Need To Be Asked

In the past, Rajan and James (2008) have raised serious concerns about the fact that the inflated costs of large-scale surveys such as NFHS-3 have not led to an increase in quality of data but for providing a neat income to the consulting firms (Rajan and James 2008). While questions have been raised about data quality in NFHS, the violations of the rights of the field researchers under contract have not received any attention. Even during the current NFHS-4 when such violations were brought to light (as early as January 2015 by the first author of this article), there was a serious lack of cognition by any of the agencies ­involved in NFHS-4. Moreover, the IIPS has also attempted to cover itself with a “Limitation of Liability” clause:

FA hold IIPS harmless from any liability claim for loss or damages of property or injury or death of persons or any cause of action of whatsoever nature that may arise out of FA performance of this contract (International Institute for Population Sciences 2014: 44).

The death of the four workers and injury to two others on 12 May 2015 brings to the forefront the harsh and unsafe working conditions under which the workers “contracted” under Vimarsh worked and continue to work. Contracting out of health services has been the mantra of late, riding on the back of the urgent need to privatise the entire healthcare system. There are several questions that we public health professionals, academicians and researchers need to ask ourselves and the concerned agencies. Should a low budget quote be the only consideration for selecting an agency to conduct a NFHS type of survey when there are competent bodies within the public sector with the necessary expertise and facilities? Notwithstanding the rhetoric of “evidence-based” studies, how can credible papers and policies be generated on the basis of poor quality data collected by poorly trained, overworked, underpaid, unhappy investigators? And importantly, who should be held liable for the death and injuries of the fieldworkers in the accident in Karnataka? Although the implementing and contracting agency is Vimarsh, should the IIPS and MoHFW not be viewed as principal employer of these workers and bear equal responsibility for all violations including non-payment of wages? Can a “Limitation of Liability” clause absolve them of their role in not monitoring the contracted FAs of their contractual obligations?

What happened in Karnataka may not be an isolated case as Vimarsh has been contracted as FA for NFHS-4 work in West Bengal and Punjab. It is also likely that such exploitative terms and conditions of work are not limited to Vimarsh alone. Hence, there is an urgent need to set up an independent process for investigating labour violations as well as the quality of data collected through such contractual arrangements with private FAs in the ongoing NFHS-4.

Notes

References

[All URLs accessed on 26 June 2015]

Ahiraj, M (2015): “Four Killed, Two Injured in Accident,” Hindu, http://www.thehindu.com/news/national/karnataka/four-killed-two-injured-in-accident/article7197258.ece    

Times News Network (2014): “Gujarat High Court Says National Family Health Survey for 2014–15”, http://timesofindia.indiatimes.com/city/vadodara/Gujarat-high-court-stays-National-Family-Health-Survey-for-2014-15/articleshow/40565638.cms?  

International Institute for Population Sciences (2014): “Draft Request for Proposal (RFP) for Procuring Mini Laptops and Accessories for CAPI in National Family Health Survey (NFHS)-4 2014-2015, http://www.rchiips.org/NFHS/NFHS4/pdf/NFHS4%20CAPI%20BID_I.pdf , Mumbai: International Institute for Population Sciences.

Rajan, S Irudaya and K S James (2008): “Third National Family Health Survey in India: Issues, Problems and Prospects,” Economic & Political Weekly, November, Vol 43, No 48, pp 33–38, http://www.epw.in/national-family-health-survey-3/third-national-family-health-survey-india-issues-problems-and-prospe.