35. The Health of the Health Department
After leaving the Urban Development Department, I took charge of the Health and Family Welfare Department as per the government’s order. Once again, my minister was Shri Nitinbhai Patel. When he was 38 years old, Chief Minister Keshubhai had appointed him as Health Minister — at that time, I was a Deputy Secretary in the same department. It seems Health was written in our shared destiny, as this was the third time I had come back to this department.
During the earlier two stints, I had worked under the supervision of the then Additional Chief Secretaries on limited subjects. But now, as Additional Chief Secretary, the entire department was under my charge.
Minister of State for Health
For the first six months, I worked with Shri Shankarbhai Chaudhary, the Minister of State (Independent Charge) for Health. He was a disciplined leader — a good listener who spoke only as much as needed. He seemed to have consciously emulated the personality of Narendra Modi, and though relatively young, he had already acquired considerable political maturity.
Cabinet Meetings
As per long-standing tradition, Cabinet and Secretaries’ meetings were held every Wednesday morning.
Out of two adjacent halls, one would host the officers’ meeting and the other the Cabinet meeting. When needed, officers would be called into the Cabinet hall for joint discussions.
The secretaries’ meeting usually lasted about an hour and a half, while the joint meeting with the Cabinet continued as per the agenda. Throughout my career, I had the privilege of attending more than 750 such meetings, which might be a record in itself.
New Chief Minister and Chief Secretary
In August 2016, Vijay Rupani became the Chief Minister, and my old friend J. N. Singh took over as Chief Secretary.
Since both had assumed office together, their coordination was excellent.
The Chief Secretary began preparing notes highlighting key activities of each department and started reading them out during Cabinet meetings. This gave everyone a consolidated understanding of the state’s progress and issues, which made the sessions far more engaging — and consequently, the duration of officers’ presence in Cabinet meetings increased.
The 2017 Assembly Elections
The December 2017 Gujarat Assembly Elections turned out to be fiercely contested.
Even after the introduction of EWS reservations following the Patidar reservation movement, discontent persisted.
It was a test of popularity for many political leaders.
The ruling party retained power, but with a reduced majority of 99 seats, while the opposition, despite a favorable atmosphere after 22 years of exile, could not capitalize on the opportunity in the second phase of polling.
Allocation of Portfolios
After the elections, a new cabinet was formed. The Chief Minister and Deputy Chief Minister remained unchanged, and everyone waited for the allocation of departments.
That day, the Cabinet and Secretaries’ meeting began at 5 p.m. Normally, the Secretaries’ session would conclude in about an hour and a half before officers were called into the Cabinet hall. But that evening, no such instruction came.
Tea and snacks were over, and it was nearly dinner time — clearly, some confusion persisted among the ministers regarding portfolio allocation or other matters.
Finally, the departments were distributed.
The Chief Minister retained the Urban Development Department, while Deputy Chief Minister Nitinbhai Patel was given Finance, Roads & Buildings, and Health & Family Welfare portfolios.
And thus, I found myself once again working with Nitinbhai Patel.
Health Minister
Once, during a conversation, we discussed how those who had worked in Prime Minister Narendra Modi’s office when he was Chief Minister of Gujarat had later gone on to hold prestigious and powerful positions — and even after retirement, continued to play influential roles. Names like Dr. P. K. Mishra, Dr. Hasmukh Adhia, Shri Kailasanathan, Shri Anil Mukim, Shri Pankaj Kumar, Shri Arvind Sharma, and Shri Girish Murmu came up. Some of them might even be celebrating a silver jubilee of working alongside Mr. Modiji.
He added, “In government service, if one gets to work closely with a great statesman, it bears rich fruits.”
Laughing, I replied,
“Even I have been destined to work alongside a political leader — but neither his coin flips, nor mine.”
That day, Nitinbhai laughed as heartily as I had ever seen him laugh.
No one could match his intelligence and sharpness in understanding files. Even if a file was thick, one glance was enough for him to grasp its essence — and to instantly sense the intent behind it. Files might pile up, but he never signed anything without personally reading it.
His language carried the tone of North Gujarat — straightforward and blunt — which sometimes made maintaining relationships diplomatically a challenge. But from his ministerial chair and on the floor of the Legislative Assembly, he served both the government and his party with deep commitment.
Duties as Additional Chief Secretary
As Additional Chief Secretary (Health and Family Welfare), my work spanned a vast range of areas: medical services, medical education, AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy), food and drug regulation, the Project Implementation Unit (PIU), GMERS, and GMSCL, etc.
Across the state, there was an enormous health workforce — district and civil hospitals, medical and nursing colleges, civil surgeons, medical specialists, doctors, superintendents of community health centers, and paramedical staff — a massive army of healthcare professionals.
As Chairman of GMERS (Gujarat Medical Education and Research Society), I oversaw the functioning of its eight medical colleges, in addition to six government-run colleges.
As Chairman of GMSCL (Gujarat Medical Services Corporation Limited), I had to ensure that medicines and medical equipment reached every hospital and health center in the state on time.
As Head of the PIU, I worked with Chief Engineers, Superintending Engineers, and Deputy Engineers across the civil, electrical, and mechanical wings to build new hospital and college campuses, complete ongoing projects, and maintain or repair existing infrastructure.
The Food and Drugs Regulatory Department, led by its Commissioner, managed a statewide network of inspectors, laboratories, and enforcement officers. The AYUSH Directorate oversaw Ayurveda hospitals and dispensaries, Ayurvedic practitioners, the Medicinal Plants Board, and the Homeopathy services with its homeopathic doctors.
I also served as Chairman of the Governing Boards of two prestigious institutes — the U. N. Mehta Institute of Cardiology and Research Centre and the Institute of Kidney Diseases and Research Centre (IKDRC) — providing them strategic direction and administrative support.
In addition, as a member of the Governing Board of the Gujarat Cancer Research Institute (Cancer Hospital), I was responsible for improving its management systems and, as Additional Chief Secretary, ensuring timely completion and inauguration of new hospital buildings.
The scope was vast, and the administrative machinery enormous.
Karmyog (Path of Duty)
We began the task of improving the health of the Health Department itself.
Shortage of Doctors
The shortage of doctors in government hospitals, dispensaries, and health centers had long been a persistent problem. When Primary Health Centers (PHCs) lacked MBBS doctors, and Community Health Centers (CHCs) and hospitals lacked specialist physicians, the delivery of medical and healthcare services suffered. The shortage of specialists in CHCs was nearly 80 percent.
Hospitals attached to medical colleges could maintain service levels because of faculty members and resident doctors available there.
With the Mukhyamantri Amrutam (MA) scheme of the Gujarat government and the Pradhan Mantri Jan Aarogya Yojana (PMJAY) of the Government of India, low-income families gained access to treatment in private hospitals at government expense. While these schemes expanded healthcare access, they also increased the strain on government hospitals, as doctors began to prefer the private sector.
When there’s a shortage in the well, how can water reach the fields? Across the country, against the population standard of one doctor per 1,000 people, perhaps only half a doctor is available. The only real solution was to increase the supply of doctors. After all, how long could the private sector keep drawing doctors trained in government hospitals? At some point, the government needed to win back the service spirit.
New Medical Colleges
The Gujarat government implemented Brownfield and Greenfield policies to open new medical colleges.
Under the Brownfield policy, new medical colleges-cum-hospitals were established using existing government hospital campuses.
Under the Greenfield policy, private institutions were to build their own infrastructure entirely.
For each student seat, the government grant under the Greenfield scheme was double that under the Brownfield scheme.
We began approving new colleges. As a result, Dahod, Palanpur, Amreli, Bharuch, Nadiad, and Visnagar opened new medical colleges, while institutions in Godhra, Navsari, Porbandar, and Modasa started preparations to establish theirs.
Dahod had become a district, but its old Cottage Hospital was merely upgraded to a Civil Hospital, which didn’t significantly expand its medical services. The Civil Hospital had around 100–120 staff, including doctors and paramedical workers. As a result, private hospitals and clinics flourished, and for advanced treatment, patients still had to go all the way to Vadodara. The hospital also served patients from Madhya Pradesh and Rajasthan, making it an ideal location for a new medical college-cum-hospital.
Just a few months earlier, I had also helped Dahod secure Smart City status.
The Zydus organization came forward to partner with us. An unused Ayurvedic hospital building, lying idle and deteriorating, along with the old cottage hospital campus, provided the necessary space for the new college. The institution agreed to cover the construction costs of the Ayurvedic hospital building at market rates. Under the Brownfield scheme, the government provided the land.
The government granted approval, and work began, but the Medical Council of India (MCI) raised objections, pushing the matter all the way to the Supreme Court. After winning the case, Dahod was finally blessed with a new medical college-cum-hospital.
Today, it has around 200 doctors and specialists, modern diagnostic facilities like CT scan, X-ray, and Sonography, and advanced laboratories — marking a huge leap in healthcare services, benefiting the tribal and rural population of the surrounding regions and neighboring states.
MCI → NMC and Increase in Seats
A major obstacle in starting new colleges or renewing existing ones was the MCI’s rigid standards, which seemed to measure compliance “in centimeters.” Once the Central Government took notice, it replaced MCI with the National Medical Commission (NMC), which brought much-needed reforms and fewer complaints.
Even then, if faculty shortages weren’t managed flexibly, many medical colleges across India would have been forced to shut down, worsening the doctor shortage amid a growing population. Some pragmatic compromises were necessary to sustain expansion.
Then came the EWS (Economically Weaker Section) reservation. To accommodate the EWS quota without reducing seats for existing categories, total seats were increased by about 33%.
As we continued opening new colleges, the impact became visible.
When I took charge, Gujarat had 2,900 MBBS seats. By the time I handed over charge two years later, that number had risen to 5,500.
Postgraduate (PG) seats had increased from 1,000 to 1,900.
Fees in Private Colleges
One issue that remained ambiguous was the fee structure.
Under the Brownfield scheme, the government grant was ₹7.5 lakh per student per year, while under the Greenfield scheme, it was ₹15 lakh per student per year.
With an average of 150 seats per college, this meant:
Brownfield colleges received ₹11.25 crore per year, totaling ₹56.25 crore over five years.
Greenfield colleges received ₹22.5 crore per year, totaling ₹112.5 crore over five years.
After the EWS quota, 50 seats were added in each category, increasing total grants to roughly ₹75 crore (Brownfield) and ₹150 crore (Greenfield) over five years.
A Fee Determination Committee, chaired by the Commissioner, was supposed to recommend fee levels based on income and expenditure as per departmental resolutions.
However, that year, for some reason, the Additional Chief Secretary (Health) was excluded from the process, and the committee’s recommendations went directly to the government, which issued the final decision.
Later, it came to light that the committee had not considered the government grants provided per student as part of institutional income. This effectively made these colleges charge fees similar to private institutions, while still receiving government grants, turning those grants into advantage for the institutions.
It is for the government to decide whether the government grants should be counted as part of institutional income — and whether the benefit of that income should be passed on to students.
If counted, it would reduce student fees — and since the government pays the fees for reserved-category students, it would also lower the financial burden on the state.
Inauguration of Hospitals and Medical College Complexes by the Prime Minister
We had the honour of organizing two major public inauguration ceremonies of health complexes under the auspices of the Prime Minister.
One such event was held at Vadnagar, where the new Medical College was inaugurated, along with the Himatnagar Hospital and Junagadh Hospital.
The Junagadh Hospital Episode
Before the Junagadh Hospital inauguration, an unexpected incident occurred.
It was the monsoon season, and heavy rainfall lashed the city. Videos began circulating on social media, showing rainwater pouring inside the ground floor of the hospital as if from a waterfall. The videos went viral — even reaching the Prime Minister’s Office (PMO).
Our opponents were elated, hoping for embarrassment.
My head spun when I saw it.
I immediately summoned the Chief Engineer of the PIU.
“Paragbhai, how could this happen?” I asked.
The hospital was an eight-story building. How could rainwater from the top make its way down and fall like a stream inside the ground floor?
When our teams rushed to investigate, it turned out that the drainage holes in the porch ceiling of the ground floor had not been cleaned. As a result, rainwater backed up and leaked inside through the windows, creating that “indoor waterfall” effect.
We promptly cleared the blockages — old plastic bags, debris, and all — and re-inspected the entire building thoroughly. Once everything was rectified, the Prime Minister inaugurated the hospital as planned.
Medisity Ahmedabad
The Ahmedabad Medisity was a dream project of the Prime Minister — a vision to bring “all medical services under one roof.”
The plan aimed to transform the Asarwa Civil Hospital Campus, already one of Asia’s largest hospitals, into a full-fledged Medisity complex.
However, many projects there had stalled or slowed down, and what was needed was a strong push to bring them to completion.
That push came with my arrival.
I began weekly monitoring of progress. We restarted work on a 1,200-bed hospital building, whose frame had stood incomplete for 3–4 years.
We completed flooring, OT units, laboratories, gas lines, furniture, and equipment installation — everything necessary to make it fully functional.
This new 1,200-bed Women and Children’s Hospital was completed and later proved crucial during the COVID-19 pandemic.
During the Prime Minister’s grand inauguration event, not only was this 1,200-bed MCH Hospital opened, but also the newly completed Eye Hospital, Dental Hospital, and Cancer Hospital Blocks A and B within the same campus.
Our PIU teams worked day and night to clear old dilapidated structures and remove thousands of tons of debris to prepare the campus for the event.
When the ground was finally ready, we hosted the Prime Minister’s program in the active campus of Asia’s largest public hospital — a truly unparalleled event.
The energy and enthusiasm of the students and attendees were electrifying — the entire venue resonated with chants of “Modi! Modi!”
After the event, the head of the Prime Minister’s security team told me he had never seen such a charged and energetic crowd at any PM program before.
That afternoon, crowds thronged the roads before and after the event, making the inauguration an unforgettable occasion.
Remaining Hospitals
We could have included two more hospitals from the Medisity campus in that inauguration. However:
The new Kidney Hospital had not yet completed its operation theaters (OTs).
The U.N. Mehta Cardiology Institute was structurally ready, but equipment installation and final finishing work were still underway.
So we decided to keep its inauguration separate, scheduling it for October 2, 2019 — an appropriate and symbolic date.
The Grand New Building of the U.N. Mehta Cardiology Institute
The completion of the new 800-bed U.N. Mehta Institute of Cardiology and Research Centre remains one of the most memorable accomplishments of my life.
The foundation was laid in May 2017, but soon after, the monsoon rains filled the excavation pits with water. The surrounding structures became structurally at risk, so the foundation had to be reinforced with steel framing.
For nearly two years, we held review meetings — monthly at first, then every Tuesday — and oversaw the hospital’s steady rise.
We finalized tenders, procured state-of-the-art equipment, and ensured the installation of all modern facilities.
However, just as we began coordinating with the Prime Minister’s Office to schedule the inauguration, I was transferred. The hospital was later inaugurated, but the plaque bore the name of the officer who succeeded me.
At the Institute, Dr. R.K. Patel continued to serve beyond the official age limit through his transparent and dedicated administration, earning widespread respect.
That year, the U.N. Mehta Institute ranked #1 in Gujarat and Ahmedabad, and #9 nationwide in cardiac care. With the addition of 800 beds, it became the largest cardiac care institute in the world with 1250 beds, surpassing even FUWAI Hospital in Beijing, which has 1,238 beds.
The institute received multiple national awards, expanded postgraduate seats, and began preparations for heart transplant surgeries — standing on the threshold of making medical history.
Civil Hospital and Dr. Mukund Prabhakar
The Civil Hospital, Ahmedabad, was managed with remarkable effectiveness by Dr. Mukund Prabhakar, who served as Superintendent for 16 years. His tenure earned the hospital numerous awards and public satisfaction.
An accomplished orthopedic surgeon, he gained recognition for knee replacement surgeries. Earlier, a robotic surgery system had been installed, but due to the high cost of branded kits, it remained underutilized.
Even after his official retirement, his services were briefly extended, though the government later decided not to renew his tenure. Subsequently, he joined SMS Hospital, leaving a lasting mark there as well.
Kidney Hospital and Dr. H.L. Trivedi
The Institute of Kidney Diseases and Research Center (IKDRC) at the same campus owes its national reputation to Dr. H.L. Trivedi, a visionary whose service mission defined the institution.
In 1986, the government converted the unit into an autonomous society under the Societies Registration Act, appointing Dr. Trivedi as Director. Through his lifelong commitment, the institute achieved great prominence — but he continued to serve well beyond the official retirement age, remaining on full salary until around 2013–14, when ill health finally compelled him to step down at the age of 84. His GPF deductions were even continued throughout.
Later, he handed over charge to a female officer, while the government created a university (without an affiliated college) and appointed him Vice-Chancellor (Emeritus).
When his health deteriorated and he was placed on a ventilator, the issue of his pension surfaced. As no service book existed, a new one was prepared, and his pension was fixed retroactively based on the official retirement date, excluding the extended paid years.
Dr. Trivedi and the Ahmedabad Kidney Hospital had become synonymous — his name and legacy were woven into every corner of the campus, with busts and plaques commemorating him across units. His office was filled with awards and trophies.
Interestingly, he had hired a Gujarati writer — known for penning a former Chief Minister’s autobiography — at a monthly salary of ₹75,000, along with an office and attendant. Though his own autobiography was never completed, he spent years meeting kidney transplant patients, offering them comfort and encouragement — a compassionate endeavor that lasted nearly 15 years.
After my tenure, when the matter came to the notice of the Government, it decided not to extend his contractual position, formally concluding his association with the institute.
Leadership Transition and New Era in IKDRC
After the acting female director retired three years later, a new Director had to be appointed. Following deliberations, the Board selected Dr. Vineet Mishra.
Dr. Mishra’s leadership brought remarkable improvements — he completed and commissioned the new hospital building, enhanced services, and won Service Excellence Awards. He expanded the institute’s work to include liver and pancreas transplants, thus broadening its scope.
He also facilitated the establishment of more dialysis centers across the state, giving thousands of kidney patients a new lease on life.
Few know that within IKDRC, besides kidney and liver treatments, there is also a Department of Obstetrics, Gynecology, and Child Welfare, offering IUI and IVF services.
In fact, my two grandsons were born there during the COVID-19 period (2020 and 2021) under the care of this exceptionally skilled team.
The institute now also performs robotic surgeries and houses specialists in urology and autoimmune disorders — continuing to uphold its founder’s spirit of medical excellence.
SOTTO
A major initiative during my tenure was the establishment of SOTTO (State Organ and Tissue Transplant Organisation) — to ensure that organs donated by patients at the brink of death (cadaver donations) were utilized ethically and efficiently.
Through timely retrieval and fair distribution of such organs, many lives were saved.
Gujarat Cancer Research Institute (GCRI)
Another major institution within the campus is the Gujarat Cancer Research Institute (GCRI) — a renowned hospital comparable to, or even larger than, Mumbai’s Tata Memorial Hospital.
It provides comprehensive cancer treatment, having saved countless lives or extended them, easing the pain of families during their most difficult moments.
The Chairman of its Governing Body is an industrialist, but as the Additional Chief Secretary, being a member of the Board of Governance and given that most of the funding came from the state, my voice carried weight in its operations.
During my tenure, two new hospital blocks were completed. Advanced machines like the 3D Tesla MRI and CT Scan were installed, and when the Prime Minister inaugurated the complex, the institute’s treatment quality gained national recognition.
We also advanced plans for Proton Radiation Therapy, a cutting-edge treatment that targets tumors with great precision, minimizing damage to surrounding tissues.
Although the equipment was extremely expensive, we allocated a budget because, as a government, our duty is to serve the people.
While the proposed Siddhpur unit could not be completed, the Rajkot satellite center became a boon for the people of Saurashtra, and although the Surat unit faced some delays due to local management issues.
We received complaints about a private medical store near the its campus in Ahmedabad. Desperate families often fell prey to suggestions that an expensive injection could “cure cancer quickly,” leading to the unnecessary use of costly drugs.
Since death is inevitable, counseling for relatives of terminally ill patients be institutionalized. Such guidance could help families avoid emotional and financial distress caused by prolonged ventilator support and expensive, futile treatments in private hospitals.
New Dental and Eye Hospitals
The Dental Hospital and the Eye Hospital (situated in the adjacent Manjushree Mill compound) on the campus are both government-run institutions. Their expert doctors have earned reputations that rival private hospitals in quality of care. Both were inaugurated by the Prime Minister.
A photograph taken during the inauguration of the Eye Hospital, with both the Prime Minister and Chief Minister, remains one of my cherished memories, as I happened to stand at the center in that frame.
We also approved a grant of about ₹800 crore for the Sardar Vallabhbhai Patel Institute of Medical Sciences and Research (SVP Hospital) built by the Ahmedabad Municipal Corporation (AMC) — transforming Ahmedabad into a hub for medical tourism.
The Medisity Campus
Today, the Medisity Campus in Ahmedabad stands as a world-class healthcare hub with over 7,500 beds, advanced equipment, and state-of-the-art treatment facilities.
Within just two years, its hospitals began winning prestigious awards:
Kayakalp Award under Swachh Bharat Mission (2017, 2018, 2019)
Best Multi-Specialty Tertiary Care Government Hospital of the Year (2018) to Civil Hospital
IMA President Appreciation Award (2018)
FICCI Healthcare Excellence Award for Service Excellence – Govt Spine Institute (2018)
IKDRC won Healthcare Service Excellence Award (2019)
Institutes like UNM, IKDRC, and the Govt Spine Institute also earned NABH accreditations, while other units won honors in their respective specialties.
We had nearly fulfilled the dream of Medisity.
A Coordination Committee of heads of nine institutions was formed, with the Additional Chief Secretary as its chairperson. From September 2017 onward, we began monthly meetings, hosted by a different hospital each time.
We introduced:
Dress codes for doctors and staff
Color-coded bed linens, changed daily for hygiene
Doctor of the Month and Employee of the Month awards, with their photos displayed prominently to inspire others
Alumni meets for each institution
These efforts nurtured unity and a family spirit across the Medisity community.
We also started joint flag-hoisting ceremonies on August 15 (Independence Day) and January 26 (Republic Day).
A Medisity Anthem and Pledge were created, recited and sung during these events.
We began felicitation programs in the campus auditorium to honor outstanding staff, instilling a spirit of service and transforming the organizational culture.
The next step was to develop Electronic Health Records (EHR) for all patients within the Medisity hospitals — to ensure continuity of care and avoid duplication of procedures.
Although HIMS modules existed, they were used mainly for counting patient numbers.
Thus, the vision for a fully integrated digital medical ecosystem — blending compassion, innovation, and accountability — was steadily taking shape.
Ease of Medical Services
Public hospitals indeed provide services, but the waiting times are long — queues for registration, for doctor consultations, for X-rays, for lab tests, and for the pharmacy. One round of examination and obtaining medicines could take four to six hours.
We introduced a token system and an online appointment system, which offered some relief. Still, the discomfort and impatience of sick patients and their relatives were natural. And what could the doctors do?
In large campuses like Civil Hospital, Ahmedabad, a single doctor may have to examine 250 to 400 patients in one sitting. We provided doctors with laptops, created a network linking X-ray, lab, and pharmacy, and designed modules to enable doctors to select medicines and procedures digitally, aiming to speed up services through IT integration.
However, many doctors said they were more comfortable writing prescriptions by hand, and using laptops would consume more time. They suggested that computer operators could assist them, but that, too, had risks — a single operator’s mistake could lead to serious errors. So the system continued much as before.
Later, we implemented the token system across all hospitals in the state so that patients and their relatives would not have to stand in long queues.
Once, I saw a pharmacist explaining medicine dosages orally to an elderly woman. How could she possibly remember all that?
We immediately arranged to paste stickers on each medicine strip, indicating morning–afternoon–evening doses and whether to take them before or after meals. This became a permanent practice.
While doctors continued their routine ways, we improved patient convenience through better supervision, clean drinking water, canteen facilities, and enhanced oversight of each hospital unit.
For indoor patients, we ensured:
Daily bed sheet changes,
Regular and deep cleaning of wards,
Timely medical attention, and
High-quality food.
Transportation in Medisity
The Medisity Campus in Ahmedabad functions like a small city, with a daily population of around 50,000. Moving between departments and corridors could be exhausting — no wonder our doctors and staff remained lean and fit!
We introduced mini-buses and e-rickshaws, set up rickshaw stands, and created organized parking zones for staff and vehicles to improve mobility.
Earlier, rickshaw drivers and private vehicles caused traffic jams outside the gates, so we began controlling entry and parking inside the campus roads.
Addressing Anti-Social Elements
In the evenings, some addicted or unruly individuals would loiter near certain gates or occupy footpaths.
We hired ex-servicemen as security officers, posted armed guards at gates, and effectively curbed this nuisance and disorder.
We also learned that when a public facility is ready, it should be opened for use immediately. Waiting for a VIP inauguration often leads to theft or damage of fixtures, taps, and fittings. A trial run also helps identify and fix any shortcomings before formal inauguration.
Rain Basera (Night Shelter)
At night, it was common to see relatives of patients sleeping on the pavements outside Civil and other hospitals — a natural consequence in a densely populated country. Patients always have one attendant, who rotates with others, so accommodation and food are major problems for them.
We built gazebos with drinking water and toilet facilities and initiated discussions for constructing a Rain Basera (night shelter). A suitable site was chosen, the design finalized, and tenders issued.
Though costs came below SOR (Schedule of Rates), approval delays halted progress — and then COVID-19 struck.
Later, the teams after me completed the Rain Basera, though delayed, at a higher cost due to re-tendering. Today, it stands as a fully functional facility — a blessing for attendants of patients, especially those from Rajasthan and Madhya Pradesh.
For example, at the Cancer Hospital, patients often wait 1–2 days for test reports. Now, instead of sleeping outside or returning home, they can stay comfortably in the Rain Basera.
Food Facilities
Patients received food within the hospital, but their attendants had to arrange it privately — buying whatever was available outside or relying on occasional charity meals.
We collaborated with Akshaya Patra Foundation, ensuring that fresh, hot, and hygienic meals were available twice a day at a nominal cost.
This reform — along with better shelter, transport, and service systems — made public healthcare in Gujarat more humane, efficient, and dignified for everyone.
Super Specialty Hospital in Gandhinagar
Services at Civil Hospital, Gandhinagar were increasing, but the facilities were becoming outdated. During emergencies—especially heart attacks—people were hesitant to go there. The old buildings, too, required repairs and reconstruction, so we took up that task.
We designed a project and made budgetary provisions for a super specialty hospital. The officers who succeeded me carried the work forward. Additionally, the U.N. Mehta Institute has established a separate unit for cardiac and neuro care, adding prestige to Gandhinagar recently.
Stem Cell Hospital in Surat
In Surat, a centrally air-conditioned building with three floors—complete with equipment, furniture, and fittings—was lying unused. It had been constructed for a Stem Cell Hospital, but after the project failed, the building remained idle.
Repurposing it as a general hospital was challenging, since a centrally air-conditioned structure wasn’t suitable for that purpose—it would require structural alterations, including adding new windows, which made the task complex and discouraging.
We decided to allocate the three ready floors to the U.N. Mehta Institute and the Cancer Hospital to start their satellite centers, and to redesign and modify the upper floors (adding windows and ventilation) to convert them into a general hospital.
AIIMS, Maternity, and Other Hospitals in Rajkot
In Rajkot, a hospital under the Pradhan Mantri Jan Arogya Yojana had been under construction for years. We coordinated with the concerned authorities, completed the project, and got it inaugurated.
The maternity (Janana) hospital there also needed complete reconstruction. Since delivery services could be temporarily shifted elsewhere, we relocated operations, demolished the old building, and began new construction as per the updated design.
During construction, one large banyan tree stood in the way.
In Rajkot, even small matters can become sensitive issues in the press. Since the Chief Minister hailed from the city, environmental reasons were cited, and the design was modified to preserve the tree.
Today, people sit under its shade—perhaps unaware that it still guards the hospital.
That mother-and-child hospital campus is so vast that if one banyan tree had been removed and five new ones planted, it would have been a lush green campus today.
When AIIMS was sanctioned for Gujarat, Rajkot was chosen as the site. We took the lead in identifying, acquiring, and coordinating land to expedite the AIIMS project.
Gujarat — The Pharmacy of India
India is known as the pharmacy of the world, and Gujarat is the pharmacy of India. Over 70% of pharmaceutical chemicals (APIs – Active Pharmaceutical Ingredients) are imported from China, due to cost advantages and large-scale production. But the formulation and innovation are done in India — which is why Indian medicines are affordable.
There are three types of medicines: Generic, Branded Generic, and Branded.
On a medicine strip, the chemical name appears in small letters, while the brand name is in large letters.
The price difference between generic and branded medicines could be astonishing — ₹1 versus ₹50 or even more.
Through marketing, branded drugs are projected as having higher potency and better efficacy, which is why they dominate private hospitals and clinics.
Since prescription-only rules prevent patients from buying medicines freely, the cost burden ultimately falls on them. Even beneficiaries under government schemes like MA or PMJAY often hit the reimbursement ceiling.
Pharma companies also sponsor foreign trips or conferences for doctors, building strong networks of influence.
We may glare angrily at Red China, but if we stop importing APIs or boycott Chinese products entirely, not just medicines—many heartbeats in India would stop too.
Generic Medicines
To make low-cost generic medicines available to the public, the state government launched Jan Aushadhi Kendras (Public Medicine Centers).
Initially, a contract was signed with Hindustan Antibiotics Limited (HAL), a government of India enterprise, to operate these centers within hospital campuses. However, the agreement made the state government responsible for all operational losses.
This meant that, apart from the costs of setting up stores, the government had to bear expenses for staff, electricity, telephone, medicines, and expired stock — covering the gap between sales revenue and total cost.
We terminated the HAL contract upon its expiry and invited private entrepreneurs to open new Jan Aushadhi Centers under a revised model.
With the launch of the Central Government’s Pandit Deendayal Jan Aushadhi Scheme, new centers also began opening across Gujarat. We eventually reached nearly 500 such centers in the state.
As a result, patients gained access to affordable medicines, saving crores of rupees collectively.
Even hospital superintendents, who earlier used to purchase emergency medicines from private pharmacies at MRP due to delayed GMSCL supplies, came under strict cost control.
However, the true success of the scheme depends on both private and government doctors prescribing generic medicines — and that remains a challenge.
Hospital Maintenance and Repairs — A Major Challenge
The Project Implementation Unit (PIU) was strengthened to ensure efficient construction, repairs, and maintenance of hospitals. Its quality of work was on par with the state’s Roads and Buildings Department.
However, maintaining public facilities is never easy. Some patients and relatives misuse amenities — throwing inappropriate items into toilets, breaking fixtures, or leaving taps open, causing blockages or leaks.
In public buildings, no one feels responsible. If a tap breaks, someone must still take the initiative to shut the water supply and get it fixed. With limited staff, PIU faced difficulty in ensuring timely repairs and maintenance — but somehow, they managed.
Dentists at CHCs
To improve the condition of Community Health Centers (CHCs), dentists were recruited, dental chairs were purchased, and special emphasis was placed on dental healthcare.
Kolvada Ayurvedic Hospital and New Recruitment
Under the National Health Mission (NHM), Ayurvedic manpower was added to Primary Health Centers, which strengthened staffing, but many Ayurvedic doctors felt their work lacked true professional fulfillment.
We inaugurated the Kolvada Ayurvedic Hospital and made it fully operational.
We also recruited new Ayurvedic practitioners to expand the system.
However, coordination among senior Ayurvedic physicians proved difficult.
Instead of focusing on the growth and promotion of Ayurveda, many were more interested in commissions, perks, and holding superior posts, even if that meant juniors holding charges above seniors, causing resentment.
As a result, my dream of making Ayurveda as popular as Allopathy remained unfulfilled.
Otherwise, nearly 90% of patients visiting PHCs could have been effectively treated with Ayurvedic medicine, avoiding chemical-based drugs.
But due to the lack of strong teams, poor coordination, and inadequate budget for Ayurvedic medicines, it was difficult to make Ayurveda as mainstream and successful as in Kerala.
During my tenure, the Jamnagar Ayurvedic University was declared an Institute of National Importance, largely due to the efforts of Vaidya Rakesh Kotecha, Secretary, Ministry of AYUSH, Government of India.
In Homeopathy, despite limited public trust, we strengthened it as part of the AYUSH system through new recruitments, infusing it with fresh energy.
Food and Drug Control Administration (FDCA)
Another key unit under us was the Food and Drug Control Commissioner’s Office, along with its district offices across Gujarat. Its laboratory in Vadodara is especially renowned.
The GMSCL (Gujarat Medical Services Corporation Limited) procures medicines in bulk, taking random samples from each batch for testing in FDCA and other certified laboratories.
The department also investigates food adulteration — especially in milk and ghee — and handles sample collection and testing. Hence, its credibility and impartiality are vital.
Even so, occasional doubts and allegations arose against the department. Its commissioner, however, was so competent that he received six years of post-retirement extensions.
Enhancing the Efficiency of GMSCL
The GMSCL’s efficiency improved considerably through regular tender committee meetings that helped understand the technical aspects of drugs and equipment.
By engaging expert doctors, we ensured better insight into equipment and supply issues, such as:
Shortage of technicians for available equipment,
Delays in AMC (Annual Maintenance Contracts) causing service breakdowns, and
Weaknesses in inventory management.
Once the engine (the core system) picked up speed, the rest of the train (the health services) followed efficiently.
Care for Senior Citizens
We focused on the difficulties faced by senior citizens seeking medical care.
In cities, many elderly parents live alone, as their children move abroad or to other cities for work or study. When their health suddenly deteriorates, they are often unable to seek help themselves.
We started a pilot project in Gandhinagar.
Elderly citizens were registered, and a mobile dispensary was deployed with a doctor and a nurse. Every fortnight, they visited senior citizens, checked vitals like BP, heart rate, oxygen level, and blood sugar, and provided medicines or hospital referrals when needed.
In emergencies, they would call 108 and arrange hospital transport.
The pilot project succeeded, and our goal was to expand it statewide.
However, after my tenure, it’s unclear whether it was discontinued or scaled up.
Because the health system was fully occupied with COVID-19 for two years, staff shortages likely hindered the project’s continuation.
In Gandhinagar’s sectors, many retired AIS officers reside. Their sector dispensaries function well, and we even added Homeopathic and other services to make them more useful.
108 Boat Ambulance
The 108 Emergency Ambulance Service, capable of arriving within 10–20 minutes, had become a symbol of Gujarat’s healthcare success.
Expectant fathers were now at ease knowing that their wives in labor pain would receive timely care.
Through schemes like Chiranjivi Yojana and the push for institutional deliveries, both maternal and infant mortality rates dropped significantly.
A High Court Justice, however, remarked that while 108 ambulances serve on land, the government should also provide boat ambulances for fishermen at sea, who face emergencies in the Arabian Sea.
He issued a directive with a time-bound order.
In the spirit of humanity, we rented boats, converted them into ambulance boats, assigned doctors and nurses, and successfully launched 108 services at sea — pleasing both the court and the fishing community.
Files and Administrative Challenges in the Medical Department
The Health Department deals with a vast number of subjects and offices, so the pile of files never diminishes.
The medical unions are also highly assertive. They know that if doctors go on leave or strike, the resulting public outcry is enough to pressure the government.
So even if the Finance Department (FD) objects to certain GRs (Government Resolutions), issues such as:
Regularizing ad-hoc services,
Doctors deputed to GMERS seeking to retain lien with government,
Those returning from GMERS demanding higher pay protection (causing anomalies where subordinates earn more than seniors),
all create bureaucratic knots that are hard to untangle.
In short, the medical administration is like a tangled thread — each attempt to pull it straight risks another knot forming elsewhere.
Coordination Issues with the Commissioner
Our department was well known for coordination problems between the Additional Chief Secretary and the Commissioner of Health. Officers around them kept fueling the fire, making sure it never died out. I, however, had a habit since my State Transport (ST) days — of holding weekly meetings. Every Monday we’d all meet, discuss ongoing work, plan new initiatives, share tea, and disperse. During the Wednesday afternoon secretaries’ review, our department’s performance was always up to the mark.
For the first six to eight months, everything went smoothly — until one vehicle exchange incident and the removal of the Commissioner’s reporting link to the Additional Chief Secretary threw the situation into chaos.
The Vehicle Dispute
As Chairman of GMSCL, I was the superior officer, and the Health Commissioner was a member. However, the Innova car assigned to the GMSCL Chairman was being used by the Commissioner in addition to her own official vehicle.
I, as Additional Chief Secretary, had a Ciaz car. For field visits, we would use an older spare Innova from Civil Hospital. This arrangement worked fine until, after the inauguration of the new Medical College at Vadnagar by the Prime Minister, our Innova met with an accident on the way back.
So, I recalled the GMSCL Chairman’s Innova — which the Commissioner was using — and gave her the Civil Hospital Innova instead. Moreover, through a GMSCL Board resolution, we decided to purchase a new Innova for the Commissioner as a board member.
But would the Finance Department (FD) ever grant such an approval easily? Of course not.
The FD didn’t approve it, and the matter got twisted in such a way that the Chief Minister was informed that the Additional Chief Secretary had “snatched away” the Commissioner’s vehicle. The Chief Minister told me this in person — so there was no question of hearsay.
The Commissioner already had her official vehicle. The dispute was only about the additional vehicle. In fact, apart from the official car, she used GMSCL Innova, and after exchange, using the Civil Hospital Innova, and possibly a hired NHM vehicle as well.
I had to carefully explain the matter to the Chief Minister and clear the misunderstanding.
GMSCL General Managers
The Gujarat Medical Services Corporation Limited (GMSCL) handled procurement of medicines and equipment for all hospitals, CHCs, and PHCs across the state. If medicine supplies were delayed, it created public outrage and political pressure. If equipment was not delivered or AMCs were not renewed in time, hospital staff would sit idle, and patients would suffer. If patients had to get X-rays or CT scans done outside, the media would immediately criticize the government.
To manage this, GMSCL had one General Manager (GM) for drug procurement and another for medical equipment.
Our operations were running smoothly — inventory monitoring, indenting, tendering, procurement, inspection, and supply were all well-coordinated with the performance of two General Managers and the team GMSCL. But the Commissioner for strange reason issued additional charge of Additional Director (Family Welfare) charge order to one of the GMs without the permission of the Government. Since the officer was from the Public Health side, he was also told to sit in the Commissioner’s office, which badly disrupted our procurement and supply operations.
I had to intervene firmly and order the officer not to leave GMSCL without government instruction, and to continue managing inventory and supply efficiently.
The officer was highly competent — he finalized many pending tenders, regularized drug supplies across the state, and, through his honesty, discipline, and consistency, helped the government save significant amounts through negotiated tenders.
Under GMSCL, we procured new CT scanners, X-ray machines, lab equipment, dental chairs, etc., and ensured timely AMCs — keeping medical services across Gujarat running efficiently.
Attempts to Transfer GMSCL and PIU Control
Later, efforts began to transfer control of GMSCL and the Project Implementation Unit (PIU) from the Additional Chief Secretary to the Commissioner. I thought — let’s dedicate this to Lord Krishna if it helps. But considering the dignity of the post and those who would hold it after me, I couldn’t just sit idle. I involved the Deputy Chief Minister, and those attempts were foiled.
Did the officer who succeeded me later hand over those functions to the Commissioner? That, I cannot say.
The August 15 Incident
On August 15, I had a mild fever. After attending the helipad function in Gandhinagar, I proceeded to Ahmedabad Medisity for the flag-hoisting ceremony. An officer got into my car and began qua telling me along the way. Out of courtesy, I remained silent. But when I got down at Civil Hospital, my headache worsened with the fever, and my enthusiasm for the event faded.
My driver whispered, “Sir, why did you listen to all that in front of me?”
Medicity Authority
I had developed the Medicity campus meticulously — completed pending works, ensured coordination, and streamlined its administration.
We even issued a government resolution (GR) to form the Medicity Authority. The registration form was signed by all members. But one officer, for reasons best known to him, stopped the employee going for registration, struck off her own signature from the form, and stalled the registration process.
At that time, signatures of all GR-designated members were mandatory for registration. I don’t know what became of that Authority later.
As per my design, Medicity was to be given a notified area status — with a distinct civic and medical governance system — to make it a self-sufficient, well-managed institution.
Prime Minister’s Inauguration Event
On the day of the Prime Minister’s inauguration at the Medicity campus, the inauguration of the Jamnagar Medical College campus and its hostel buildings was also scheduled.
Since both programs were to be graced by the Prime Minister, it was decided — by the Chief Principal Secretary to the Chief Minister and the Chief Secretary — that I, as Additional Chief Secretary, would manage the main stage event at Ahmedabad, while the Health Commissioner would handle the Jamnagar visit. Accordingly, I managed the Ahmedabad function, and the Commissioner was sent to Jamnagar.
In Ahmedabad, the minute-to-minute program, including the list of officers’ names, had already been approved by Delhi. Therefore, no changes were permitted. However, when the Commissioner got a seat with the Chief Minister in the helicopter, she arrived at Ahmedabad to attend the program along with him. The list of dignitaries invited to present floral bouquets had been approved by Delhi as well, and her name was not on it. Since last-minute changes were not allowed, her name could not be added on the spot — and she was displeased.
Suggestion from a Retired IAS Officer
A retired Additional Chief Secretary from the 1972 batch came to me with a project proposal from EY. The plan was to assess our doctors and medical staff against world-class standards, and then align their training with an international medical institute.
While we were still in preliminary discussions, I was stunned to hear from the Chief Minister himself that rumors were circulating — suggesting that this officer and I were planning some major wrongdoing together.
I told the Chief Minister that he should meet the officer personally and listen to his presentation to understand the idea. The Chief Minister merely smiled and brushed it off.
We also had talks with a U.S.-based organization regarding the use of Artificial Intelligence (AI) — particularly for interpreting X-ray images for radiological diagnosis. Since the government already faced a shortage of radiologists, this seemed promising. However, concerns about data privacy and potential misuse arose, so the idea was left at the discussion stage. Ironically, five years later, AI has brought a revolution to medical treatment — just as we had envisioned.
All India Service Rules
Two sensitive cases came before me.
In the first, an officer had switched an existing government online portal to a new private and foreign-linked platform without declaring that a family member had an interest in it. A good number of Ayurveda graduates were recruited under NHM and were put for training and promotional work for this new arrangement. I refrained from writing any remarks on that file, though the Health Minister did. What the General Administration Department (GAD) eventually did with it — I do not know.
In the second case, another officer’s personal life became part of their Performance Appraisal Report (PAR). I separated the personal from the professional and evaluated the officer purely on work performance.
Meanwhile, I kept receiving reports that an officer was whispering against me to the Chief Minister, CMO, and GAD officers — spreading malicious rumors and digging into my past.
I had already met the Chief Secretary earlier regarding coordination problems with that officer, but he simply said, “You handle it,” and washed his hands of the matter. Worse, he removed me as the reporting officer for that officer’s 2017–18 PAR, thereby weakening my administrative authority.
As a result, the next 12–15 months became extremely difficult — both for working and getting work done.
I had to steady myself — because while I was trying to preserve the health of the Health Department, my own health began to deteriorate.
PhD Registration
To regain focus, I turned to study. My blog and spiritual journey were ongoing, yet out of a desire to earn the “Dr.” prefix before my name, I registered for a PhD at GTU (Gujarat Technological University). My research topic aimed to develop an IT-based solution to address the shortage of specialist doctors in the state’s Community Health Centres (CHCs) and to provide advanced healthcare access to rural populations.
Swine Flu
It seems inevitable — being in the Health Department and falling ill. I contracted swine flu. One day, while taking steam inhalation with hot water, I accidentally spilled it and burned both my feet. Between the illness, physical pain, and a year of professional mental stress, my health broke down severely.
The Final Phase
By June 30, 2019, rumors were already circulating that I would become the next Chief Secretary. But instead of being assigned the Finance or Home Departments, I was transferred to the Agriculture Department in September 2019 — and I understood the administrative maneuvering behind it.
I served as Additional Chief Secretary of Agriculture for 11 months and retired on July 31, 2020. Just three and a half months later, I suffered a heart failure on December 15, 2020 — three stents were placed, and I survived.
But before reaching that turning point, I still had one final journey left — to lead the Department of Agriculture, Farmer Welfare, and Cooperation. There, I launched the Natural Farming Mission and initiated the Seven Steps for Farmer Development campaign — while also facing the locust invasion and helping manage the COVID-19 crisis.
15 October 2025
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