Mad Over Modular

Kolhapur: Infection control has become central to modern hospital design. The concept of modular infrastructure, encompassing modular operation theatres (OTs) and modular intensive care units (ICUs), has gained considerable traction for its ability to minimise hospital-acquired infections and improve clinical outcomes. By ensuring sterile air circulation, sealed interiors, and contamination-resistant surfaces, these systems are designed to shield patients from secondary infections and enable faster recovery. Given their widespread adoption in private hospitals, the decision to replicate such facilities in government medical colleges is, in principle, welcome.

The question that has triggered unease within sections of the medical fraternity, however, is not about necessity but about cost. And, increasingly, about clinical rationale.

Modular Mayhem

Over the past year, Maharashtra's Medical Education Department has aggressively sanctioned modular facilities at Rajarshi Shahu Government Medical College and Chhatrapati Pramilaraje (CPR) Government Hospital in Kolhapur. Between October 2023 and July 2024, seven separate administrative orders were issued, cumulatively approving Rs 126.12 crore for 21 modular facilities across departments. Work orders have reportedly been issued and several projects inaugurated.

The approvals include seven modular OTs for the Surgery Department at Rs 1.98 crore per unit; a single modular OT for Cardiac Surgery at Rs 51.27 crore; a modular ICU with equipment for Medicine at Rs 26.50 crore; a Trauma ICU at Rs 11.20 crore; a Respiratory Care ICU at Rs 7.20 crore; a paediatric NICU at Rs 15.43 crore; a Burn Care Complex at Rs 14.29 crore; a Nephrology Dialysis ICU at Rs 25.88 crore; and a modular physiotherapy laboratory at Rs 13.69 crore. The total number of units ordered was 21, and a total amount of Rs 126.12 crore was sanctioned.

Surgeons and physicians who are expected to use these facilities privately admit that the sanctioned amounts appear significantly higher than prevailing market benchmarks.

Comparisons with reputed private hospitals, including a recently commissioned super-speciality hospital in Kolhapur, suggest that modular OTs there were developed at approximately Rs 30–50 lakh per theatre, while modular ICUs typically ranged around Rs 1 crore, depending on specifications.

At CPR, the per-theatre cost in certain cases approaches Rs 2 crore, and in some approvals, even higher. In certain approvals exceeding Rs 20 crore, documentation reportedly does not clearly delineate item-wise cost components, raising further questions about financial transparency.

Market logic would ordinarily suggest that large-volume government projects attract cost efficiencies through negotiation leverage. That the sanctioned amounts are, in some cases, reportedly double or triple private-sector benchmarks has, understandably, raised eyebrows.

Nowhere is this scrutiny sharper than in the case of the physiotherapy laboratory. On 9 July 2024, the Medical Education Department issued an administrative order (Machinery-2024/PR.430/Pr.Sha-1) sanctioning Rs 13.69 crore for establishing a modular physiotherapy lab at CPR. Modular OTs and ICUs emerged from advances in infection control, particularly for patients with compromised immunity, where controlled airflow and sterile environments are medically justified.

But physiotherapy departments typically cater to patients undergoing rehabilitation for orthopaedic or musculoskeletal conditions. These are individuals who are otherwise stable and not immunocompromised. Whether a fully modular setup is clinically essential for such services, or an overextension of a concept designed for high-risk zones, is a question now being raised not only by citizens but by administrators of large private hospitals in Kolhapur itself.

A closer look at comparable institutions in the city, including four private hospitals with capacities exceeding 300 beds, suggests that fully equipped physiotherapy departments have been established at costs well below Rs 1 crore. Even voluntary organisations such as the Rotary Club, which have invested consistently in modern physiotherapy services over decades, have reportedly not incurred expenditure anywhere near the sanctioned figure.

'Excessive' Risk

Faculty members within the institution have privately described the broader trend as excessive, warning that indiscriminate “modularisation” risks turning into a contractor-driven exercise rather than a patient-centric reform. Public funds, not private capital, are at stake, and that demands stricter scrutiny. Without detailed cost audits and public disclosure of tender comparisons, suspicions are unlikely to abate.

For Kolhapur's citizens, and for taxpayers across Maharashtra, the issue is straightforward: public money must deliver public value. Modernisation, if not matched by accountability, risks blurring the line between legitimate upgrade and avoidable expenditure.