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By:

Rajendra Joshi

3 December 2024 at 3:50:26 am

Procurement first, infrastructure later

Procurement at multiples of market price; equipment before infrastructure; no accountability Kolhapur: Maharashtra’s Medical Education and Public Health Departments have been on an aggressive drive to expand public healthcare infrastructure. Daily announcements of new centres, advanced equipment and expanded services have reassured citizens long denied dependable public healthcare. Procurement of medical equipment, medicines and surgical supplies is reportedly being undertaken at rates two to...

Procurement first, infrastructure later

Procurement at multiples of market price; equipment before infrastructure; no accountability Kolhapur: Maharashtra’s Medical Education and Public Health Departments have been on an aggressive drive to expand public healthcare infrastructure. Daily announcements of new centres, advanced equipment and expanded services have reassured citizens long denied dependable public healthcare. Procurement of medical equipment, medicines and surgical supplies is reportedly being undertaken at rates two to ten times higher than prevailing market prices. Basic economics dictates that bulk government procurement ought to secure better rates than private buyers, not worse. During the Covid-19 pandemic, equipment and consumables were procured at five to ten times the market rate, with government audit reports formally flagging these irregularities. Yet accountability has remained elusive. The pattern is illustrated vividly in Kolhapur. The Dean of Rajarshi Shahu Government Medical College announced that a PET scan machine worth Rs 35 crore would soon be installed at Chhatrapati Pramilaraje (CPR) Government Hospital for cancer diagnosis. But a comparable machine is available in the market for around Rs 6.5 crore. A senior cancer surgeon at a major cancer hospital in western Maharashtra, where a similar machine was recently installed, remarked that the gap between what his hospital paid and what the government is reportedly paying was enough to make one ‘feel dizzy’. The label of a ‘turnkey project’ does not adequately explain a price differential of this magnitude. High Costs CPR Hospital recently had a state-of-the-art IVF centre approved at a sanctioned cost of Rs 7.20 crore. Senior fertility specialists across Maharashtra note that even a modern IVF centre with advanced reproductive technology equipment typically costs between Rs 2.5 crore and Rs 3 crore. The state’s outlay is reportedly approaching Rs 15 crore. Equipment arrived in June 2025 and lay idle for months owing to indecision about the site. Similarly, digital X-ray machines approved for CPR Hospital and a government hospital in Nanded; available in the market for roughly Rs 1.5 crore; were reportedly procured at Rs 9.98 crore per unit. Doctors in CPR’s radiology department, apprehensive about being drawn into potential inquiries, reportedly resisted accepting the equipment. One departmental head was transferred amid disagreements over signing off on the proposal. What’s Wrong These cases point to a deeper structural failure: Maharashtra has perfected what might be called the ‘equipment first, infrastructure later’ model. In any public hospital, the administrative sequence ought to be: identify space, create infrastructure, sanction specialist posts, and only then procure equipment. Compounding the procurement paradox is a parallel policy decision. On 20 December 2025, the state government decided to introduce radiology diagnostic services through a Public-Private Partnership model (PPP). Following this, an order issued on 6 February 2026 authorised private operators to provide PET scan, MRI and CT scan services at six government medical college hospitals: in Pune, Kolhapur, Miraj, Sangli, Mumbai and Baramati. CPR already has a 126-slice CT scan machine and a 3 Tesla MRI scanner, with another CT scan proposed. If the PPP arrangement proceeds, the hospital could simultaneously run one PET scan machine, two MRI scanners and three CT scan machines. Medical experts warn this could lead to unnecessary diagnostic testing simply to keep machines occupied, thus exposing patients to excess radiation while government-owned equipment gathers dust. A similar pattern was seen during the pandemic, when the Medical Education Department spent hundreds of crores on RT-PCR machines, only to award swab-testing contracts to a private company. Many of those machines remain unused today.

A Canopy, Then a Storm

The collapse of a roof in Novi Sad has triggered a nationwide uprising against Aleksandar Vučić’s decade-long rule. Serbians want change, and they are not backing down.

It began with a sudden crash. In November 2024, the newly renovated canopy of the railway station in Novi Sad, Serbia’s second-largest city, gave way, killing 16 people. The government claimed that the section had not been part of its modernisation programme. But, in a country long haunted by graft, few believed them.


The tragedy became a spark in a long-dry tinderbox. Since then, protests - led largely by students - have swept across Serbia, entering their eighth month with undiminished fervour. From Belgrade to Niš, chants against political decay echo through city squares. The demonstrators are not merely calling for justice for the dead; they are demanding the resignation of President Aleksandar Vučić, a man seen by many as the embodiment of a stagnant and compromised political order.


Vučić, a former information minister under Slobodan Milošević and president since 2017, has held power in various guises since 2012. He has consolidated authority through media control, party loyalty and a heavy-handed security apparatus. His Serbia resembles the “stabilitocracies” of the Western Balkans where stability is prized above reform. Corruption has flourished in this soil.


Serbia’s struggle with democratic norms has long been uneven. After the 2000 ouster of Milošević, hopes were high for institutional reform and EU integration. But post-Milošević governments were mired in inertia, plagued by patronage networks and economic mismanagement. Corruption investigations often fizzled out. Media pluralism declined. For many Serbians, the past two decades have brought not a clean break from autocracy, but a more polished version of it.


This is not the first time Serbians have risen en masse against autocracy. In 2000, following rigged elections and widespread repression, citizens poured into the streets to oust Milošević. Those protests, too, were sparked by a sense of helplessness and sustained by student organisations and civic groups. The fall of Milošević was seen as a democratic rebirth. But the years since have been marked by broken promises and democratic decay. Many Serbians now see the current unrest as a continuation of that unfinished revolution.


The European Union, with which Serbia has been in accession talks since 2014, is watching nervously. Brussels has grown increasingly wary of Belgrade’s democratic backsliding, murky procurement deals and Vučić’s overtures to Vladimir Putin. The EU has repeatedly signalled that rule-of-law reforms, judicial independence and media freedom are prerequisites for membership. Serbia’s failure to deliver on these fronts has turned the accession process into a Sisyphean climb. For young Serbians, EU membership still holds the promise of mobility, jobs and dignity. But with each passing month, that dream seems more distant.


Like many embattled regimes, the Vučić administration has reached for an old playbook: blame foreign conspiracies. Officials have accused student groups of being funded by Western intelligence agencies and labelled protest leaders as ‘anti-nationals.’ Police crackdowns, digital surveillance and intimidation tactics have followed. Yet the crowds have only grown larger.


In a bid to quell discontent, the government offered free public transport in Belgrade starting January this year. It was a populist flourish in a middle-income nation where many rely on buses and trams. But even this measure was met with scepticism, seen not as reform but as a bribe. After all, the dissatisfaction runs deeper than ticket fares.


In June 2025, over a million people flooded the capital’s city centre. That is nearly one-sixth of the population. Few protests in Europe have been this proportionally large. The mood was both defiant and hopeful.


The Serbian uprising carries echoes of movements past, from the 2000 protests that toppled Milošević to more recent discontent in Bulgaria and Hungary. It also reflects a culture of civic persistence rarely seen in many other democracies. In India, for instance, where lives are often lost to infrastructural failure, from bridge collapses to fire tragedies, public outrage is usually short-lived. A few days of public outrage and angry editorials is usually followed by a quiet return to routine. The Serbian example serves as a reminder that sustained civic pressure can force accountability, and collective memory need not be so short.


The Serbian protestors are reminding the world that citizens need not settle for impunity. And that sometimes, all it takes is a single crack in the roof to bring a rotten house down. India, where anger often gives way to resignation, might watch and learn.


(The writer is a Mumbai-based Chartered Accountant, foreign language tutor and an inveterate wanderlust. Views personal.)

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