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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 Inconvenient Economist

Gita Gopinath tells India to look past tariffs and focus on the air it breathes but speaks from the IMF’s Olympian perch.

Gita Gopinath has the air of someone who expects to be listened to and usually is. Soft-spoken, rigorously precise and conspicuously unimpressed by political fashion, the IMF’s First Deputy Managing Director speaks less like a public intellectual than a judge reading out a finding. At Davos this week, she delivered one such verdict on India. Forget tariffs for now, she advised and worry about pollution instead.


Pollution, Gopinath warned, now sits at the heart of India’s growth problem. A 2022 World Bank study estimates that 1.7 million Indians (about 18 percent of all deaths) die each year due to pollution. The costs, she insisted, are not confined to environmentalists’ spreadsheets. Dirty air lowers labour productivity, raises healthcare spending and acts as a permanent drag on growth. Investors, too, notice. “If you are thinking of setting up operations in India and living there, the environment matters,” she said.


Gopinath is not an activist parachuted into economics, but a card-carrying member of the profession’s high priesthood. As the IMF’s former chief economist and now its second-in-command, she oversees surveillance, research and the Fund’s flagship publications. She helped steer the institution through the Covid-19 shock, co-authoring a widely cited ‘pandemic paper’ that set global vaccination targets and corralled the IMF, World Bank, WTO and WHO into an unusually coordinated response.


Her intellectual pedigree is impeccable. Educated and later ensconced at Harvard, with an earlier stint at Chicago Booth, she has spent two decades writing about exchange rates, capital flows, crises and monetary policy. Few economists of her generation have moved so seamlessly between the academy and the commanding heights of global policy.


And yet, therein lies the tension. When Gopinath urges India to treat pollution control as a “mission” alongside deregulation, she is surely right. India’s air is among the dirtiest in the world and its burgeoning cities routinely vanish under a grey pall each winter. But the sermon comes from a familiar pulpit. For many in emerging economies, the IMF’s prescriptions, however empirically sound, often feel like lectures delivered from glass towers, far removed from political constraint and social messiness.


The Fund has long been better at diagnosing problems than navigating democracies. It can quantify the productivity loss from polluted lungs with admirable precision. It is less adept at grappling with the electoral economy that sustains coal plants, diesel engines and construction dust. Advising India to prioritise pollution over tariffs is easy sitting in Davos but is harder to get done in Delhi, where growth and federal politics collide daily.


Gopinath herself is more nuanced than the institution she represents. Unlike some IMF grandees of the past, she does not pretend that technocratic fixes operate in a vacuum. During the pandemic, she argued for pragmatic departures from orthodoxy like fiscal expansion, coordinated action, even industrial policy-lite to fix vaccine bottlenecks. Her work on the Integrated Policy Framework acknowledges that emerging markets cannot simply float their currencies and hope for the best.


Still, the broader IMF worldview lingers in her prescriptions. Carbon taxes, tighter regulation and cleaner energy are presented as economic imperatives, not political battles. While that framing looks analytically tidy, it is also incomplete. India’s pollution crisis is bound up with urbanisation without planning, weak municipal governance and a political economy that rewards short-term fixes over long-term breathing space.


To be fair, Gopinath did not deny this complexity. By calling pollution a “mission,” she implicitly invoked the scale of effort required. Her warning that environmental damage creates “deeper and longer-lasting” harm than tariffs is a reminder that growth debates obsessed with trade skirmishes risk missing the bigger picture. The irony is that institutions like the IMF, which once badgered countries about deficits and deregulation, are now among the loudest voices urging attention to air, climate and health. Perhaps the IMF has learned, partly through crisis, that growth divorced from health and environment is illusory.


Gita Gopinath’s intervention in Davos captures both the strength and the limitation of this new posture. She is right to say that pollution is a bigger threat to India’s economy than tariffs. She is right to insist that environmental damage creates deeper and longer-lasting harm than trade skirmishes. But her warning also highlights the enduring gap between diagnosis and delivery.


While India would do well to heed such warnings, those issuing it also must remember that the hardest part of reform is not diagnosis, but politics on the ground, which is far below the Davos air.

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