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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 Road Not Taken: Could Eastern Europe Have Forged Its Own Path?

It is tempting to speculate if Ukraine and its historically-scarred neighbours had forged a pragmatic regional bloc instead of hankering after NATO membership.

In the chessboard of post-Cold War geopolitics, few gambits have been as costly as Ukraine’s pursuit of NATO membership. It was an aspiration long in the making, spurred by historical grievances against Russia, stoked by the promise of Western security and ultimately culminating in a brutal war that has left the country battered, its cities in ruins and its future uncertain. But what if Ukraine, and indeed much of Eastern Europe, had charted a different course?


History seldom offers clean hypotheticals, yet it is tempting to imagine an alternative - one where these ‘bloodlands’ once caught between Nazi Germany and Soviet Russia (to borrow the title of Timothy Snyder’s powerful book) had coalesced into a bloc of their own, independent of both Western and Eastern hegemonies. A hypothetical ‘East European Union’ that could have prioritized regional security, economic cooperation and mutual defence without becoming entangled in the power struggles between NATO and Russia. Such a path was never truly considered. Instead, countries of the former Eastern Bloc drifted westward, seeking solace in the institutions that had once viewed them as Cold War pawns.


The region has, for centuries, been the fault line of empires - Ottoman, Austro-Hungarian, German and Soviet. The breaking of Nazi Germany’s stranglehold over this region was followed by tightening of Moscow’s iron grip under Joseph Stalin. To quote Churchill, an ‘Iron Curtain’ descended on this region, and for nearly half a century, as the Cold War raged, Eastern Europe was reduced to a collection of satellite states, ruled by Kremlin-appointed puppets who siphoned national wealth to serve Soviet ambitions.


When the USSR collapsed in 1991, the region’s nations found themselves adrift, struggling to redefine their identities in a rapidly changing world. While Gorbachev’s policies of Glasnost and Perestroika cracked open the Soviet monolith, they also exposed the economic stagnation and political repression plaguing Eastern Europe for decades.


Missed Opportunity

In the 1990s, as Western Europe cemented its unity through the European Union, Eastern Europe remained fragmented. Countries like Poland, Hungary and Romania sought EU and NATO membership as a means of securing their newfound sovereignty. Ukraine, however, found itself in a precarious position being too large, too geopolitically sensitive and too entangled with Russia to make a clean break. Had Ukraine, along with its regional neighbours, sought to build a separate coalition, one neither beholden to Moscow nor dependent on Washington, could it have averted its current crisis?


Ukraine’s flirtation with NATO was always going to be provocative. The military alliance’s constitution permits the installation of lethal intercontinental ballistic missiles (ICBMs) within member states - an intolerable prospect for Russia when placed right across its border. NATO’s gradual expansion eastward had already set off alarm bells in Moscow, and Ukraine’s growing Western orientation was the final straw.


Imagine, for a moment, if China were to establish a missile base in Sri Lanka’s Hambantota port, mere miles from India’s southern coast. The outcry from New Delhi would be deafening, and a military response almost inevitable. This is precisely how Russia viewed Ukraine’s potential NATO membership: an existential threat.


Thus, in 2022, Vladimir Putin acted pre-emptively, launching an invasion under the guise of protecting Russian interests. Ukraine, now three years into a devastating war, has paid the price of its NATO ambitions with thousands of lives. Entire cities lie in ruins. The economy has been shattered. The U.S. under Trump has curtailed its military aid, and while Europe and the UK remain sympathetic, their financial and military capacities are limited. Meanwhile, peace talks remain elusive, trapped in a cycle of accusations, counter-accusations, and failed negotiations.


It is tantalizing to speculate what might have happened had Ukraine and its Eastern European neighbours pursued a path that prioritized regional unity over alignment with global superpowers instead of chasing NATO membership. The idea is not without precedent. Regional alliances have long shaped global politics, instances being the Nordic Council, the Gulf Cooperation Council, ASEAN. An Eastern European Union, had it existed, might have provided Ukraine with the safety and stability it so desperately sought, without the antagonism that NATO membership entailed.


Such a bloc could still be conceivable today. If Ukraine, Poland, Romania, Hungary and other regional players came together in a strategic alliance, they might be able to strike a security deal with Russia - one that preserves their sovereignty while maintaining economic ties with the West. This approach would require pragmatic leadership, diplomatic finesse and a departure from the entrenched Cold War mentality that continues to shape East-West relations.


But geopolitics is rarely governed by reason alone. It is driven by ambition, fear and historical grievances. And so, while an Eastern European coalition remains an intriguing possibility, the more likely reality is that Ukraine will continue to suffer the consequences of its NATO aspirations.


In the end, Ukraine’s NATO dream may not have been a mistake in principle, but in execution. A dream pursued without sufficient power to defend it, without full commitment from allies, and without a clear understanding of Russia’s red lines, can quickly turn into a nightmare. For Ukraine and the world, the cost of this miscalculation is still being counted.

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