The day starts at 2.27 am for Srinivas, an emergency medical technician in a 108 ambulance which plies across west Godawari district in Andhra Pradesh, where the founder of 108 helpline, B Ramalinga Raju, was born and spent his school years.

Srinivas gets a call from the Hyderabad-based call centre that Durga Devi in Mente Vari Thota is having breathing problems. The call centre also tells him where to take the patient.

Every health centre in the state has been mapped and the moment a call comes for emergency medical assistance, the exact location of the ambulance is available for the attendant. The call centre tracks each of the 650 ambulances running in Andhra Pradesh, responding to about 6,000 calls.

Srinivas -- a degree holder in microbiology who earns Rs 7,000 a month -- is among the 12,000 employees of 108 helpline, operated by the Emergency Management and Research Institute in four states.

Despite its success, EMRI is as much under a cloud today as its founder Ramalinga Raju, with a public interest litigation in the Supreme Court questioning the way he got 12 state governments to implement it and reimburse 95 per cent of its expenses.

Andhra Pradesh, Gujarat, Uttarakhand and Goa have been fully covered by the helpline and it has been launched in Tamil Nadu, Karnataka, Rajasthan, Assam, Meghalaya Madhya Pradesh and Punjab.

The petitioners, Ambulance Access Foundation India, based in Chennai and Transparency in Contracts, based in Kochi, point out that eight of the 12 memorandums of understanding entered into with states for public-private partnership were without any advertisements seeking expression of interest .

The key issue is that the states entrusted Rs 1,800 crore (Rs 18 billion) annually (if 10,000 vans are to run in all the states by next year) to a private company without going through a transparent selection procedure.

EMRI projects itself as the cheapest and says there were no competitors.

With 650 ambulances in Andhra Pradesh, annual recurring expense on a single ambulance is Rs 126,000 per month including the salaries of ambulance personnel, call centre workers and fuel charges.

Of this, the foundation pays five per cent and the rest is reimbursed by the government.

Centralised Accident & Trauma Services, which has been in Delhi for the last two decades, spends Rs 180,000 per month, just on the salaries of the six employees on a single ambulance. Technicians of the same qualification as Srinivas are paid around Rs 30,000, on par with government pay scales.

Though EMRI is cheaper, there is no proof that it is better. In fact, the Delhi government was on the verge of signing an MoU with EMRI in March last year and was stopped only by the protests of CATS workers' union.

CATS officials say that EMRI drew its clout from heavy weights on their board like former president Abdul Kalam, Tarun Das of the Confederation of Indian Industry, Kiran Karnik, former president of Nasscom, and KV Kamath of ICICI bank [Get Quote]. Today, two of them have been taken on the board of Satyam [Get Quote] by the government, making many see red.

What also aided the spread of EMRI to 12 states was the fact that the ministry of health winked at states using its funds meant for institutional delivery of babies to fund the ambulances.

EMRI admits that 40 per cent of the funds provided by the states come from the National Rural Health Mission fund. However, the health ministry says it never signed any agreement with Satyam or the EMRI Foundation. "It is purely the prerogative of states to use NRHM money for strategies they think would help meet targets. It is a not-for-profit service and since states are giving money they would have the right to audit the expense too," said Amarjit Sinha, joint secretary in charge of NRHM in the ministry.

Shaffi Mather, advocate for AAFI said, "The major faults with the deals were lack of transparency and competitive bidding. The cost estimates were inflated when compared with private operators (rather than CATS)."

But it is a fact that EMRI helpline is fast becoming a source of livelihood for many across the country and cannot be wished away.

The EMRI helpline, with six workers for every ambulance, will employ 60,000 workers across the country by 2010, manning 10,000 ambulances. The 40 acre premises of the EMRI Foundation in Hyderabad is buzzing with young recruits from various states who are attending 45-day courses before they join work. It is a semi-government job, says a recruit, happy despite the low salary.

Meanwhile, EMRI has already asked for private partners to fund the helpline which till now drew 5 per cent funding from Ramalinga Raju, who is now in jail after confessing to financial irregularities in the firm.

EMRI, and its sister helpline Health Management Research Institute and other charities funded by Raju had always drawn praise, but now few dare to speak good about them.

Amita Joseph, director, Business Community Foundation, said, "Ramalinga Raju has shown what works in the areas of education, health, safe water and sanitation. He took it to a new height and handed most of it to the government. Let us not meddle with what good has been done. There is no precedent for this kind of work."