Committees galore, no action

Kolhapur: Something remarkable has happened to heart care in India over the past two decades. Procedures that once required a patient to travel to a major city — angiography, angioplasty, complex interventions — are now available in district hospitals. The machine that made this possible is the catheterisation laboratory, the Cath Lab, a sophisticated imaging suite that has quietly become the backbone of modern cardiac treatment.

Maharashtra has been expanding this network. That is the good news. The troubling part is what the expansion is costing.

The big manufacturers in this space: Philips, GE HealthCare, Siemens Healthineers; price a quality Cath Lab at roughly Rs 6–8 crore. Bundle in installation, civil works, ancillary equipment, the whole turnkey package, and you are still looking at Rs 10–12 crore by most industry reckonings. So when procurement figures in Maharashtra climb to Rs 25–40 crore for a single unit, the gap demands an explanation.

Two government resolutions from the State's Medical Education Department tell the story bluntly. On January 25, 2024, a Cath Lab was approved at Rs 16.50 crore. Six months later, on July 5, 2024, the same department cleared Rs 39.76 crore on a turnkey basis for a biplane Cath Lab at CPR Hospital in Kolhapur. That is a difference of Rs 23.26 crore.

The Public Health Department has since sanctioned Rs 99.85 crore for Cath Labs in Pune, Kolhapur, Jalna, and Gadchiroli, working out to roughly Rs 24.96 crore apiece.

The Issue

To understand how prices get this far from reality, you have to follow the supply chain. Maharashtra once bought medical equipment through government rate contracts. When irregularities surfaced there, procurement moved to the Haffkine Institute. That arrangement bred its own dissatisfactions, and purchases shifted again, this time to District Planning and Development Council funds.

In the earlier model, manufacturers bid directly. That meant the original company stood behind the warranty, the maintenance, the performance; all of it contractually binding. But as tender prices crept upward, manufacturers grew cautious. They have global pricing norms to protect and reputations to consider. Quietly, many stepped back from tenders where the quoted figures looked hard to justify.

Distributors filled the vacuum. The mechanics are simple: a manufacturer invoices a distributor at a standard rate; the distributor quotes the government at a far higher one. The manufacturer's exposure is limited to what it charged the distributor. The markup in between sits beyond the reach of direct corporate scrutiny. With enough institutional weight on the buying side, public controversy becomes easier to contain.

Inquiry After inquiry

The Cath Lab story would be troubling enough on its own. But it is part of something larger; a pattern of governance failure in Maharashtra's health sector where accountability has become almost theoretical.

The pandemic made this visible to everyone. While people hunted for oxygen cylinders and basic medicines, procurement deals were allegedly being struck at many times the market rate. Legislative uproar followed.

Audit inquiries were commissioned and reportedly confirmed financial irregularities running into crores. And then? Years on, critics point out that not a single clerk was suspended. The officials against whom inquiry reports recorded the most serious findings are said to have been promoted.

At CPR Government Hospital and Rajarshi Shahu Government Medical College in Kolhapur alone, the count of inquiry committees reportedly crosses a hundred. A fire at a trauma care centre allegedly cost patients their lives; an inquiry was ordered and apparently went nowhere. A lift malfunction injured a patient; a committee was formed, accountability never fixed.

The irony

An inquiry into inflated procurement was apparently abandoned after its own chairperson resigned, citing pressure. A clerk allegedly misappropriating fees from paramedical courses was referred to a committee; what followed remains opaque. In at least one case, people who were themselves the subject of ongoing scrutiny were later appointed to chair other committees. Files pile up. Conclusions do not.

Credibility Deficit

Health is not an abstract policy domain. When a hospital lift fails and nobody answers for it, when procurement is inflated and the inquiry dissolves quietly, the consequences fall on patients; people who often have nowhere else to turn.The credibility deficit this creates is real and cumulative. Once officials understand that irregularities carry no personal cost, a culture sets in that is very difficult to reverse.

Maharashtra needs its Cath Labs. That is not the argument. The argument is that spending public money to build health infrastructure, while tolerating opacity in how that money is spent, is not a health policy. it is a contradiction. Restoring trust will take more than the next committee.

(Concludes)