Committees galore, no action

Kolhapur: Something remarkable has happened to heart care in India over the past two decades. Procedures that once required a patient to travel to a major city — angiography, angioplasty, complex interventions — are now available in district hospitals. The machine that made this possible is the catheterisation laboratory, the Cath Lab, a sophisticated imaging suite that has quietly become the backbone of modern cardiac treatment. Maharashtra has been expanding this network. That is the good...

min read

Kolhapur: Something remarkable has happened to heart care in India over the past two decades. Procedures that once required a patient to travel to a major city — angiography, angioplasty, complex interventions — are now available in district hospitals. The machine that made this possible is the catheterisation laboratory, the Cath Lab, a sophisticated imaging suite that has quietly become the backbone of modern cardiac treatment. Maharashtra has been expanding this network. That is the good news. The troubling part is what the expansion is costing. The big manufacturers in this space: Philips, GE HealthCare, Siemens Healthineers; price a quality Cath Lab at roughly Rs 6–8 crore. Bundle in installation, civil works, ancillary equipment, the whole turnkey package, and you are still looking at Rs 10–12 crore by most industry reckonings. So when procurement figures in Maharashtra climb to Rs 25–40 crore for a single unit, the gap demands an explanation. Two government resolutions from the State's Medical Education Department tell the story bluntly. On January 25, 2024, a Cath Lab was approved at Rs 16.50 crore. Six months later, on July 5, 2024, the same department cleared Rs 39.76 crore on a turnkey basis for a biplane Cath Lab at CPR Hospital in Kolhapur. That is a difference of Rs 23.26 crore. The Public Health Department has since sanctioned Rs 99.85 crore for Cath Labs in Pune, Kolhapur, Jalna, and Gadchiroli, working out to roughly Rs 24.96 crore apiece. The Issue To understand how prices get this far from reality, you have to follow the supply chain. Maharashtra once bought medical equipment through government rate contracts. When irregularities surfaced there, procurement moved to the Haffkine Institute. That arrangement bred its own dissatisfactions, and purchases shifted again, this time to District Planning and Development Council funds. In the earlier model, manufacturers bid directly. That meant the original company stood behind the warranty, the maintenance, the performance; all of it contractually binding. But as tender prices crept upward, manufacturers grew cautious. They have global pricing norms to protect and reputations to consider. Quietly, many stepped back from tenders where the quoted figures looked hard to justify. Distributors filled the vacuum. The mechanics are simple: a manufacturer invoices a distributor at a standard rate; the distributor quotes the government at a far higher one. The manufacturer's exposure is limited to what it charged the distributor. The markup in between sits beyond the reach of direct corporate scrutiny. With enough institutional weight on the buying side, public controversy becomes easier to contain. Inquiry After inquiry The Cath Lab story would be troubling enough on its own. But it is part of something larger; a pattern of governance failure in Maharashtra's health sector where accountability has become almost theoretical. The pandemic made this visible to everyone. While people hunted for oxygen cylinders and basic medicines, procurement deals were allegedly being struck at many times the market rate. Legislative uproar followed. Audit inquiries were commissioned and reportedly confirmed financial irregularities running into crores. And then? Years on, critics point out that not a single clerk was suspended. The officials against whom inquiry reports recorded the most serious findings are said to have been promoted. At CPR Government Hospital and Rajarshi Shahu Government Medical College in Kolhapur alone, the count of inquiry committees reportedly crosses a hundred. A fire at a trauma care centre allegedly cost patients their lives; an inquiry was ordered and apparently went nowhere. A lift malfunction injured a patient; a committee was formed, accountability never fixed. The irony An inquiry into inflated procurement was apparently abandoned after its own chairperson resigned, citing pressure. A clerk allegedly misappropriating fees from paramedical courses was referred to a committee; what followed remains opaque. In at least one case, people who were themselves the subject of ongoing scrutiny were later appointed to chair other committees. Files pile up. Conclusions do not. Credibility Deficit Health is not an abstract policy domain. When a hospital lift fails and nobody answers for it, when procurement is inflated and the inquiry dissolves quietly, the consequences fall on patients; people who often have nowhere else to turn.The credibility deficit this creates is real and cumulative. Once officials understand that irregularities carry no personal cost, a culture sets in that is very difficult to reverse. Maharashtra needs its Cath Labs. That is not the argument. The argument is that spending public money to build health infrastructure, while tolerating opacity in how that money is spent, is not a health policy. it is a contradiction. Restoring trust will take more than the next committee. (Concludes)

When the Princess Left Her Fortress…

Anishkaa Muthe
Dec 30, 2024
4 min read

Updated: Jan 2, 2025

I recently saw a movie, it had this dialogue “teenage girls are psychopaths” and maybe it is right, maybe we are a generation full of messed up kids trying to survive in this deathly jungle we’ve created for ourselves. And this survival gets harder when you’re a 16-year-old that moves into a city way bigger than their own, to ‘step into the world’ with rosy dreams and rosy expectations. I am one of those 16-year-olds, who with very romanticised notions, very naively decided to step into the ‘City of Dreams’: Mumbai.

Mumbai, is probably 10 times the size of my not very humble, but very little town. Moving to Mumbai was my dream since 1st grade, and when that dream manifested, I was on Cloud 9. I thought my life would be perfect, I’d have the perfect group of friends, I’d go to fancy parties, I’d do lots of events in college, I’d be known, I’d be in my ‘Academic Beast’ ‘It Girl’ era and what not; but reality is pretty far from any of that. Back in my town, I was the top of the hierarchy, the Perfect Girl, centre of attention, the Lovely Queen; after moving to Mumbai, my life of the last 13yrs came crashing down on me. I became this introverted, invisible person; the friends’ group or lots of parties definitely did not happen, neither did the academic beast and It girl era.

I came to realise that Mumbai, no matter how pretty, beautiful and picture-worthy, is very harsh and extremely tough. No matter how much anyone says ‘Mumbai embraces all’, the ‘All’ still do feel left out to some extent, when everyone around you is this confident Mumbai Kid and you’re this awkward girl from out of town who knows nothing about the city, its people or its ‘culture’, who’s trying to push through this humongous crowd that’s, without trying very hard, swallowing you down; but standing here, watching this city move past me, I wonder Does Mumbai really not bother about anyone Or Is it just not willing to let you in?

But there’s still something to hang on to, somewhere to belong, isn’t there? When you go back home and you have friends there; Spoiler Alert: you don’t. When I went back home for my first holiday, I realised I didn’t belong there anymore, now I was the Mumbai Girl; 13yrs lost and forgotten, within 3 months. That’s when it hit ‘I’m all alone now’ neither do I belong in Mumbai, neither do I back at home. Trust me, I have never felt more lost in my life.

I’m the kind of people who thrive on attention and external validation, to have that very thing taken from me was very hard to live with. So, I chose to cope by holding on, holding on how? Well, simple tactic, making an indirect statement saying “you excluded me, but I belong in places better than you” how I did that? I held onto my past self, my actions were based on how pretty, fun and ‘happening’ my life was to look on Instagram. I did have fun, not that I didn’t, but most of it was for the eyes of the world and not my own satisfaction [it still is that way, I haven’t gotten any better yet].

Then came my midterms, and I wasn’t as great as I thought I’d be and my extracurriculars weren’t anything major either. That made me realise that I was like any other kid around me here, unlike when I was back home, always the different one, the one that stood out, and suddenly I didn’t anymore, I was ordinary. The realisation hit me, right in the face, hard and strong, that in this huge ocean, I was no whale or shark, just another little fish in the Shoal. My future suddenly became scary, thinking about college and university became terrifying and I just wanted to avoid it all, simply run away [I still do, sometimes] And now, I’m a mess.

But not all of it was bad honestly, Mumbai taught me a lot of things, it humbled me and it helped see: within myself and so many things about myself that I never really knew and were suddenly crystal clear in front of my eyes, as if a very loud noise had been shut down and I could hear clearly again. Back at home, I had this persona designated to me: ‘The Perfect Girl’ and suddenly I didn’t have to be anyone anymore, it was harder that way honestly, to not have a script to follow anymore. I had to discover myself and who I truly was for the first time Ever; I think that’s what I’m doing now, getting to know myself beyond who I was 6 months ago.

Things aren’t any better right now, I don’t think they will be for very long and sometimes moving here may seem like the biggest mistake I’ve ever made, but I wouldn’t want it any other way. So, this new year I have one resolution: I’m going to find who I am, a new persona, a new person, not defined by her past self, past life and this Social Jungle of teenagers she’s surviving in. This new year will be of rediscovery. So, here’s to 2025 and to all of us, whose lives changed because they stepped into the big, bad world out there; let us all be proud of ourselves as this year ends, because leaving our homes and lives behind is not easy and we lived that down: The Shift, the way it hit our egos and shattered our sense of belonging, but we didn’t run away, we strived through it and are surviving to see the light of day.

So, A Very Happy New Year People.

(The author is a student of St. Xavier College, Mumbai.)

1 Comment

Jayaram Kousik .

Jun 12, 2025

Great write, yes Mumbai is a jungle and you have to fund your true bearings and none towards your destination