Afghan health authorities taken to AGO over malpractice
Government documents obtained by Kabul Now suggest that Afghanistan’s Ombudsperson Office (AOO) has found nine former and current officials of the Ministry of Public Health (MoPH) as suspects, introducing them to the Attorney General’s Office (AGO) on charges of duty negligence and violation of procurement regulation. As documents show, the suspects have violated appointment procedure while hiring health workers at the Afghan-Japan and Mohammad Ali Jenah hospitals. They have failed to pay salaries of the health workers on due time and held training programs on how to operate ventilators. As shown in AOO report, the suspects have violated procurement regulation and misappropriated Covid-19 fund.
The suspects, who have been introduced to AGO, are as follows: Ferozuddin Feroz, former Minister of Public Health; Doctor Mamusi Zewar and Doctor Shafiqullah Shahim, former finance and administrative deputies of the Ministry; Doctor Feda Mohammad Paykan and Doctor Wahid Majrooh, former and incumbent medical service deputies of the Ministry, Mirlais Mustafa, head of the Ministry’s emergency department; Hayatullah Nawabi, representative of the Ministry’s medical science directorate, Nasir Islam, representative of the Ministry’s pharmacy directorate, and Abdulrazaq Ibrahimi, representative of the Ministry’s department for emergency relief.
As showed by the AOO report, a committee assigned to conduct efficiency evaluation at Mohammad Ali Jenah Hospital has found a number of inefficiency at the Hospital. Finding by the assessment committee showed that the hospital authorities failed to supply oxygen for Covid-19 patients, pay salaries of hospital workers on due time, supply medicines, and supply oxygen balloons.
Finding by Afghanistan Medical Council also indicates that health officials at the Afghan-Japan Hospital have failed to pay salaries of health workers on due time. They have failed to supply medicines, food and other required medical kits for health workers.
Procurement regulation violated
Two official letters by AOO (issued on July 23, 2020 and September 27, 2020) introduced the above-listed ex and current health officials to the AGO, suspecting them of violating procurement regulations.
The AOO accused the ex-health minister, Feroz, of violating procurement regulation in getting a PCR machine purchased for Herat Covid-19 facility and ordering purchase and delivery of a number of medical equipment before due procedure of procurement was over. The AOO report claims that the ex-health minister receives a PCR machine from Afghan Momand Astana LTD in Kabul and sends it to Herat Public Health Department before the due official procedure is over.
According to the AOO, the ex-health minister bought a used PCR machine which does not have laptop. “The issue that the machine is used was shared with the former public health minister, Dr. Feroz. In an oral directive, Dr. Feroz said the machine should be operated till the time the borders open,” the letter, issued by the AOO, reads.
As claimed by the AOO, Asia Farma, a logistic firm, which has not signed any agreement with the Public Health Ministry, has bought a laptop and fixed it to the PCR machine. The question why and how Asia Farma has supplied a laptop for the second hand PCR machine remains anonymous.
Under a directive by the ex-health minister, Feroz, some medical equipment, including eight CR machines and one DR machine, have been taken to store house of public health ministry before due official procedure was over, the AOO claims.
Qais Anil Company LTD, in a single-source procurement process, signed procurement agreement with the Ministry and the procurement process started on March 08, 2020. Though the proposal offered by the Company underwent an assessment from March 18, 2020 to April 01, 2020, the AOO has found that the Company has sent the required medical equipment to the Ministry’s store house and the Ministry received them on April 04, 2020, even before completion of assessment period and signing the contract.
Documents reveal that Feroz has ordered officials at the Ministry and third-party hospitals to proceed with the process in accordance with “the terms of the assigned contract” in their parts, though agreement was not signed between the two parties.
The AOO has also introduced Mamosi Zewar, former finance and administrative deputy of the health ministry, to the AGO on charges of violating the procurement laws. As claimed by the AOO, the former deputy health minister has ordered officials at the Ministry to allow supply of medical equipment kept in store house of the Ministry in the absence of a contract signed between the parties.
Following her directives, a CR machine was transferred to the southern Kandahar province and the Ministry of Defense has transferred 16 items of medical machines and equipment from the central store house of the MoPH to Kandahar upon official request made by Mrs. Zewar.
The letter (9740) issued by the central store house of the MoPH on August 26, 2020, addressed to the Ministry’s administrative directorate, indicates that a CR machine which had been sent to Kandahar on April 07, 2020, was brought back to Kabul on August 10, 2020 – after four months during which the machine was not used for a single time.
As per the AOO letter (16) issued in late September, 2020, Mirlais Mustafa, Hayatullah Nawabi, Naser Islam, and Abul Raziq Ibrahimi, who are all senior officials of the MoPH, were also introduced to the AGO as suspects of violating the procurement laws. The letter says that Mirlais Mustafa requested assignment of assessment delegation to the Minister in the absence of the contract while it is a duty of the central stock of the Ministry. Then, the former minister, Feroz, assigned Hayatullah Nawabi, Naser Islam, and Abdul Raziq Ibrahimi as members of the delegation.
“The delegation has received the medical equipment without [asking] for an approved contract from the company and proceeded with explanation them (the medical items). This is in contradiction with the provision of the clause 03 and 04 of the article 107 of the procurement procedure,” the AOO argued in its letter.
Pointing to the articles 388, 389, 403, and 407 of the Penal Code, the AOO has introduced health officials to the AGO on suspected charges of embezzlement, abuse of duty, and not observing the law.
Ineffective training on operating ventilators
In the letter (314) issued in July, 2020, the AOO has introduced Feda Mohammad Paykan and Wahid Majrooh, former and current deputy health ministers, to the AGO on suspected charges of having a role in offering ineffective training on operation of ventilators.
According to the letter, the ventilators in Covid-19 facilities, particularly in Afghan-Japan Hospital, Mohammad Ali Jenah Hospital, Shaykh Zahid Hospital, Khairkhana 102 Beds Hospital, Herat’s Shaydayee Hospital, and Nangarhar’s Covid-19 Hospital, have not been used properly due to the absence of skilled operators to operate them. In some provinces, health workers have simply reported the ventilators as “damaged or inactive” in a bid to hide their incompetency.
The AOO states that death toll of Covid-19 patients, who were in critical condition and needed ventilators, was extremely high. For instance, the AOO has reported that one patient out of 40, who were connected to ventilators at Mohammad Ali Jenah Hospital, has survived. In Herat, two out of 60, who were connected to ventilators and in Nangarhar, one out of four, have survived. “Death toll of those patients, who were connected to the ventilators, are hugely high. This suggest that training programs on how to use the ventilators were not effective,” the AOO wrote to the AGO.
Inaccuracy in needs assessment
As written in the AOO’s letter (314) issued on July 23, 2020, the Ombudsperson Office found Feda Mohammad Paykan and Wahid Majrooh, former and current deputy health ministers, as suspicious for lack of accuracy in needs assessment and introduced them to the AGO. Inaccuracy in needs-assessment, as stated in the letter, has led to lack of medicines, medical equipment, and medical machines in covid-19 medical centers.
The AOO has described lack of medicines in Covid-19 hospitals as a “serious problem”, adding that medicines remained unused in store house for mismanagement in the hospitals to categorize these medicines properly. It has further stated that Afghan Japan Hospital, in the capital Kabul, has ran out of some medicines while some other needed medical equipment remained unused in its store.
Moreover, the MoPH has provided Afghan Japan hospital with Gon personal protective clothes while the Hospital had requested the MoPh to provide Kit personal protective clothes. “The Gon clothing is a head-to-too covering which is very hard for doctors to wear it due to its overheating. This type of clothing should have provided during the peak and first wave of coronavirus for doctors but [the Ministry] failed to do so.”
The AOO has also stated that the number of existent ventilators at the hospitals exceed the required level and few of them have been used.
In addition to the above-listed suspects, the AOO has also found Mamusi Zewar and Shafiqullah Shahim, former deputy health ministers, as suspected for inaccuracy in needs-assessment of employing health workers. In the letter, it has written to the AGO that the health ministry has hired far more work forces for Covid-19 facilities than their actual needs. For example, it denotes, 450 physicians, nurses, and ordinary workers have been employed for Mohammad Ali Jenah Hospital while an average of 50 patients are hospitalized at the Hospital in a normal situation. It simply means that the MoPh has hired nine health workers for each patient. With a daily average of 65 hospitalized patients, 780 employees have been hired for the Afghan Japan Hospital – suggesting that 10 health workers are assigned for one patient at a time. “In General, the AOO’s findings suggest that the number of employees at the hospitals are more than the needed number [of health workers] for the patients.”
Pointing to the articles 388 and 389 of the Penal Code, the AOO has found the former and current health officials as suspected of committing “embezzlement” during their tenure at the Ministry.
In a letter to the AGO issued in July, 2020, the AOO says that there is not an accurate figure of those employed at Afghan Japan and Mohammad Ali Jenah hospitals. It further notes that the Ministry of Public Health has shared different figures and reports with the ombudsperson office.
The AOO has also denoted that employees of the two hospitals have not been hired in a transparent appointment process but through orders by the health officials.
Documents obtained by Kabul Now suggest that a number of personnel of the Covid-19 facilities have been hired for positions which do not match their educational backgrounds. For instance, a graduate of law has worked for a while as head of doctors in the eastern Nangarhar province. Likewise, an undergraduate student of Jalalabad University has been hired for the following three positions at the same time: secretary to former head of hospital, public relations officer, and administrative deputy of the hospital.
Pointing to the articles 389, 403, 390, and 388 of the Penal Code, the ombudsperson office has found Shafiqullah Shahim, former deputy health minister, Wahid Majrooh, current deputy health minister, and Muhibullah Khayyer, General Director of the Ministry’s Medical Science Directorate as suspected of committing embezzlement and abuse of duty.
Difference in weight of oxygen
In the letter (314), the AOO has written to the AGO that the weight of oxygen provided by the contractors to the hospitals are far less than the amount which was agreed between the contracting parties in the contracts. “The standard capacity of an oxygen balloon is 40 Kg but officials of Afghan-Japan Hospital have said that the oxygen amount [of the balloons] delivered to the hospitals by the [provider] companies is not 40 Kg,” part of the letter reads.
Referring to the articles 403, 389, and 388 of the Penal Code, the ombudsperson office has found Shafiqullah Shahim and former head of Afghan-Japan and Mohammad Ali Jenah hospitals as suspected of committing embezzlement and abuse of duty for it.
Findings of evaluation committees
According to evaluation conducted by Afghanistan’s Medical Council (AMC) and assessments carried out by new leadership of the Afghan-Japan hospital, a total of 28 shortcomings including incapacity in service deliver, have been listed. As claimed by the AMC authorities have failed to pay salaries on due time. They also have failed to supply medical equipment, food, medicine and health stuffs on due time.
Late in July, 2020, the newly appointed leadership of the hospital conducted assessments which not only confirm what found by the AMC but reveal more shortfalls and problems at the hospital.
In addition to Afghan-Japan hospital, a five-membered committee assigned by the Ministry of Public Health has also assessed the service delivery in Mohammad Ali Jenah Hospital. The committee conducted its assessment during June 30 to July 18, 2020, finding a total of 19 problems and shortfalls in service delivery at the hospital.
The problems and shortfalls listed by the committee are as follow: failure in salary payments, unhealthy food for patients, lack of medicines, irregularities in store house, irresponsible transfer of equipment, improper usage of oxygen balloons by the patients’ attendants, at least six ventilators remained unused, 60 unpacked brand new patient monitors, transfer of hygiene kits outside of hospital by employees, lack of special clothes and ID cards for nearly 160 servants, and not holding trainings for capacity building at the hospital.
The committee made ten recommendations to the leadership of the Ministry for resolution of the problems it found at the hospital in a bid to improve its service delivery.
Response of suspects and authorities
To seek responses, Kabul Now has talked to some former and current health officials who were found as suspected of violations by the AOO, over past one month. Except Wahid Majrooh who rejected to talk to Kabul Now reporter.
Although an assistant to Feroz promised to share his response regarding the AOO’s finding about him once the former minister, who was on a trip abroad, reach his destination, the former minister has not been reachable for Kabul Now since then.
Shafiqullah Shahim termed all accusations against him as irrelevant or some cases of what the AOO found as violations were not committed when he was the finance and administrative deputy health minister. “There has been separate leaderships, in which I wasn’t a member, either at the time when the decision was made or at the time when it was accomplished,” he asserted.
“The Ombudsperson Office is an unprofessional and unexperienced. The Attorney General’s Office rejected and pronounced their accusations as baseless at the time,” said Mamusi Zewar regarding her case. Zewar added that she acted responsibly and with honesty during her tenure at the Ministry of Public Health.
Feda Mohammad Paykan, another suspect for the violations, described the “shortfalls and problems” as very natural in Afghanistan. The health authorities are struggling with a weak health system, poverty, lack of financial resources, lack of technicians and managers, lack of infrastructure for hospitals, unbalanced number of health workers and beds considering the huge number of patients, a poor service delivery, and dozens others. He further noted that the AOO was not capable of understanding the technical issues of the Ministry, adding that it was better that a professional authority should have assessed and evaluated the weaknesses of the covid-19 response. “Introduction [of us] to the Attorney General’s Office is surely unjust and it will not contribute to the improvement of the system. Of course, when it comes to embezzlement and peculating the financial resources, the relevant institutions have the authority to assess the issue seriously.”
The AOO, accused by the suspected people of not having the required capacity and understanding, told Kabul Now that it has conducted assessments professionally based on “existent documents with impartiality, honesty, and integrity” according to the law.
Jamshid Rasooli, spokesperson for the AGO, told Kabul Now that the dossiers were under their investigation. “An important part of this case is taking quotations. To assess it, we have asked experts to comment regarding the issue because the equipment were purchased during the coronavirus outbreak. The work is also underway regarding appointment.”
This report has financially been sponsored by the European Union. Etilaatroz is responsible for content and it doesn’t necessarily reflect EU’s position.
This report has been developed by Etilaatroz’s Elyas Nawandish and Khadim Huyssain Karimi and translated to English by Mokhtar Yasa.