"I've escaped it, a life wasted/And I'm never going back again." - Pearl Jam, "Life Wasted"

Thursday, July 14, 2005

Gimme Some Truth

The original Susan Long piece that started it all. It's a long but good read.

The NKF: Controversially ahead of its time?

Controversy stalks the National Kidney Foundation, with critics lambasting its fund-raising methods, brazen self-promotion and work practices. Is the NKF just a cutting-edge charity ahead of its time, or is there more to those rumblings?

A RETIRED contractor who wants to be known only as Mr Tan used to be a National Kidney Foundation (NKF) donor until he was hired to install some bathroom fittings for its new headquarters at Kim Keat Road in 1995.

Inside chief executive T.T. Durai's office suite on the 12th floor of the $21 million building, he says he 'lost it' when he had to install, among other things, a glass-panelled shower, a pricey German toilet bowl and a gold-plated tap.

'I started screaming my head off. The gold-plated tap alone cost at least $1,000. It was crazy. If you're Bill Gates and own your own multinational, whatever you want, fine. But you're a charity, using donors' money,' he huffs.

After his outburst, he was told to 'just do' his job. The shower stall remained, but the taps he eventually installed were 'scaled down' to an upmarket chrome-plated model.

To this day, the 54-year-old belongs to NKF's die-hard detractor camp, unmoved by its shining success in social entrepreneurship and its track record in saving lives.

As he puts it: 'After that day, not a cent from me. I'm not going to pay for gold-plated taps.'

Asked for its response to the contractor's story, the NKF's public relations arm sidestepped the details and said yesterday: 'Since you can't give us details of the contractor ... it is difficult for us to give an answer to enlighten your readers.'

In the past fortnight, the NKF has hogged the headlines. Propitiously, the news of its amazing $189 million in reserves broke the very day it celebrated its 35th anniversary on April 7.

Since then, a stream of more than 130 people - former employees, former donors and disgruntled members of the public - have e-mailed or called this newspaper to let off steam about its hard-sell tactics, thick carpets and controversial chieftain.

At the same time, about 30 others, individuals and organisations, have sent in letters of support for the organisation, praising its dialysis programmes and pledging continued donations. So far, the NKF kitty appears none the worse for wear despite all the caterwauling.

On April 11, its 11th NKF Charity show raised $6.7 million, just a fraction short of last year's $6.8 million. Last night, it netted another $6.4 million.

These serious sums of money - how the NKF gets it, spends it and accounts for it - have been a well-gnawed bone of contention among its naysayers. Way before details of its $5 million tie-up with insurance giant Aviva unleashed a ferocious debate on donor privacy issues, charges of 'invasive' fund-raising have dogged the outfit.

But the NKF has made no bones about gunning for the charity dollar - the more the merrier, just like any other profit-and-loss business. Relentless innovation over the years has brought new ways of fund-raising: greeting cards, live charity shows, donations via SMS, consultancy services, even selling its spare telemarketing capacity to private companies.

In the social service sector, the NKF is the unparalleled paragon of the art of 'heart sell'. Most impressive of all, notes Mrs Tan Chee Koon, executive director of the National Volunteer and Philanthropy Centre, is its ability to tap on the health screening it conducts for heartlanders to ensure a 'sustained pool of regular givers'.

Unlike many charities which rely on large, one-off infusions from wealthy foundations, NKF's bread and butter is the $3 to $5 monthly Giro donations from about one million ordinary Singaporeans. With such a big base of small heartland givers - its website says nearly two out of every three Singaporeans are donors - the pennies add up.

Every day, seven days a week, some 100 'prevention evangelists' and nurses fan out to companies, army camps, condominiums and churches islandwide to test the blood, body fat and urine of at least 1,600 people daily. Since 1997, more than one million Singaporeans have undergone these free health screenings, which are followed typically by an impassioned pitch: 'This is something we're doing for you; is there something you'd like to do for us?'

A voluntary sector consultant notes: 'Even old grannies are not spared the spiel. Most are pressured to do a Giro contribution for a minimum of six months. Nothing they do is illegal, but it's all very aggressive. Nothing wrong with that, but when they push the fund-raising envelope, they tend to be insensitive to the larger consequences for the charity sector.'

But the NKF's head of what it calls 'prevention marketing', Ms Shirley Tan, makes no apologies for the 'heartfelt pleas' it delivers along with its basic health checks, which she notes would cost at least $60 in private clinics. She says these are 'free-will offerings' and the 'evangelists' have no financial targets to meet at each venue.


NKF chairman Richard Yong, 63, a former private banker who has been on the NKF board for 18 years, makes clear that lucre is the necessary lifeblood of the organisation.

Every cent literally buys time for each patient. And the NKF's mission to save the lives of those with kidney failure is undeniably daunting, which explains why there are no other self-funded, non-profit dialysis providers in the world.

Each patient is admitted for life - or until they are lucky enough to get a kidney transplant. The average life expectancy of those on dialysis is 10 to 15 years, at a cost of $150,000 upwards a head to the foundation.

Mr Yong says patients themselves pay from nothing to $800 each month for three-times-a-week dialysis which would cost at least $3,000 each month outside.

The incidence of kidney failure here - increasingly a lifestyle disease closely associated with diabetes and hypertension - is now the third highest in the world, trailing only affluent countries like the United States and Japan.

This, coupled with a fast growing grey-haired population, means that the NKF has plenty of costly work cut out for it. Its money-minting machinery, however, was not always so hard-nosed or well-oiled. Starting out in an unprepossessing Singapore General Hospital attic with just two beds and one metal tray in 1969, Mr Yong says, it battled the same growing pains that less publicised, cash-strapped charities face today.

When it set up its first dialysis programme in 1982 in Kwong Wai Shiu Hospital, it dispensed free treatment with little regard for outcomes and costs.

In 1986, it ran out of money, so he and other board members had to make the heart-wrenching decision of who among their 32 patients should continue with dialysis, and who would have to be sent home with morphine to die.

'I couldn't sleep; I couldn't eat. Who were we to play God?' he recalls. It hit home then: It was important to have 'healthy reserves that can withstand even the most dire economic times', and self-generated income 'so that we can be independent, instead of on our knees, poor and begging for life'.

So the irony is that, despite being one of the oldest, the NKF is yet one of the most progressive charities here. As a mature 35-year-old, it is looking at sustainability and continuity issues for the next 100 years, even as most other voluntary welfare organisations (VWOs) grapple with day-to-day survival issues.

In the international arena, it is such a trail-blazing model of social entrepreneurship that American universities like Harvard, Johns Hopkins and the Massachusetts Institute of Technology have done case studies on it.

Locally, however, it is so far ahead of its time that society has yet to keep pace. Unlike in the West - where charities aggressively campaign for the charity dollar, professional fund-raising is a bona fide industry and tie-ups with commercial entities are old news - the social sector here unfortunately is still in its infancy.

According to Mr Terry Farris, head of charity management for Asia at European private bank Mees Pierson, the fact that it costs money to raise money- the accepted norm, he says, is now 15 to 20 cents out of every dollar - may not have sunk in here yet.

Many VWO chiefs note there still exists an arcane expectation that non-profits should survive on the 'goodwill and sacrifice' of volunteers, even though it is recognised worldwide that the public good is much better served by hiring professional managers at market rates.


THE NKF has tried to break away from the 'third-tier' image charities suffer from, by sourcing for talent worldwide and paying them fair market value.

According to NKF's honorary treasurer Loo Say San: 'Many Singaporeans prefer not to work for charitable organisations, so we go overseas to hire.'

It does its recruitment drives at top institutions like the Indian Institutes of Management and Beijing University, competing with the likes of General Electric and Morgan Stanley for the best brains money can buy. Since 2001, it has also tapped the skills of a steady stream of MBA interns from top business schools like Harvard and Stanford.

Its staff strength is 947, a figure that NKF defends as necessary to man the three shifts of dialysis sessions, each lasting four hours, which its 22 centres around the island run daily.

Pressed for details on staff composition, Mr Yong said 'more than half are medical personnel'. The rest are spread among the administrative, marketing, fund-raising and communications departments.

The taboo it seeks to break is that charity is synonymous with poor quality. As Dr Gerard Chuah, an eye surgeon and chairman of the NKF Children's Medical Fund, says: 'What bothers me is when people say, why can't you continue to function out of containers? Hello, just because we're a charity doesn't mean we have to operate in a hovel out in the rain.

'Would you ask a family member of yours who has an honours degree to work in a container? We want to get the best people we can find who will run good programmes to save more lives.'

Even when administering its dialysis and patient rehabilitation programmes, the NKF approach is controversial. You might call it 'tough love'. According to Mr Job Loei, a dialysis patient who also helps counsel new admissions at NKF, those wallowing in self-pity are set straight.

NKF demands that patients co-pay for dialysis, hold down jobs and stick to their diet - or pay more. Patients' fees, for example, are reduced by $50 to $100 as an incentive, if they find a job, get promoted, tie the knot, give birth, or even when their school-going children score As.

It helps patients find jobs, provides courses to upgrade their qualifications and holds personal grooming classes to help them remain attractive to their spouses. If their children's grades slide, it even helps engage, and provides subsidies of up to 80 per cent for, tuition teachers to coach them.

As Mr Yong says: 'We don't dialyse them to go home and sleep. We want them to have jobs, bring home the bacon, contribute to the economy, have normal relations with their spouses and their children to do well in school. We say openly to them: If you want to die, go and die by yourself; don't come to us'.'

As a result, 93 per cent of NKF dialysis patients work, support their families and lead productive lives, compared to less than 60 per cent worldwide. The general philosophy is: No free rides.


LIKEWISE for employees, adds Mr Loo. They are constantly reminded that their wages come from donor dollars. To prevent wastage, there is an extensive list of fines, from $5 for getting to work five minutes late, to $30 for forgetting to switch off the lights. All staff functions are held in the in-house auditorium 'for fear of being labelled spend-thrift' if they venture outside.

For the record, Mr Yong says, there is no such thing as 'first-class travel'. Senior executives, from directors up, including CEO Mr Durai, fly business class. The rest fly economy.

Little is known of Mr Durai, 56, apart from the fact that his name T.T. (Thambirajah Tharmadurai) means a charitable man in Tamil. A former presidentof the then University of Singapore Students' Union, he graduated with a law degree and worked in the government legal service for six years until 1977.

The elegant and eloquent man eschews publicity and, despite 3 1/2 hours spent with top officials at the NKF last week, this reporter received only a handshake from him. No quotes.

His staff know him as a 'visionary' who cares deeply for NKF patients and knows each one by name. He is also a 'tough taskmaster' who works from 6am to10pm, and eats and showers in his office.

He is said to run a tight, results-oriented ship, with a labyrinth of departments within departments and units within units. But even the most embittered acknowledge it is a 'dynamic' workplace and training ground.

Its staff turnover is high; employees are so often poached that managers now have to sign three-year contracts. One downside cited by former employees is a corporate culture described as 'cagey', in which staff are discouraged from discussing finances. Despite much public prodding and the Finance Ministry's encouragement to charities to reveal the salaries and benefits of their top employees, NKF top guns are sticking to their guns not to allow more public disclosure.

What they keep reiterating is: 'Although the NKF is a non-profit organisation, the people who have chosen to work in the NKF are private individuals, who are entitled to their privacy.'

But therein lies the chink in an otherwise spiffy armour: NKF's forward-looking business model lacks the financial transparency that would enable it to stand tall and get out of its controversy-laden shell.

After all, if it is governed by the creed of the marketplace, it should also apply rigorous standards of disclosure and accountability.

As a VWO analyst notes: 'You can find out how much any CEO of a public company makes, so why not them? How can it be that when they feel like it, they can be private, but when raising funds, they are non-profit and public? If any member of the public asks, why shouldn't the information be made available to them?'

As society matures, says Mr Farris, people will have higher expectations of non-profit governance.

'Like it or not, if you turn over as much as $67.5 million a year, you're a business, though it be the business of doing good,' he says. 'As a charity, you have to always remember: You are spending other people's money.'

On the NKF's part, so often has it been bad-mouthed - which it attributes to 'professional jealousy' - that it seems to have developed a persecution complex of sorts.

'Why is it us, always us?' is a plaintive cry its board members often utter.It has also gone beyond plaintive cries, to being the plaintiff in defamation suits - at least three times. In 1999, for instance, it sued Madam Tan Kiat Noi for sending out an e-mail message accusing it of paying ridiculously high bonuses to its staff. An estimated 100,000 people received it. The case was settled after she apologised publicly, and paid $50,000 in damages, as well as NKF's legal costs.

Whither the NKF from here? Although it continues to bid the public judge it by its works and its effectiveness, detractors will continue to be fixated by the shroud over its numbers. Like it or not, rumblings are likely to persist until there is more publicly-transparent accounting.


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