When the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) was set up in the shadow of the cold war in the 1960s as part of America's bid to contain the spread of communism, it was awash with money.
Originally, a social venture of the South-East Asia Treaty Organisation (SEATO), the China containment military alliance similar to the NATO block, it was first named Cholera Research Laboratory and only to become icddr,b – that is how its name is written, in all lower case letters – in 1978. More funds flowed in with the name change.
Decades later, the organisation of international repute is now soliciting monetary donations from the public by SMS as it says it is hurting for lack of funds.
It has been seeking funds through mobile phone messages since April 7. It has put up appeals for donations on its website, which, the institution claims, are to be spent on hospitals for free services.
But how did an organisation that once was in no shortage of funds and had saved millions of diarrhoea victims' lives with one single innovation – oral rehydration therapy– has fallen in such a state?
In short, the answer seems to be donor fatigue.
In two of its hospitals in Mohakhali and Chandpur, icddr,b provides free treatment to more than two lakh patients a year on average.
And it now seeks crowdfunding to continue the health care against its declining income which was further contracted by the Covid-19 pandemic. All donations will be subjected to tax rebate.
icddr,b officials said every year it costs $5 million to run the hospitals, with funds largely generated from its diagnostic laboratory and "unrestricted" donations which they can use freely.
The institution received about $170,000 in donations as of August 6 since April this year.
icddr,b has four main donors – the Bangladesh government, the Global Affairs Canada, the Swedish International Development Cooperation Agency, and the Department for International Development of the UK – and the money it gets from them can be spent unrestrictedly.
However, this only makes up 15% of its funds and the remaining 85% is restricted funds which can only be used for research. That portion is donated mainly by the Bill and Melinda Gates Foundation, the United States and the United Kingdom governments, the UNDP and the Global Fund to Fight Aids, Tuberculosis and Malaria.
Institutional donations make up to 80% of icddr,b's yearly revenue and this has been fluctuating for the last couple of years.
With Covid-19 suddenly appearing on the scene, its income from donors and other sources have declined when its spending increased due to the implementation of strict safety measures to contain virus transmission. So, they are now struggling to provide free life-saving services for their patients.
In 2019, its receipts of unrestricted funds declined by 6% from the previous year. And it bagged about 7% less grants in 2017 than 2016.
In the meantime, iccdr,b says its revenue has also been hit while its operating costs of hospitals have increased.
Explaining the reason for rising costs, it says it used to admit about 500-600 patients a month three years ago, but the number has shot up to 1,000. Rising costs of medicines and health care equipment have also led to cost escalation.
Its diagnostic centre – reputed for being accurate and high standard – sourced about 8% of its income, but that has fallen sharply as patients fizzled out due to the pandemic, officials said without giving any numbers.
Professor John D Clemens, executive director at icddr,b, told the Business Standard, "We anticipate that our current annual diarrhoeal disease hospital budget will increase substantially. People's support will help us to sustain our life-saving services to our vulnerable patient population. No gift is too small, no gift is too large."
"It is our honour to serve the people of Bangladesh during this unparalleled time of need. Together, we will weather the storm," he added.
Above 80% of revenue comes from donors
According to its financial statements, the institution's total revenue amounted to $65.92 million in 2017 while it was $67.16 million in the previous year.
In the following two years, the revenue along with grants increased slightly but not in proportion with its expenditure. In 2018, the institution's revenue amounted to $70.24 million and in 2019, it stood at $71.98 million. The donor grants in this revenue was $58.94 million in 2018 and $59.43 million in 2019.
Compared to this income, icddr,b's expenditure is increasing at a faster pace which makes its surplus slimmer than expected. In 2019, the institution's total expenditure stood at above $71.42 million, resulting in a mere $0.558 million of surplus. In the previous year, after spending above $69.67 million, the institution managed to save $0.567 million.
Covid-19 tests in icddr,b
Although only their staff and family members underwent Covid-19 treatment at icddr,b hospital, the institution has been conducting free Covid-19 tests since late March in collaboration with the government. The government provides testing kits, but the institution itself is bearing the rest of the cost. icddr,b lab has so far done more than 36,000 Covid-19 tests free of cost.
The institution has also been conducting Covid-19 tests commercially since June, charging the government-fixed Tk3,500 in fee. So far, icddr,b has performed more than 4,000 commercial tests. Every day, it conducts Covid-19 tests both free of cost and paid tests. However, more tests are done for free. On July 25, 414 free tests were done at the icddr,b lab while 179 tests were with fees.