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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.

India’s Choice: Compete with China or Create Differently

China’s dramatic rise as a scientific powerhouse has sparked frequent comparisons with India, often leading to calls for increased public spending on research. The disparity is clear. China’s gross R&D expenditure crossed USD 440 billion in 2022 (about 2.55 percent of its GDP) while India’s remains around USD 17 billion, or just over 0.65 percent of GDP. China filed over 85,000 international patents in 2023, compared to approximately 2,000 from India. These figures fuel the belief that India must scale up its investment in science and technology to remain globally competitive.


However, numbers alone do not capture the deeper contrasts between the two countries. China’s scientific surge is the result of tightly coordinated, state-led planning. Mission-mode programs like ‘Made in China 2025’ and the ‘14th Five-Year Plan’ have focused on artificial intelligence, semiconductors, and clean energy. Universities and research institutions are aligned with national strategic goals, and translational research is both encouraged and incentivized through well-integrated public-private mechanisms.


India, by contrast, faces systemic fragmentation. Research institutions often function in silos, industry linkages are weak, and bureaucratic delays hamper innovation. While Technology Transfer Offices are slowly expanding, they lack the agility seen in other innovation-driven economies. Many Indian scientists remain focused on publication counts rather than solving real-world problems. The recently operational Anusandhan National Research Foundation (ANRF) holds promise in addressing these gaps, but its impact will depend on sustained engagement and reform-minded implementation.


China’s system, however, comes at a steep cost. Academic freedom is constrained by political oversight. The restructuring of the Chinese Academy of Sciences in 2023 and the enforcement of ideological conformity across universities are reminders that research there is tightly controlled. While scientists have access to massive funding, their intellectual autonomy is limited. In contrast, Indian researchers, despite working with fewer resources, enjoy considerably greater freedom to choose their research directions, critique policies, and explore basic science without state interference.


That said, this freedom is occasionally interpreted in ways that risk detachment from societal needs. Under the banner of “curiosity-driven research,” some scientists pursue topics with little regard for long-term societal benefit. While open-ended inquiry is vital for scientific advancement, it should not become a pretext for disengagement from pressing public challenges. Scientific freedom must be balanced with responsibility. It is also worth appreciating that the Indian government does not impose ideological or programmatic diktats - a liberty rare in many parts of the world and one that should not be taken for granted.


Research integrity is another domain where both countries face serious challenges. China leads the world in retracted research papers. According to Retraction Watch, it accounts for over 30% of all retractions globally. Many are due to plagiarism, data fabrication, image manipulation, or ghost authorship. A Nature analysis from 2021 noted that nearly 500 Chinese papers are withdrawn annually. The intense pressure to publish for promotions and rewards has led to the proliferation of paper mills and academic fraud.


India is not immune. It ranks among the top 20 countries in terms of retractions, with many cases flagged on platforms like PubPeer. Concerns include plagiarized text, duplicate images, and questionable authorship. The problem is compounded by the persistence of predatory journals, some of which were once even endorsed by regulatory bodies. While India has taken steps to weed out such journals, enforcement remains inconsistent. In both countries, the “publish or perish” culture incentivizes quantity over quality, eroding public trust in scientific literature.


These concerns raise deeper questions about how science is assessed, funded, and rewarded. If India is to strengthen its global position, it must not only spend more, but spend wisely. That means building trust-based funding systems, fostering industry-academia collaboration, supporting long-term research with measurable outcomes, and creating robust checks for ethical conduct. Simultaneously, India must reform the way it evaluates scientific work—moving beyond publication counts and impact factors to reward innovation, reproducibility, and societal relevance.


Would Indian scientists prefer the Chinese model in exchange for more funding? Most would argue that true innovation requires intellectual freedom. The ability to ask inconvenient questions, challenge prevailing norms, and explore unconventional ideas has always driven breakthroughs. India’s pluralistic, democratic, and culturally diverse ecosystem, despite its imperfections, offers a more humane and open foundation for scientific progress.


That said, India cannot afford inertia. Without structural reforms, efficient governance, and accountable institutions, it risks losing talent to systems that offer better infrastructure even if they come with restrictions. India must enhance its public science ecosystem while also incentivizing private sector R&D. Ethical research conduct, transparent peer review, and data openness should become institutional norms, not afterthoughts.


Rather than comparing itself to China or any other country, India would do well to build its own scientific path rooted in autonomy, integrity, and long-term value. Learning from others is both necessary and wise, but replicating foreign models without reflection is not. India’s strength lies in its ability to create differently, not merely compete. The real choice is not between catching up and falling behind, but between replication and reinvention. India has the opportunity to choose wisely.


(Disclaimer: This article is not a criticism of China or any other country. It is a reminder to Indian scientists to make the most of the financial and institutional support available in India and to ensure that their research leads to meaningful outcomes for society)


(The author is the former Director, Agharkar Research Institute, Pune; Visiting Professor, IIT Bombay. Views personal.)

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