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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.

Gun Violence in America

Updated: Jan 2, 2025

Gun Violence in America

On December 16, 2024, tragedy struck Abundant Life Christian School in Madison, Wisconsin, where a 15-year-old student, Natalie Rupnow, fatally shot a fellow student and a teacher before taking her own life. Six others were injured, with two in critical condition. This devastating event is a grim reminder of the United States' ongoing struggle with gun violence, particularly in schools.


A Long History of Gun Ownership in America

The issue of gun violence in the United States cannot be discussed without acknowledging its deep-rooted history of gun ownership. The right to bear arms is enshrined in the Second Amendment of the U.S. Constitution, adopted in 1791, which states: “A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.”


Initially, this amendment was intended to empower citizens to form militias for self-defense during a time when standing armies were distrusted. Over the centuries, however, the interpretation of the Second Amendment has evolved. Today, it is often cited as a justification for individual gun ownership, a concept reinforced by landmark court cases such as District of Columbia v. Heller (2008), which affirmed an individual's right to own firearms for self-defense.


Gun culture is deeply ingrained in American society, with nearly 400 million firearms in civilian hands—more guns than people. This level of accessibility, coupled with a powerful gun lobby led by organizations like the National Rifle Association (NRA), has made significant legislative reform difficult.


Gun Violence in Numbers

According to the Centers for Disease Control and Prevention (CDC), firearms cause approximately 40,000 deaths annually in the United States—equivalent to 109 deaths per day. This figure includes homicides, suicides, and accidental shootings. Among children and teenagers, firearms are now the leading cause of death, surpassing motor vehicle accidents.


School shootings are a particularly horrifying aspect of gun violence in America. Since 1990, there have been over 800 incidents in K-12 schools, resulting in more than 500 deaths and over 1,000 injuries. High-profile tragedies such as the Columbine High School massacre (1999), the Sandy Hook Elementary School shooting (2012), and the Marjory Stoneman Douglas High School attack (2018) have shocked the nation and the world, yet meaningful reforms remain elusive.


A Global Comparison

The United States stands out among developed nations for its high rate of gun violence. In countries like Australia, Canada, and much of Europe, strict gun control measures have significantly reduced firearm-related deaths. For example: By contrast, the firearm-related death rate in the United States is 12.2 per 100,000 people, significantly higher than other developed nations. The prevalence of guns and the lack of uniform gun control laws contribute to this disparity.


Challenges in Addressing Gun Violence

Efforts to reduce gun violence in the U.S. have faced significant obstacles. One of the most notable is the prohibition of federal funding for gun violence research. In 1996, Congress passed the Dickey Amendment, effectively barring the CDC from studying gun violence as a public health issue. Although the funding ban was partially lifted in 2019, its legacy has left the country with a limited understanding of the causes and solutions to gun violence.


Advocates have long called for measures such as:

• Universal Background Checks: Closing loopholes in gun sales to ensure that all firearm purchases are subject to background checks.

• Safe Storage Laws: Requiring gun owners to store firearms securely to prevent unauthorized access.

• Bans on Certain Firearms: Prohibiting the sale of assault-style weapons, which are often used in mass shootings.


The Debate Over Gun Rights and Reform

The debate over gun control in the United States often pits the rights of gun owners against the need for public safety. Opponents of stricter gun laws argue that restrictions infringe on constitutional rights and fail to address the root causes of violence, such as mental health issues. Proponents, however, point to the success of gun control measures in other countries and the overwhelming public support for policies like background checks.


A Way Forward

Despite the challenges, there is growing momentum for change. Grassroots organizations, survivors of gun violence, and some lawmakers are advocating for comprehensive reforms. The Madison school shooting serves as a stark reminder of the urgency of these efforts. As the nation grapples with its gun violence epidemic, it must look to both its history and the experiences of other countries to find a path toward a safer future.


(The author is a resident of US. Views personal.)

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