Bihar's health procurement row: Allegations, evidence and accountability

By Kumar Krishnan* 

Spending public money is easy. Ensuring that every rupee is spent prudently, transparently and for the purpose for which it was sanctioned is far more difficult. This becomes particularly important in the health sector, where public expenditure is ultimately meant to serve patients and strengthen an overstretched healthcare system.

The Bihar Medical Services and Infrastructure Corporation Limited (BMSICL) occupies a critical place in the state's healthcare architecture. It is entrusted with the procurement of medicines and medical equipment, as well as the construction of hospitals and medical institutions. Any question concerning its procurement practices or construction projects is therefore not merely an administrative matter — it concerns public money, institutional accountability and, ultimately, the quality of healthcare available to citizens.

A BMSICL tender and the construction of the Rajkiya Maharani Rameshwari Indian Medical Science Institute in Darbhanga have recently come under scrutiny following allegations of financial and administrative irregularities raised by Buxar MP Sudhakar Singh. The allegations, by themselves, cannot be treated as established facts. But neither should serious allegations relating to public expenditure be dismissed without examination. The appropriate response is an independent scrutiny of the records, followed by conclusions based on evidence.

The tender in question is identified as BMSICL/2023-24/ME-317 and relates to materials used in medical-waste management. According to the details available, 57 purchase orders were issued between April 2024 and April 2026. The allegation is that payments amounting to around Rs 305.53 crore, including taxes, were made against these purchases, while the corresponding market value has been stated to be approximately Rs 29.05 crore — a difference of nearly Rs 276.48 crore.

The figure is striking and plainly warrants scrutiny. But it would be premature to describe the entire difference as a loss to the exchequer, let alone as evidence of corruption. A meaningful price comparison requires a like-for-like assessment. The specifications, material, quality, durability, warranty, transportation, installation and other services included in the government purchase must be compared with those included in the market quotation.

The central question, therefore, is not simply whether the government paid more than the market rate. It is whether it paid an unreasonably high price for an equivalent product under equivalent conditions. That distinction is essential.

For instance, the price cited for a 45-litre microwave-based waste bin procured by BMSICL is Rs 11,474, against a stated market price of Rs 1,162.50. For a 75-litre version, the corresponding figures are Rs 15,490 and Rs 1,550. There are also allegations of several-fold differences in the prices of biodegradable bags.

These figures raise questions, but they do not by themselves settle them. Were the products identical? Did the government purchase include additional features or services? Were transportation, installation or warranty costs incorporated into the quoted price? Were the market quotations obtained for products meeting exactly the same specifications?

An independent financial and technical examination should answer these questions. If it establishes that comparable products were procured under comparable conditions at substantially inflated prices, the matter would clearly require deeper investigation.

The tender conditions also merit examination. A pre-bid meeting was held on August 28, 2023, after which certain conditions were reportedly amended. The processing capacity is stated to have been increased from 20 litres to 35 litres per cycle. Changes were also reportedly made to requirements relating to turnover, the financial capacity of the original equipment manufacturer, experience and testing.

An amendment to tender conditions is not, in itself, evidence of wrongdoing. Procurement rules often permit modifications following pre-bid consultations or technical considerations. What matters is the rationale behind the changes. Who proposed them? Why were they accepted? What concerns were raised at the pre-bid meeting? Did the revised conditions widen competition or narrow it? Did they materially alter the field of eligible bidders?

The tender reportedly included firms such as S.S. Medical System, Nuzen Associates, Haresh Agencies, Unisafe Systems, Trimmed Associates, Global Medical and M.W. Overseas. Questions have also been raised regarding relationships between certain bidders and their technical eligibility.

Here again, allegations must not be converted into conclusions. The relevant evidence lies in the original tender file, ownership and partnership documents, eligibility certificates, experience records and the proceedings of the technical evaluation committee. Those records should establish whether every successful bidder satisfied the prescribed conditions.

There is another important issue: the number of microwave-based medical-waste treatment machines. The initial requirement was reportedly nine machines, which later increased to 23. An increase in procurement is not inherently irregular — requirements can change as the number of healthcare facilities or the volume of waste increases. But such an increase must have a documented basis.

Why were 23 machines required? Where were they installed? How many are operational? What proportion of their capacity is actually being utilised?

Public procurement cannot end with the issue of a purchase order or the arrival of equipment at a warehouse. Its success must ultimately be measured by utilisation. If machines purchased with public money remain unused, the question is not merely whether the purchase was procedurally valid but whether it served a public purpose.

The same principle applies to materials supplied to regional warehouses. Such a supply arrangement is not, by itself, irregular. But there must be a traceable chain from demand to procurement, from procurement to storage, and from storage to actual use by hospitals. Who requisitioned the material? How much was supplied? When was it received? From which warehouse was it issued? Where was it ultimately used?

This chain of accountability is the real test of a government procurement system.

The Darbhanga medical institute presents a different but equally important dimension of public accountability: construction quality.

The development of the Rajkiya Maharani Rameshwari Indian Medical Science Institute involved an administrative sanction of approximately Rs 195.63 crore. Such a large public investment carries an obvious obligation to ensure that construction conforms to prescribed technical and safety standards.

According to the details available, a technical report dated December 5, 2024, raised concerns regarding construction quality. The average strength reported for the academic building was around 25 megapascals, and that of the administrative building around 19.5 megapascals. Subsequently, an order dated January 1, 2025, reportedly directed that certain portions — including elements such as pile caps, plinth beams and columns — be demolished and reconstructed.

These details require careful verification. A technical report recording deficiencies is a fact if the report itself is authentic; it is not, however, proof of corruption. The methodology of testing, the number and location of samples, the design specifications and the prescribed strength of the concrete must all be examined. If necessary, confirmatory tests should also be considered before drawing conclusions about structural quality.

The more consequential question concerns what happened thereafter.

If portions of a building were found deficient and ordered to be reconstructed, on what basis was subsequent payment made? Was the work measured and recorded? Was the rectification completed? Was a completion or quality certificate issued? Was the work inspected again before payment? Which officials certified the work and authorised the payment?

These are not accusations. They are basic questions of public financial accountability.

The role of the then Managing Director, Dharmendra Kumar, may also require examination, but it would be wrong to presume culpability merely because an officer occupied a particular post. His actual responsibility can be established only by examining the relevant file notings, approvals, technical recommendations and payment records.

This distinction between allegation and evidence is central to responsible journalism. Public institutions must be questioned rigorously, but individuals must not be pronounced guilty without proof.

The government would do well to address the matter through an independent inquiry rather than allow it to remain confined to political allegations and counter-allegations. Such an inquiry should examine the complete tender file, pre-bid proceedings, subsequent amendments, eligibility of bidders, technical evaluation, rate determination, purchase orders, supply certificates, stock registers, hospital requisitions, installation records, utilisation of equipment and payment documents.

The comparison of procurement prices with market prices should also be independently undertaken, but strictly on a like-for-like basis. In the Darbhanga project, the original technical report, design specifications, quality-test records, rectification order, measurement books, contractor bills and payment approvals should be examined.

Transparency in public administration does not end with floating a tender. It means being able to answer a much longer chain of questions: What was required? How much was required? How was the price determined? Who supplied it? Where did it go? Who used it? What was the basis of payment?

Public money is not the private money of an official, contractor or government corporation. It comes from citizens. In the health sector, every rupee carries an even greater public obligation because it is ultimately meant to improve treatment, infrastructure and access to care.

The issue, therefore, is not who made the allegation. The issue is whether the questions raised can be answered through documentary evidence.

If the allegations are unfounded, a transparent inquiry will establish that. If procurement was carried out properly, the records should demonstrate it. If the construction met the required standards, technical documentation should establish that as well. And if there were violations of rules, inflated payments or failures of oversight, an impartial inquiry should identify responsibility.

The credibility of public institutions depends not merely on how much money they spend, but on whether they can account for why it was spent, at what price, with what safeguards and with what public outcome.

That is the larger question raised by the BMSICL episode. It is not simply about bins, machines or a building in Darbhanga. It is about the integrity of a system entrusted with public money.

And in a democracy, asking who is accountable for that money is not an act of distrust. It is the most elementary demand of public accountability.

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*Independent journalist