top of page

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.

From Vision to Action: Building Thane’s First Biomedical Waste Facility

With TMC land, IIT-Bombay guidance, and a mix of savings and loans, we built a biomedical waste facility.

In an earlier article, I reviewed hospital technologies for managing biomedical waste, from microwaves to autoclaves, and their challenges in India. Furthermore, I highlighted how the shift focused on innovative developments and inspiring success stories within the country. From the Make in India–driven Srjanam automated biomedical waste treatment plant at AIIMS, New Delhi, to the grassroots, community-led efforts of Thane’s Enviro-Vigil NGO, these initiatives showcase both cutting-edge technology and sustained local action that are shaping the future of sustainable biomedical waste management in India.


While these innovations highlighted what was possible at a national and institutional level, our own journey in Thane began much closer to home. With limited experience but a strong resolve, we decided to take on the challenge of creating a functional biomedical waste facility ourselves.


Given our non-technical backgrounds, we were naturally a little apprehensive at first, but we decided to take the plunge and give it a try. A few pharmaceutical companies already had incinerators, and a couple of scientist friends introduced us to the machines. We also sought guidance from experts at IIT-Bombay to learn and adopt the technology. After several rounds of discussions, deliberations, and careful consideration, we finally decided to accept the challenge and move forward.


The Thane Municipal Corporation (TMC) provided the required land within the premises of Chhatrapati Shivaji Maharaj Hospital in Kalwa. When we visited for the first time, the site was completely covered with construction and demolition debris collected from across the city. Our initial task was to clear the debris and level the land to make it suitable and safe for our operations. We rolled up our sleeves and started working on it.


Another significant hurdle was raising sufficient funds. This was necessary not only to acquire the incinerator, autoclave, and other machines. We would also have to develop the necessary infrastructure, including a storehouse, office space, and a large room to house the incinerator. The total budget at that time was around sixty lakh rupees. We contributed a portion from our personal savings and secured a loan from a local bank to cover the remaining amount.


The next step was to complete all legal formalities and obtain authorisation from the Maharashtra Pollution Control Board (MPCB). Eventually, after clearing the debris, constructing the infrastructure, procuring the equipment, and installing everything in accordance with standard norms and specifications, the facility was fully operational.


In the meantime, we organised a seminar for doctors and hospital staff in collaboration with the Indian Medical Association, Thane chapter, to provide detailed information about the common biomedical waste facility we were setting up and to address any questions or concerns they had. In addition, we developed a comprehensive training programme for nurses and housekeeping staff across the hospitals to help them understand the provisions of the 1998 biomedical waste rules and to clarify the responsibilities of each employee, especially regarding proper waste segregation. We began conducting these training sessions in every hospital using slideshows and posters, even before the incinerator and other equipment were installed.


Beyond these internal initiatives, we also created awareness posters featuring appeals from eminent Marathi film and theatre actors such as D. Girish Oak, Suhastai Joshi, and Sarika Nawathe. The posters showed the actors urging the general public to consider whether they were aware of biomedical waste, followed by the message: “Ask your doctor whether they are segregating their waste.” This initiative aimed to educate ordinary citizens about a completely new category of waste, something no other operational facility in India had attempted at the time.


We officially began collecting and treating waste in March 2003, and the facility was formally inaugurated by Shri Ram Naik, then Petroleum Minister, Government of India. By that time, we had also started enrolling clinics and hospitals to connect with our facility in compliance with the rules, ensuring a structured and law-abiding system for biomedical waste management.


Curious to know what happens next? Stay tuned for next week’s continuation, and have a fantastic weekend!


(The author is an environmentalist. Views Personal.)

Comments

bottom of page