Diligence - to whom is it due?

The loose end of Jagtaran Devi’s bright red sari had been draped over her white hair. It slipped off as she suddenly became animated and started to speak.
No, she really didn’t understand all these rules and regulations that we were talking about, she told us. Then she held up her left hand, fingers clenched, little wrinkled thumb sticking up. All she knew was that whenever she used her thumbprint, it generally got her something in the end – a bag of rice for example, perhaps this time a cataract operation.

We laughed, but would have forgiven the staff at Laxman Eye Hospital if they had burst into tears of frustration. Every year, they grapple with Indian bureaucratic systems linked with potential funding for eye surgery. The latest is the Ayushman Bharat, a government scheme designed to help those registered as living below the poverty line (BPL). In theory, such people get free medical care and the hospitals treating them receive financial reimbursement from the government.
The LEH is in the business of curing the blind – as I write, over 2000 patients are getting their sight restored every month. And the majority of their patients certainly live in dire poverty. The hospital managed to get accreditation to the AB scheme, installed specific software and allocated members of staff to be dedicated soley to this work. They diligently collect 15 pages of documentation on each patient, scan and feed this information into the data hungry AB system. The majority of applications are rejected, sometimes for the tiniest mismatch on the multiple and varied documents required (e.g. a one letter discrepancy in the patient’s name). A year into the scheme, the hospital has just about broken even regarding the money they have spent on the AB and the money they have actually received.
So will Laxman Eye Hospital turn away the bewildered Jagtaran Devi if the ‘computer says No’?
Well of course not. LEH staff apply the same care, attention and great effort (= diligence) in both tackling Indian bureaucracy and in treating patients. Established for the sole purpose of bringing eye services to the poorest, they would never turn away Jagtaran Devi. Their diligence is due to her.

I love the word diligence. It is derived from the Latin diligere – ‘to single out, esteem, prize, love.’ This, to my mind, implies that something or someone is being sort out for their worth. Discovering gems of human beings doing brilliant work is what drives me to travel the length and breadth of Bihar, time and time again.
The meaning of the word diligence has obviously evolved through time to a less exuberant, more matter-of-fact definition : careful and persistent work or effort.

 But what of the term ‘due diligence’?
As a legal phrase it came into common usage in the 1930s. It refers to the ‘care that a reasonable person should exercise to avoid harm to others or their property.’  In order to be thorough, this process should be investigative and bring as much relevant information to the table from all sides before a contract or agreement is entered into. All thoroughly sensible.
Due diligence was adopted by the business world and became a kind of financial checklist. It is now part of the lexicon of charities and grant-making organisations worldwide. Within the philanthropic world it developed its own jargon and spawned a kind of industry of ‘consultants’ who offer their services to help decipher this vague, generic language for those desperately seeking funds. It creates and reinforces power asymmetries and, especially in the field of global health, is jeopardising progress. A clarion call to resist becoming part of this can be found in a recent article by the Development and Environment Centre at Oslo University.
Global health nonsense  - read more here

Increasing digitalisation has pushed due diligence processes into being heavily weighted towards the collection of online data rather than on-site and face-to-face transactions. The distance between the human beings for whom charities and foundations were set up to help and those holding the power of decision-making within these organisations has became a yawning chasm.

It need not be this way. In fact, the UK Charity Commission does rather well in sticking to the crucial point of due diligence for charities i.e. that no-one should be ripped off or exploited in the process of either giving or receiving funds.
It’s simple advice is:  know your donor, know your beneficiaries, know your partner.
The only thing I would change about this advice is to put the beneficiaries first. If you always plan your due diligence procedures with them as your priority, I believe you have a far better chance of arriving at the truth of a situation and there is less of a risk of anyone being ripped off or exploited.

All this was going through my mind one day back in December 2022 in Aurangabad district, Bihar. We were at another Second Sight ‘partner’ called Drishti Eye Care Hospital. Gathered together in an office with parrot green walls were : me and SS trustee Francisca, Azhar Khan and his wife Almas who run the hospital, Adrian, a long-term Second Sight funder and two representatives from a huge Indian philanthropic Foundation based in Bangalore. We had originally been approached by the Foundation about a year back because they had heard of our long association with eye hospitals in rural Bihar. They had funds to give to blindness eradication programmes. Outside the room hundreds of patients shuffled around – the ‘beneficiaries’ for us and, should they decide to fund surgery at the hospital, for the Foundation, too.

The two representatives exuded praise for what they saw at the hospital. One of them, a doctor who had previously worked for the Bihar state government, expressed amazement that such excellent work was being done in rural Bihar. And was moved almost to tears when referring to the ‘huge burden’ of blindness for the poor. He marvelled at our wide knowledge of eye services in his home state.
We encouraged them to join the outreach teams in the villages to truly understand how much rural ophthalmology relies on the support of the community. They said they would love to. But couldn’t. The 48 hour site visit was just a small part of a lengthy Due Diligence procedure. The whole process would take ‘some time’ and would depend, in the end, on scrutiny of documentation by their Finance Team who would go into the very minutiae of the financial management of the hospital. Even after that, the Foundation’s board would have to schedule discussion of the project into their busy schedule and there would certainly be more requests for further documentation and signing of papers.

At which point I thought that it might be illuminating for them to hear from the quiet, self-effacing Second Sight donor, Adrian.
‘Perhaps Adrian can tell you why he decided to give his money away’ I suggested.
Heads turned quizzically in his direction.

’I’m a mathematician’ he said. ‘I have money. And I want it to cure blind people. There are so many people needlessly blind in Bihar. And cataract surgery is such a cheap way to help them. I don’t want to give my money to an organisation that will spend it on lengthy due diligence. I give it to Lucy. She is my due diligence. Of course, I also visit and see with my own eyes. I have been to most of the hospitals and have spent a lot of time in the villages with the outreach teams. But in the end, it is down to trust.’

What Adrian didn’t say was that, should he wish at any point to see documentation of all the many many thousands of blind patients whose surgery he has paid for over the past 15 years, I can give this to him.
The surgical data (which the hospitals keep routinely anyway) includes name, age, village, vision prior to surgery and post-operative vision, surgeon’s name and any complications of surgery and how treated.
If you want a due diligence method that guarantees your money is being spent on restoring sight to blind patients there is no better documentation.

However, I think Adrian might prefer the human evidence that his money is being well spent. And perhaps the patient he will remember best was actually operated on by the Drishti team three years ago.
Months after her surgery, Shanti Devi had wandered into the hospital grounds carrying a wicker basket full of hay for her cattle. Called over by staff to meet Adrian she had been asked why she thought he had paid for her surgery.
Without hesitation she had replied : ‘Pyaar hua heh’. He did it out of love.

Know your donor, know your beneficiary, know your partner. It’s a process that should engage, involve and empower all parties concerned. Trust (but not blind trust) is a good basis for success.

 Lucy Mathen

#knowyourdonor #knowyourbeneficiary #knowyourpartner #trustbutnotblindtrust #duediligence