The Last Mile of Healthcare Is 'Made in India'—If We Let It Be

A few months ago, I stood inside a district hospital in Champawat, a hill town in Uttarakhand, watching technicians commission India's indigenously built 1.5T superconducting MRI at that altitude. Patients from surrounding villages had, until then, travelled six to eight hours to Haldwani or Dehradun for a scan most of urban India takes for granted. Some postponed the trip. Some never made it. That gap — between what modern medicine can do and what most of India can reach — is what I have spent three decades trying to close, first at a multinational, and now building indigenous manufacturing capacity from the ground up.

I arrived at this conviction through arithmetic, not slogans about self-reliance. India has roughly one MRI scanner per 100,000 people in its metros, and a fraction of that in Tier-2 and Tier-3 towns, where most of the country lives. Imported equipment is priced for markets with different reimbursement structures and volumes; waiting for it to trickle down means waiting too long. The realistic path is to manufacture here, price life-cycle cost for the market served, and build the service backbone behind it.

Why Adoption in Smaller Cities Still Lags

Adoption lags not because Indian-made equipment is clinically inferior — increasingly, it is not — but because the ecosystem around it was built for imported brands before domestic manufacturing matured.

Tender specifications are a good example. Many are still written, sometimes unconsciously, around the exact feature sets of established multinational products — a bore diameter, a gantry configuration— that Indian manufacturers can match on clinical outcomes but lose on paper, because the clause was never written with Indian patients in mind. Specifications should describe the outcome a Tier-2 or Tier-3 hospital needs, not a foreign catalogue.

Smaller-city hospitals also cannot absorb downtime the way a metro centre can; a scanner down for three weeks because a spare part is stuck in customs is worse than no scanner at all. Manufacturers must earn trust by investing in local service networks — technicians within a few hours of every installation, spares held in-country, response times guaranteed and met.

Then there is a factor no policy paper captures: the referring doctor. Word of mouth among clinicians carries enormous weight in smaller cities. A radiologist who has seen an indigenous MRI perform reliably at altitude will tell three others. We need more visible, well-documented installations like Champawat — proof points, because that is how confidence spreads in healthcare.

What Government Can Do—And Why It Matters More Here

In most industries government is one customer among many. In medical equipment, it is often the largest buyer, through state medical services corporations, central procurement bodies, and public hospital networks. That gives policy a direct lever, and three changes matter more than any subsidy scheme.

First, preferential treatment for Indian manufacturers in public tenders must mean more than eligibility to participate — it should translate into real price and evaluation weightage, as other strategic sectors already enjoy. A domestic manufacturer competing rupee-for-rupee against a global brand with decades of amortised R&D and scale is not on a level field.

Second, we need to revisit the reflexive requirement that high-end equipment carry US FDA or CE certification even for domestic procurement. These are excellent standards for their own contexts, but requiring them as a precondition pre-qualifies imports and disqualifies Indian manufacturers before any clinical comparison is made — even when the manufacturer fully complies with India's CDSCO framework. A company meeting every Indian regulatory requirement should compete on those merits alone.

Third, and perhaps most useful, is price preference in high-technology categories — MRI, CT, and comparable systems — where manufacturing is most capital-intensive. A calibrated preference here would give Indian companies the revenue visibility to invest in manufacturing depth and R&D, not low-value assembly. This is not a request for permanent protection, but for the runway every country's medtech industry, including the ones we now import from, was given at an equivalent stage of development.

What This Is Really About

None of this argues against imported equipment, which will and should remain part of India's healthcare infrastructure, particularly at the frontier of technology. It argues that a country of India's size cannot outsource the diagnostic backbone of its Tier-2 and Tier-3 healthcare system to import cycles and supply chains that can be disrupted overnight, as many saw during the pandemic.

I think about the family in Champawat who no longer has to choose between a six-hour journey and a delayed diagnosis. Multiplying that story across hundreds of towns like it is not a manufacturing ambition — it is a healthcare access mandate, one Indian industry, alongside a government willing to back it with real procurement policy, is capable of meeting.