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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.

Will Trump’s First 100 Days see a new Power Play in South Asia?

Updated: Jan 9, 2025

As Donald Trump returns to the White House for his second innings, South Asia braces for a major shift in its geopolitical order.

Donald Trump

When Donald Trump steps into the White House for a second term on January 20, 2025, his first 100 days is expected to send ripples across the globe, but perhaps nowhere more so than in South Asia. In this new phase of his presidency, the contours of global power dynamics—particularly those between India, China, and the United States—are expected to be set for a major recalibration. Trump, ever the epitome of unpredictability, is about to inject a new wave of volatility into the already fraught strategic triangle of these three giants.


Trump’s first term saw the U.S. positioning India as a key counterweight to China in Asia—a stance likely to deepen in the second term. His re-election has already triggered efforts to cement closer ties between Washington and New Delhi, with a focus on defence pacts, intelligence sharing, and energy exports. Trump, more pragmatic than ideological, has worked to weave India into Washington’s broader strategy of countering China’s ambitions. Nowhere is this more evident than in the Quad, a loose but increasingly relevant alliance of the U.S., India, Japan, and Australia, all united in their opposition to Beijing’s territorial expansion in the Indo-Pacific.


For India, this partnership promises much. It could modernize infrastructure, bolster defence capabilities, and provide access to a global market less dependent on China. Yet, the stakes are high. As India draws closer to the U.S., it risks being drawn into a more entrenched geopolitical rivalry. The 2020 Galwan Valley clash, in which Chinese and Indian troops skirmished, sharpened China’s perception of New Delhi’s growing alignment with Washington. Beijing views this as a direct challenge to its regional hegemony, and the result has been an increasingly aggressive stance along the Line of Actual Control (LAC).


The delicate balance for India is evident. While the U.S. provides strategic reassurance in the face of China’s growing military and economic power, this partnership also complicates India’s longstanding policy of non-alignment. Trump’s enthusiastic support of India in international forums like the G20 has elevated New Delhi’s global profile. However, the benefits of this alliance come at a cost: India’s evolving relationship with the U.S. is pushing the region toward deeper polarization. China, ever calculating, will no doubt seek to counterbalance this shift through its own alliances, particularly with Russia and Pakistan.


While the India-U.S. relationship holds promise, it is not without complications. India’s historical ties to Russia, particularly in the realm of defence, have long created friction with Washington. India’s dependence on Russian military systems, notably the S-400 missile defence system, has long been a contentious issue. The U.S. has already signalled its displeasure with these ties, threatening sanctions under the Countering America’s Adversaries Through Sanctions Act (CAATSA). The tension between these two superpowers highlights Trump’s dilemma in his second term: how to integrate India into a broader U.S. strategy while also acknowledging the deep, historical ties that New Delhi has with Moscow.


Xi Jinping, China’s ever-assertive leader, looms large in the background. The growing confrontation between the U.S. and China has placed India in a precarious position. As Washington escalates its criticism of Beijing—on issues ranging from human rights abuses in Xinjiang to its actions in Hong Kong—India finds itself with a diplomatic opening. Trump’s rhetoric against Beijing has created opportunities for India to reinforce its strategic alignment with the U.S., especially in the Indo-Pacific, where the emergence of the Quadrilateral Security Dialogue (Quad)—a group comprising the U.S., India, Japan, and Australia—has created a new framework for regional security, seeking to push back against China’s territorial expansion. The broader regional context will bear significant weight on Trump’s approach to South Asia.


Yet, as India embraces its newfound role in the U.S.-led alliance, it also faces the inconvenient reality of economic interdependence with China. Despite efforts to diversify supply chains away from China, India remains deeply dependent on Chinese imports, particularly in electronics and pharmaceuticals. The economic complexity of this relationship risks limiting India’s strategic flexibility, forcing it to navigate between the U.S. and China’s competing spheres of influence.


While Trump’s second term promises to intensify the U.S.-India relationship, it will also place India in a position where it must continually balance its historical ties to Russia with its emerging role as a partner of the U.S. This is especially true as Washington’s dual-front strategy seeks to isolate both Russian and Chinese influence on the global stage. India’s challenge will be to navigate these shifting alliances while preserving its autonomy in a rapidly changing world.


In this dynamic geopolitical landscape, Trump’s first 100 days will be critical in determining the future of South Asia. India, already a crucial player in the global order, will need to carefully balance its alliances with Washington and Moscow while maintaining its autonomy in the face of China’s growing assertiveness. On the other hand, how Trump handles the U.S.-China rivalry, especially in South Asia, will have far-reaching implications not just for India, but for the broader geopolitical order.


(The author is an educationalist. Views personal.)

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