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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.

Battleground of the Deep: Geopolitical Storm in South China Sea

Updated: Oct 21, 2024

Battleground of the Deep: Geopolitical Storm in South China Sea

In his splendidly evocative 2014 book Asia’s Cauldron, master geo-strategist Robert D. Kaplan begins his geopolitical study of the South China Sea with a dazzling prologue on the ancient kingdom of Champa, its Hindu legacy.

In his trademark lapidary prose which has come to define his many works, Kaplan observes that Vietnam’s nearly one-thousand-mile-long coast lay astride two great civilizations: those of India and China with the South China Sea being “the maritime heart” of the Indo-Pacific region.

Long before the Cold War fault lines of North and South Vietnam, Kaplan notes there was a similar one in ancient times with the Sinicized Dai Viet, which established itself in Hanoi in North Vietnam clashing with Hindu Champa in the South. Dai Viet ultimately gobbled up Hindu Champa.

Fittingly, Prime Minister Narendra Modi’s historic visit to Brunei this week resurrects the legacy of Champa and the Indian influence to counter a truculent China in the Indo-Pacific and the flashpoint that is the South China Sea.

His meeting coincides with heightened tensions between China and its neighbours in the Indo-Pacific region, particularly the Philippines and Malaysia.

Last week, a Chinese coast guard vessel’s ramming of the Philippine flagship BRP Teresa Magbanua brought the confrontational environment in the South China Sea region into sharp relief. The Philippines has intensified its maritime patrols, only to face increasing provocations from China. The aerial domain is also becoming contentious, with the Philippines’ increased air patrols prompting warnings from Chinese think tanks about potential clashes.

Meanwhile, China recently demanded that Malaysia halt its oil exploration activities near the Luconia Shoals citing encroachments on its areas marked by the so-called ‘Ten-Dash Line’. This, despite Malaysia’s efforts to placate China, including remarks by Prime Minister Anwar Ibrahim emphasizing mutual benefit.

In this charged diplomatic atmosphere, India’s role comes as a deus ex machina in defusing tensions and rallying the Southeast Asian nations to counter China. During his meeting in Brunei, PM Modi reiterated India’s support for The Association of Southeast Asian Nations (ASEAN) centrality and peaceful resolution of disputes. The trip, marked by discussions on strengthening defence ties, exploring cooperation in liquefied natural gas (LNG) and renewable energies, and enhancing long-standing space partnerships, is indicative of India’s intent to deepen its engagement with Southeast Asia to counterbalance China’s domineering influence in the region.

The South China Sea, covering approximately 3.5 million square kilometres, is one of the world’s busiest maritime trade routes which accounts for a third of global shipping traffic.

Its resource-rich waters, with vast reserves of oil and natural gas buried beneath its seabed, make it a prime geopolitical prize – a veritable waterborne ‘Constantinople’ to which China, along with Malaysia, Brunei, Taiwan, Indonesia, the Philippines, and Vietnam are among the seven claimants to parts of the South China Sea.

For nearly two decades, China’s aggressive assertion over the South China Sea has been marked by a campaign of artificial island-building, military fortification, and assertive maritime patrols. Beijing justifies its expansive claims with the so-called ‘Nine-Dash Line’ - a vaguely defined demarcation that cuts into the exclusive economic zones of several Southeast Asian nations, including Vietnam, the Philippines, Malaysia, and Brunei. These nations, along with the self-governing territory of Taiwan, find themselves in a precarious position as they confront a rising China intent on rewriting the rules of maritime conduct.

India, under its 2014 Act East Policy, has increased its engagement in the region, highlighting the importance of freedom of navigation and the rule of law, including adherence to the United Nations Convention on the Law of the Sea (UNCLOS). By aligning with ASEAN nations like Brunei, India reinforces the call for a Code of Conduct in the South China Sea, advocating for a rules-based order and peaceful resolution of disputes — a veiled critique of China’s expansionism.

The policy’s ten-year milestone was marked by increased diplomatic engagements, including visits from the prime ministers of Vietnam and Malaysia to India, and President Droupadi Murmu’s trips to Fiji, New Zealand, and Timor-Leste.

In the midst of the China-U.S. rivalry, as Southeast Asian nations struggle to navigate tensions. But ASEAN’s long-sought Code of Conduct for the South China Sea continues to be stalled by diverging member priorities and chiefly by China’s reluctance to compromise.

Political scientist John Mearsheimer, in his classic work, The Tragedy of Great Power Politics claims that global hegemony is made difficult by the “stopping power of water.” As tensions in the South China Sea persist, it will need more than water to halt China’s hegemony. That counter could be in the form of India’s Act East strategy with its emphasis on a rules-based order.

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