- Anam and Deepak Jadhav
Summary observations about Maharashtra’s controversial ambulance PPP
- High costs: Maharashtra’s ambulance service, handed over to private companies in PPP mode in 2025 will cost average Rs. 3.5 lakh per ambulance per month — about one and half times higher than Andhra Pradesh and Karnataka, raising questions of unjustified public expenditure and profiteering by companies.
- Tender irregularities: The main tender documents were drafted not from government office, but from the office of one of the involved companies. Criteria were tailored to exclude competitors, leaving only the BVG–Sumeet consortium as bidder. Sumeet was simultaneously a government advisor and bidder, exposing serious conflict of interest. The work order was issued even before the consortium was formally registered.
- Dubious contractors: Sumeet Facility is linked to controversies in other states and political patronage. BVG India faced a High Court-mandated forensic audit (never completed) but was still awarded the contract.
- Service quality failures: Ambulances often fail to reach patients within the ‘Golden Hour’. Documented delays (80–120 minutes in many districts); deaths reported in rural/tribal areas due to non-arrival of ambulance in time.
- Exploitation of ambulance staff: Contractual drivers face long hours, low pay, poor working conditions, and unsafe vehicles. They have repeatedly protested, demanding fair wages and humane schedules.
Policy recommendations
- Cancel the current PPP contract and return ambulance services to direct operation by Maharashtra government, following Karnataka’s example.
- Conduct independent inquiry into tender process, financial irregularities, and political links, ban dubious companies from further public tenders.
- Enforce strict service norms for pickup and transfer times (15–30 minutes as per area). Ensure staff welfare – mandate fair wages, regulated hours, and occupational safety in service design.
Overall message: Essential life-saving services like ambulances must not be outsourced to profit-driven contractors. Publicly run ambulance systems should be ensured for accountability, affordability, and protection of both patients and frontline workers.
Ambulances are meant to be lifelines for people in moments of crisis. Emergency ambulance services embody the state’s duty to protect lives. But in Maharashtra the State Government is outsourcing this essential service through large scale but dubious Public–Private Partnerships (PPPs), and these lifelines have been converted into profit lines for private operators. In this article we discuss how the Maharashtra Government has entered into a major ambulance contract, where profit is taking precedence over patients, and corruption appears to be undermining patient care and staff welfare.
The Public Health Department of Maharashtra is running the ‘Maharashtra Emergency Medical Services’ (MEMS) project through a network of nearly 1000 ambulances stationed across the state. These ambulances are supposed to provide either Basic or Advanced Life Support, operate 24×7, and aim to provide emergency first aid while transporting patients to the nearest hospital within the ‘Golden Hour’. Any patient in critical condition can dial 108 to access these services free of cost.
This major service is run through a Public-Private Partnership (PPP) model in Maharashtra. From 2014 to 2019, the contract for operating 937 ambulances was awarded to BVG India, at an annual cost of Rs. 300 crore annually, borne by the State Government. The ambulances were owned by the Maharashtra Government, but BVG was responsible for their operation costs and salaries; this contract was extended till 2024. Last year a new tender was issued, and in 2025, the contract was jointly awarded to BVG India, Sumeet Facility, and SSG Transport Sanitaria, while raising a whole range of questions and concerns.
Expenditure on ambulances under PPP in Maharashtra – higher than other states?
The new, ten-year contract includes provisions to expand and upgrade the 108 ambulance service in the state. However, social activists, Right to Information activists, and opposition leaders have accused the Government of political interference and large-scale irregularities in the deal. The cost of the deal as detailed below, along with other related issues, has raised numerous questions.
The ambulance and equipment to be purchased under this contract are estimated to cost approximately Rs. 580 crores. The operations and maintenance cost would be around Rs. 700 crores in the first year, with an 8% annual increase. According to reports, the cost of the overall contract for 1,756 ambulances could be more than Rs. 10,000 crore. The cost per ambulance in Maharashtra is estimated to amount to an average of Rs. 3.5 lakh per month.
If we compare this with Andhra Pradesh under a contract that ended in 2024, the monthly operational cost per ambulance per month during 2023 and 2024 is estimated to be in the range of Rs. 2.05 lakh to Rs. 2.13 lakh, varying somewhat across years. In case of Karnataka, in 2025 the State Government terminated its PPP contract and decided to operate the ambulance services directly, to ensure substantial cost savings and adequate employee welfare. As per available sources the expected cost per ambulance per month in Karnataka is around Rs. 2.1 lakhs.
Maharashtra’s projected monthly cost per ambulance (Rs. 3.5 lakh) appears to be significantly higher, around one and half times higher than these comparable states. This raises major questions about the justification for this much higher expenditure under the newly launched PPP for ambulance services.
Serious irregularities in the tendering process
Not only is the high cost budgeted in the new MEMS contract a matter of concern, but serious irregularities were also found in the tender process, raising suspicion of misconduct and conflicts of interest. The following points confirm this:
- Fraud in drafting the tender documents: A cyber forensic report revealed that the crucial tender documents were not prepared by Government officials but rather, were drafted at the Pimpri office of Sumeet Facilities (one of the ambulance contractors) and were uploaded by a private individual who held no official designation.
- Exclusion of competing companies: The tender documents were allegedly tailored to benefit the BVG-Sumeet consortium. Initially, over 30 companies showed interest in bidding, but the exhaustive requirements set in the tender led all other companies to fail to meet the criteria. This eliminated all the competition and BVG-Sumeet was the sole bidder.
- Major conflict of interest: Sumeet Facilities is also a Government advisor, and thus legally prohibited from participating in the tender process. Despite this, the company was awarded the contract, which is a clear violation of conflict of interest norms.
- False claims and invalid procedures: It was claimed that the tender was approved in a Cabinet meeting on March 13, 2024, but the proposal was not actually on the approval list. Nevertheless, a work order was issued on March 15, 2024. Additionally, the consortium receiving the order was officially registered only in April 2024, nearly a month after receiving the contract.
- Contractor’s dubious background:
Sumeet Facility’s highly dubious record: Amit Salunkhe, partner in Sumeet Facility, was recently arrested in a liquor scam in Jharkhand. The company also faced action in Chhattisgarh, but was still awarded the Maharashtra tender. Salunkhe is reported to be a close aide of Shrikant Shinde, who is the son of Maharashtra Deputy Chief Minister Eknath Shinde.
Serious allegations against BVG India: BVG India Limited held the state level ambulance contract in Maharashtra between 2014 and 2019, but was allowed to continue operations till 2024 without any formal extension process. In those ten years, there were no records maintained for public funds received. The High Court ordered a forensic audit of BVG India Limited, and the Government assured the court that the company would not be allowed to participate in future tenders until the audit results were available. However, this promised forensic audit was never conducted and despite that, the company was allowed to participate in the fresh tender and was awarded the contract.
Major concerns about the PPP model for ambulance services
Delayed and unreliable services
Past experiences of patients and users reflect the substandard quality of services being provided by 108 ambulances in Maharashtra, despite their high cost to the public. Reaching the hospital within the ‘Golden Hour’ remains a distant dream, as ambulances frequently fail to even pick up the patient within that critical time window. According to a major, recent study on MEMS, in most districts the time required for ambulance to reach and then transfer the patient to desired facility exceeded the golden hour. The duration of hospital-to-hospital transfer calls within districts typically ranged from 80 to 120 minutes (Ahana Sarkar, Vipul Parmar, Arnab Jana and Sujata Saunik, 2024). In rural areas where the services are extremely necessary, complaints about delayed arrivals are frequent. In tribal-dominated areas like Palghar, women have died due to ambulances not reaching on time. There have been incidents reported from the media in Nashik, Pune, Parbhani, Solapur and Chhatrapati Sambhaji Nagar where the condition of the patients became critical due to the 108 ambulance reaching the accident site very late. Cases of patients dying because of delayed ambulance arrivals and even ambulances catching fire have been reported from Sindhudurg and Palghar districts.
In urban areas, ambulance utilisation is low because one can usually reach the hospital faster using public or personal transportation.
“When calling for a 108 ambulance, the call is connected with the driver from the call centre. Often the driver is unavailable. They say that the vehicle has gone on another call and they are far away from the scene. Therefore, no one waits for 108 ambulances in the city in an emergency. The patient is taken to the hospital by any other vehicle available. As a result, the use of this service is very limited in the city.” –A resident of Solapur
Exploitation of contractual drivers
In addition to user dissatisfaction, the contract-based drivers of these 108 ambulances are quite dissatisfied with their working conditions and the outdated condition of the ambulances. Drivers have staged repeated protests demanding better working conditions and adequate wages, which caused service disruptions.
“In many districts, especially in rural and remote areas, 108 ambulances are old and in disrepair. The doors of these vehicles do not close properly, the chassis are rusty and the necessary medical equipment (e.g. oxygen cylinders, stretchers) is damaged. Due to being outdated and poorly maintained, the ambulances suddenly stop or have to be started by manually pushing them. These ambulances have often been operated for distances that are more than twice the prescribed norms. Certain old ambulances have even caught fire while running. Therefore, we feel that we are not driving ambulances but rather living bombs in which patients as well as staff are at risk.
In some places, a single driver has to work 24 hours a day. The remuneration for this work is also very low. 108 ambulance drivers have staged protests from time to time for salary hikes, reasonable working hours and other demands.” – 108 Ambulance Driver
It is worth noting that the new ambulance tender does not specify employee salaries or working hours. Thus, the situation of low wages, long working hours and exploitation of contractual staff is likely to continue.
Overpriced ambulance purchases: The new contract allows ambulances to be purchased at around triple the market rate, with the Government covering half the cost, yet ownership remains with the contracting company.
Falsified records: There are reports that ambulance doctors are sometimes forced to record fake cases, which inflates the service record but constitutes tampering with medical records and misleading the Government.
Ambulances carrying the dead: Ambulances are sometimes misused as mortuary vans, endangering healthcare personnel and diverting services away from patient care.
Karnataka decision to eliminate PPP, ambulance services reclaimed by Health department
Due to a wide range of problems faced with the private agency GVK-EMRI involved in the ambulance PPP, the Karnataka Government has now decided that the ‘Arogya Kavacha’ ambulance service would henceforth be operated completely by the Health Department directly. Health Minister Dinesh Gundu Rao has said that “This will not only make the service more effective and benefit people but will also save crores of rupees to the State exchequer. … it will also improve the system.”
Recommendations to uphold public interest
The experience of Maharashtra’s ambulance PPP starkly highlights the basic, inherent problems common to many health-sector PPPs in India—excessive costs, compromised service quality, erosion of staff welfare, and lack of accountability. The following steps need to be urgently taken:
- CCC as a response to PPP: Cancel the Current Contract – Given the highly inflated costs, multiple tender irregularities, and serious conflicts of interest, the present ambulance PPP contract should be cancelled at the earliest, while the running of this service should be taken back by the public system. Essential services like ambulances must not be held hostage to dubious private arrangements.
- Shift to a Government-run model: Ambulance services in Maharashtra should be operated directly by the State Health department, following the examples from states like Karnataka. A well managed Government-run service can ensure improved oversight, lower costs, prompt and better outreach, and improved staff conditions.
- Conduct independent inquiry: A time-bound, independent inquiry should be immediately instituted into the tender process, the financial irregularities, and the role of officials, contractors and associated political actors. Findings of the cyber forensic report must be acted upon, with accountability being fixed for malpractice. Companies with poor track records, ongoing investigations, or prior blacklisting should be barred from any further bidding.
- Strictly implement norms for pickup time and patient transfer: Avoidable delays in pickup as well as transfer of patients must be minimised according to norms (e.g. 15-30 minutes for pickup depending on urban / rural areas) and systems should ensure that all patients reach the required facility within the golden hour.
- Ensure staff welfare: The model of ambulance services must include explicit provisions for fair wages, regulated working hours, occupational safety, and grievance mechanisms for ambulance staff.
Conclusion
The Maharashtra ambulance PPP is not an isolated case— this reflects a pattern seen across health-sector PPPs in India. Profit-driven contractors impose inflated and unjustified costs which drain public resources, while service quality for patients remains variable, and often unreliable and poor. Contractual staff who are central to providing the service face exploitation and neglect. Corruption, political interference, and opaque tendering are very frequent and these further erode public trust. Maharashtra’s experience underscores a wider lesson: essential health services, particularly those with life-and-death consequences, should not be outsourced since this tends to sacrifice accountability, and compromises welfare of patients and staff. To safeguard public interest, the state must reclaim direct operation of ambulance services, and we need to demand corruption-free, people-centred governance across the health sector.
(The authors are grateful to ambulance drivers and other persons who have given information for this article. Assistance for analysis and editing has been provided by Dr. Abhay Shukla).
References:
Ahana Sarkar, Vipul Parmar, Arnab Jana & Sujata Saunik (2024) Analyzing the Maharashtra Ambulance Service “108”: The Prospect and Challenges, Health Systems & Reform, 10:2, 2380251
https://sproutsnews.com/forensic-report-exposes-ambulance-tender-scam
https://x.com/VijayKumbhar62/status/1950075832065515612
Andhra Pradesh budget documents – available at www.apfinance.gov.in/budget.html
