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.

The Brewing Tempest: India’s Looming Multi-Front Challenge

India’s Looming Multi-Front Challenge

In the annals of India’s strategic concerns, the notion of a multi-front war has always loomed as a theoretical worst-case scenario. Today, it seems less theoretical and more a stark possibility. India now finds itself in a precarious position, navigating strained relations with China, Pakistan, and Bangladesh, while domestic turbulence threatens to undermine its internal stability. The prospect of a ‘three-and-a-half-front war’ has moved from the realm of policy seminars to the reality of national security briefings.


India’s immediate worry lies to the east, where its relationship with Bangladesh has taken a sharp and disconcerting turn. The August 2024 U.S.-backed ousting of Sheikh Hasina from power was a watershed moment. Using student protests as cover, a democratically elected government was replaced with one led by the Nobel laureate Mohammad Yunus. While Yunus’s credentials may shine abroad, his ascent has sown discord at home and abroad. Sheikh Hasina, now in exile in India, remains a polarizing figure—a living symbol of a broken democratic covenant in Dhaka.


Under Yunus’s interim administration, Bangladesh has adopted policies that cut deeply into the ties that once bound the two nations. Trade restrictions have bruised Indian industries. Dhaka’s narrative, now laced with accusations of Indian interference, disregards India’s critical role in Bangladesh’s independence in 1971. To further exacerbate tensions, the new regime has demanded Hasina’s extradition, a move calculated to inflame bilateral relations.


Adding a troubling dimension to the equation is Bangladesh’s evolving military posture, supported by a trio of regional players—China, Pakistan, and Turkey. Beijing is readying supplies of advanced fighter jets and attack helicopters. Islamabad has offered training for Bangladeshi forces, while Ankara has provided drones and missile systems, with promises of more. These developments are no mere armoury upgrades but signal the creation of a strategically fortified Bangladesh, potentially aligned with adversarial forces.


But it is not just external threats that keep Indian strategists awake at night. The ‘half front’ is a vexing and amorphous challenge rooted in the nation’s domestic fissures.


India’s internal security apparatus faces mounting pressure from cross-border terrorism, much of it orchestrated by Pakistan’s Inter-Services Intelligence (ISI). Recent investigations into unrest in Manipur have revealed links to Arakan and Chin insurgent groups. Refugee influxes, particularly from Bangladesh, have brought with them not only humanitarian challenges but also security risks, with reports of terror plots linked to some of these migrants. Foreign-funded civil society organizations, while vital to democracies, have been accused of advancing anti-national agendas, channelling resources into protests, propaganda, and even electoral interference.


The economic dimension of the ‘half front’ is equally troubling. China’s economic encirclement of India has shifted from borders to boardrooms. By dumping cheap goods into the Indian market and leveraging opaque collaborations with domestic companies, Beijing continues to destabilize local industries. The $4 billion Chinese investment in Indian startups, once seen as a sign of bilateral economic integration, now appears as a potential Trojan horse.


On top of these challenges are the festering domestic grievances that simmer across India’s social and political landscape. From ethnic tensions and agrarian distress to religious discord and the proliferation of drugs, these issues create fertile ground for unrest.


So, how does India chart a course through this storm? The first step lies in diplomacy. India must recalibrate its foreign policy to counter the growing nexus of China, Pakistan, and Bangladesh. Strengthening ties with countries like Japan, Australia, and the United States will be crucial. Multilateral forums, such as the Quad, offer platforms for India to project influence and build strategic deterrence.


Modernizing the armed forces and intelligence apparatus is another urgent priority. While India’s military remains a formidable force, the threats it faces are evolving rapidly. Cybersecurity, unmanned systems, and artificial intelligence must take centre stage in defence planning. Border infrastructure, often overlooked in times of peace, must be bolstered to ensure rapid mobilization and supply chain resilience.


Domestically, the government must eradicate corruption in security, tackle root causes of unrest with equitable economic reforms, counter radicalization through education, and foster unity with targeted community outreach.


Civil society, too, has a role to play. Instead of vilifying these organizations wholesale, the government should work with credible groups to foster a sense of shared purpose and responsibility. A vigilant citizenry, armed with critical thinking and media literacy, can act as a bulwark against the tide of disinformation.


Finally, India must recognize the delicate balance between strength and restraint. To quote Sun Tzu from The Art of War: “In the midst of chaos, there is also opportunity.” The chaos India faces today is undeniable, but so, too, is the opportunity—to redefine its security paradigm, to reinvigorate its democratic institutions and reaffirm its role as a stabilizing force in a volatile region.


The stakes could not be higher. India’s ability to navigate this tempest will determine not only its own future but also the trajectory of an entire region. As history has shown, nations that weather their storms often emerge stronger, tempered by adversity and fortified by resolve. For India, the time to act is now.

(The author is a retired Indian Naval Aviation Officer and a geo-political analyst. Views Personal.)

Comments


bottom of page