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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.

The Idle Trophy Wife

I have been a vegetarian my entire life, and lately, I’ve been contemplating going vegan. However, the thought of life without paneer seems almost impossible, especially during the big fat Indian weddings, where food is the highlight. My attempts at veganism usually last no longer than a week. But after contracting typhoid (an unfortunate souvenir from a family wedding) and indulging in excess, I decided to use my two weeks of bed rest to cleanse both my body and mind. That’s when I stumbled upon ‘The Vegetarian’ by South Korean author Han Kang. I discovered, much to my surprise, that it had won the Nobel Prize for Literature in 2024. Expecting a book about soul food, I instead found a novel that profoundly altered my soul.


The story follows Yeong-hye, an ordinary woman who makes the extraordinary decision to become vegan after experiencing a disturbing dream. The novel is divided into three parts, each narrated by a different person in her life: her husband (Cheong), her brother-in-law (an unnamed artist), and her sister (In-hye). Interestingly, Yeong-hye herself is not the primary narrator; her thoughts and struggles are only revealed through her actions and interactions with others. She grapples with internal conflicts while also struggling against the rigid expectations of society. By the end of the novel, her subconscious takes over, and she stops eating entirely, believing she is transforming into a tree.


Her husband, Cheong, cannot comprehend why a mere dream has led Yeong-hye to throw away their freezer full of expensive meat and replace it with salad and seaweed soup. He doesn’t attempt to understand her restless nights or even ask what the dream was about. When she embarrasses him at a work dinner by refusing to wear a bra, he calls her family to ‘fix’ the problem. Her father’s solution? Forcing pork down her throat. When she resists, he slaps her across the face. Her family, including her husband, watches in silence, without protest.


Women often surrender so much of themselves for the people around them that, over time, they are taken for granted. Society dictates how we should live, and our behaviour is constantly scrutinized for approval. Yeong-hye had no control over her life or the people in it, so she decided to control the one thing she could - what she put into her body. But even that autonomy was unacceptable, and she was ultimately institutionalized for it. This made me think of how force-feeding is a societal ritual, especially in Indian households. Hospitality is intertwined with food, and declining an offering is often seen as offensive. But is this about them, or is it about us - our fear of upsetting others, or more so being disliked?


Yeong-hye’s brother-in-law, the artist, develops a strange obsession with her after hearing about her divorce. He fantasizes about painting a flower over her birthmark and, defying societal norms, approaches her with the idea. Yeong-hye embraces his vision as a means of creation, a form of rebirth. Their intimate connection allows her to break free from her chains, reflecting the reality of how often are we warned against associating with certain people simply because it isn’t socially acceptable. How many times are we discouraged from making choices that truly reflect our desires, simply because we fear judgment?


The novel’s final chapter shifts to In-hye, Yeong-hye’s sister, who follows every social convention and suffers all the same. Bound by duty to her son and sister, In-hye suppresses her own desires, clinging to order as Yeong-hye drifts into madness. Her struggle reflects a familiar plight: how often do women silence their instincts, convinced that self-denial is a form of care? I can recall countless times when my own dreams were dismissed as whimsical, unrealistic. But the more I ignored them, the more they persisted.


This book is a form of social activism, leaving us with more questions than answers. For me, it highlights an inevitable truth: there comes a point when we stop living for society’s approval and start seeking happiness within ourselves. Yeong-hye reached that point. She chose her own path because it was hers. She could not control the world around her, so she chose to control herself. Her ultimate vision? To become a tree, however ridiculous it was.


Reading this novel made me realize something profound: in some way, every married Indian woman is a vegetarian. I have been one all my life, but I am only now beginning to understand what that truly means. I am finally choosing myself. Shouldn’t we all?


(The author is a paediatrician and a public health specialist.)

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