WHAT IS INFRASTRUCTURE
- provides supporting services in the main areas of industrial and agricultural production, domestic and foreign trade and commerce.
- services include roads, railways, ports, airports, dams, power stations, oil and gas pipelines, telecommunication facilities, the country‘s educational system including schools and colleges, health system including hospitals, sanitary system including clean drinking water facilities and the monetary system including banks, insurance and other financial institutions.
- facilities have a direct impact on production of goods and services while others give indirect support by building the social sector of the economy
- Some divide infrastructure into two categories — economic and social.
- Economic Infrastructure associated with energy, transportation and communication are included in the former category
- whereas Social Infrastructure related to education, health and housing
RELEVANCE OF INFRASTRUCTURE
- Infrastructure is the support system on which depends the efficient working of a modern industrial economy.
- Modern agriculture also largely depends on it for speedy and large-scale transport of seeds, pesticides, fertilisers and the produce using modern roadways, railways and shipping facilities.
- agriculture also depends on insurance and banking facilities
- Infrastructure contributes to economic development of a country both by increasing the productivity of the factors of production and improving the quality of life of its people.
- Inadequate infrastructure can have
multiple adverse effects on health.
- Improvements in water supply and sanitation have a large impact by reducing morbidity (meaning proneness to fall ill) from major waterborne diseases and reducing the severity of disease when it occurs.
- In addition to the obvious linkage between water and sanitation and health, the quality of transport and communication infrastructure can affect access to health care.
- Air pollution and safety hazards connected to transportation also affect morbidity, particularly in densely populated areas.
THE STATE OF INFRASTRUCTURE IN INDIA
- government has been solely responsible for developing the country‘s infrastructure.
- government‘s investment in infrastructure was inadequate.
- Today, the private sector by itself and also in joint partnership with the public sector, has started playing a very important role in infrastructure
- rural women are still using bio-fuels such as crop residues, dung and fuel wood to meet their energy requirement.
- walk long distances to fetch fuel, water and other basic needs.
- Tap water availability is limited to only 24 per cent rural households.
- About 76 per cent of the population drinks water from open sources such as wells, tanks, ponds, lakes, rivers, canals, etc.
- Access to improved sanitation in rural areas was only 20 per cent.
- infrastructure is the foundation of development,
- India is yet to wake up to the call.
- India invests only 5 per cent of its GDP on infrastructure, which is far below that of China and Indonesia.
- In any country, as the income rises, the composition of infrastructure requirements changes significantly. For low-income countries, basic infrastructure services like irrigation, transport and power are more important.
- As economies mature and most of their basic consumption demands are met, the share of agriculture in the economy shrinks and more service related infrastructure is required.
- the share of power and telecommunication infrastructure is greater in high-income countries.
- Industrial progress depends on the development of power and electricity generation, transport and communications.
- Energy is a critical aspect of the development process of a nation.
- It is, of course, essential for industries.
- used on a large scale in agriculture and related areas like production and transportation of fertilisers, pesticides and farm equipment.
- It is required in houses for cooking, household lighting and heating
Sources of Energy:
- There are commercial and non-commercial sources of energy.
- Commercial sources are coal, petroleum and electricity as they are bought and sold.
- Non-commercial sources of energy are firewood, agricultural waste and dried dung. These are non-commercial as they are found in nature/forests.
- While commercial sources of energy are generally exhaustible (with the exception of hydropower),
- non- commercial sources are generally renewable.
- More than 60 per cent of Indian households depend on traditional sources of energy for meeting their regular cooking and heating needs
Non-conventional Sources of Energy:
- Both commercial and non-commercial sources of energy are known as conventional sources of energy.
- There are three other sources of energy which are commonly termed as nonconventional sources — solar energy, wind energy and tidal power.
- Being a tropical country, India has almost unlimited potential for producing all three types of energy if some appropriate cost effective technologies that are already available are used. Even cheaper technologies can be developed
Consumption Pattern of Commercial Energy:
- In India, commercial energy consumption makes up about 74 per cent of the total energy consumed in India.
- This includes coal with the largest share of 54 per cent, followed by oil at 33 per cent, natural gas at 9 per cent and hydro energy at 3 per cent.
- Non-commercial energy sources consisting of firewood, cow dung and agricultural wastes account for over 26 per cent of the total energy consumption.
- The critical feature of India‘s energy sector, and its linkages to the economy, is the import dependence on crude and petroleum products, which is likely to grow rapidly in the near future.
- The transport sector was the largest consumer of commercial energy in 1953-54.
- there has been continuous fall in the share of the transport sector while the shares of the household, agriculture and industrial sector have been increasing.
- The share of oil and gas is highest among all commercial energy consumption. With the rapid rate of economic growth, there has been a corresponding increase in the use of energy.
- The most visible form of energy, which is often identified with progress in modern civilization, is power, commonly called electricity.
- a critical component of infrastructure that determines the economic development of a country.
- The growth rate of demand for power is generally higher than the GDP growth rate.
- Studies point that in order to have 8 per cent GDP growth per annum, power supply needs to grow around 12 per cent annually. thermal sources accounted for almost 65 per cent of the power generation capacity.
- Hydel and wind power accounted for 32.5 per cent while nuclear power accounted only for per cent. India‘s energy policy encourages two energy sources— hydel and wind—as they do not rely on fossil fuel and, hence, avoid carbon emissions.
- This has resulted in faster growth of electricity produced from these two sources.
- Atomic energy is an important source of electric power, it has economic advantages.
Some Challenges in the Power Sector:
- Electricity generated by various power stations is not consumed entirely by ultimate consumers; a part is consumed by power station auxiliaries.
- Also, while transmitting power, a portion is lost in transmission.
- What we get in our houses, offices and factories is the net availability.
Some of the challenges that India‘s power sector faces today are
(i) India‘s installed capacity to generate electricity is not sufficient to feed an annual economic growth of 9 per cent. In order to meet the growing demand for electricity, India‘s commercial energy supply needs to grow at about 7 per cent. At present, India is able to add only 20,000 MW a year. Even the installed capacity is underutilized because plants are not run properly
(ii) State Electricity Boards (SEBs), which distribute electricity, incur losses which exceed Rs 500 billion. This is due to transmission and distribution losses, wrong pricing of electricity and other inefficiencies. Some scholars also say that distribution of electricity to farmers is the main reason for the losses; electricity is also stolen in different areas which also adds to the woes of SEBs
(iii) private sector power generators are yet to play their role in a major way; same is the case with foreign investors
(iv) there is general public unrest due to high power tariffsand prolonged power cuts in different parts of the country
(v) thermal power plants which are the mainstay of India‘s power sector are facing shortage of raw material and coal supplies.
- Thus, continued economic development and population growth are driving the demand for energy faster than what India is producing currently.
- More public investment, better research and development efforts, exploration technological innovation and use of renewable energy sources can ensure additional supply of electricity.
- Instead of investing in the power sector by adding to installed capacity, the government has gone for privatisation of the power sector and particularly the distribution (see Box 8.2) and allowed much higher prices of electricity that have impacted certain sectors very badly (see Box 3.3).
- Health is not only absence of disease but also the ability to realise one‘s potential.
- It is a yardstick of one‘s well being.
- Health is the holistic process related to the overall growth and development of the nation.
- Though the twentieth century has seen a global transformation in human health unmatched in history, it may be difficult to define the health status of a nation in terms of a single set of measures.
- scholars assess people‘s health by taking into account indicators like infant mortality and maternal mortality rates, life expectancy and nutrition levels, along with the incidence of communicable and non- communicable diseases
- Development of health infrastructure ensures a country of healthy manpower for production of goods and services. In recent times, scholars argue that people are entitled to health care facilities.
- It is the responsibility of the government to ensure the right to healthy living. Health infrastructure includes hospitals, doctors, nurses and other para-medical professionals, beds, equipment required in hospitals and a well-developed pharmaceutical industry.
- mere presence of health infrastructure is not sufficient to have healthy people: the same should be accessible to all the people.
- the initial stages of planned development, policy-makers envisaged that no individual should fail to secure medical care, curative and preventive, because of the inability to pay for it.
State of Health Infrastructure:
- The government has the constitutional obligation to guide and regulate all health related issues such as medical education, adulteration of food, drugs and poisons, medical profession, vital statistics, mental deficiency and lunacy.
- The Union Government evolves broad policies and plans through the Central Council of Health and Family Welfare.
- It collects information and renders financial and technical assistance to state governments, union territories and other bodies for implementation of important health programmes in the country.
- Over the years, India has built up a vast health infrastructure and manpower at different levels.
- At the village level, a variety of hospitals technically known as Primary Health Centres (PHCs) have been set up by the government.
- large number of hospitals run by voluntary agencies and the private sector.
- These hospitals are manned by professionals and para-medical professionals trained in medical, pharmacy and nursing colleges.
- Since independence, there has been a significant expansion in the physical provision of health services.
- Expansion of health infrastructure has resulted in the eradication of smallpox, guinea worms and the near eradication of polio and leprosy.
Private Sector Health Infrastructure:
- the public health sector has not been so successful in delivering the goods.
- More than 70 per cent of the hospitals in India are run by the private sector.
- provide healthcare for 80 per cent of out- patients and 46 per cent of in-patients. In recent times, private sector has been playing a dominant role in medical education and training, medical technology and diagnostics, manufacture and sale of pharmaceuticals, hospital construction and the provision of medical services.
- Scholars point out that the private sector in India has grown independently without any major regulation; some private practitioners are not even registered doctors and are known as quacks Since the 1990s, owing to liberalisation measures, many non- resident Indians and industrial and pharmaceutical companies have set up state-of-the-art superspecialty hospitals to attract India‘s rich and medical tourists.
Indian Systems of Medicine (ISM):
- It includes six systems — Ayurveda, Yoga, Unani, Siddha, Naturopathy and Homeopathy (AYUSH).
- But little has been done to set up a framework to standardise education or to promote research.
- ISM has huge potential and can solve a large part of our health care problems because they are effective, safe and inexpensive
Health System in India
- India‘s health infrastructure and health care is made up of a three-tier system— primary, secondary and tertiary.
- Primary health care includes education concerning prevailing health problems and methods of identifying, preventing and controlling them; promotion of food supply and proper nutrition and adequate supply of water and basic sanitation; maternal and child health care; immunisation against major infectious diseases and injuries; promotion of mental health and provision of essential drugs Auxiliary Nursing Midwife (ANM) is the first person who provides primary healthcare in rural areas. In order to provide primary health care, hospitals have been set up in villages and small towns which are generally manned by a single doctor, a nurse and a limited quantity of medicines. They are known as Primary Health Centres (PHC), Community Health Centres (CHC) and sub-centres.
- When the condition of a patient is not managed by PHCs, they are referred to secondary or tertiary hospitals. Hospitals which have better facilities for surgery, X-ray, Electro Cardio Gram (ECG) are called secondary health care institutions.
- They function both as primary health care provider and also provide better healthcare facilities.
- mostly located in district headquarters and in big towns.
- All those hospitals which have advanced level equipment and medicines and undertake all the complicated health problems, which could not be managed by primary and secondary hospitals, come under the tertiary sector.
- The tertiary sector also includes many premier institutes which not only impart quality medical education and conduct research but also provide specialised health care. Some of them are — All India Institute of Medical Science, New Delhi; Post Graduate Institute, Chandigarh; Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry; National Institute of Mental Health and Neuro Sciences, Bangalore and All India Institute of Hygiene and Public Health, Kolkata.
Community and Non-Profit Organisations in Healthcare
- One of the important aspects of a good healthcare system is community participation. It functions with the idea that the people can be trained and involved in primary healthcare system.
- This method is already being used in some parts of our country. SEWA in Ahmedabad and ACCORD in Nilgiris could be the examples of some such NGOs working in India.
- Trade unions have built alternative health care services for their members and also to give low-cost health care to people from nearby villages.
- The most well-known and pioneering initiative in this regard has been Shahid Hospital, built in 1983 and sustained by the workers of CMSS (Chhattisgarh Mines Shramik Sangh) in Durg, Madhya Pradesh.
- A few attempts have also been made by rural organisations to build alternative healthcare initiatives. One example is in Thane, Maharashtra, where in the context of a tribal people’s organisation, Kashtakari Sangathan, trains women health workers at the village level to treat simple illnesses at minimal cost.
Indicators of Health and Health Infrastructure—A Critical Appraisal:
- the health status of a country can be assessed through indicators such as infant mortality and maternal mortality rates, life expectancy and nutrition levels, along with the incidence of communicable and non- communicable diseases.
- India has about 17 per cent of the world‘s population but it bears a frightening 20 per cent of the global burden of diseases (GBD).
- GBD is an indicator used by experts to gauge the number of people dying prematurely due to a particular disease as well as the number of years spent by them in a state of disability‘ owing to the disease.
- In India, more than half of GBD is accounted for by communicable diseases such as diarrhoea, malaria and tuberculosis. Every year around five lakh children die of water-borne diseases.
- The danger of AIDS is also looming large. Malnutrition and inadequate supply of vaccines lead to the death of 2.2 million children every year.
- At present, less than 20 per cent of the population utilises public health facilities.
- One study has pointed out that only 38 per cent of the PHCs have the required number of doctors and only 30 per cent of the PHCs have sufficient stock of medicines
Urban-Rural and Poor-Rich Divide:
- Though 70 per cent of India‘s population lives in rural areas, only one-fifth of its hospitals are located in rural areas. Rural India has only about half the number of dispensaries.
- Out of about 7 lakh beds, roughly 11 per cent are available in rural areas. Thus, people living in rural areas do not have sufficient medical infrastructure. This has led to differences in the health status of people.
- As far as hospitals are concerned, there are only 0.36 hospitals for every one lakh people in rural areas while urban areas have 3.6 hospitals for the same number of people.
- The PHCs located in rural areas do not offer even X-ray or blood testing facilities which, for a city dweller, constitutes basic healthcare.
- States like Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh are relatively lagging behind in health care facilities.
- Villagers have no access to any specialised medical care like paediatrics, gynaecology, anaesthesia and obstetrics.
- Even though 315 recognised medical colleges produce 30,000 medical graduates every year, the shortage of doctors in rural areas persists.
- While one-fifth of these doctor graduates leave the country for better monetary prospects, many others opt for private hospitals which are mostly located in urban areas.
- The poorest 20 per cent of Indians living in both urban and rural areas spend 12 per cent of their income on healthcare while the rich spend only 2 per cent. What happens when the poor fall sick?
- Many have to sell their land or even pledge their children to afford treatment. Since government-run hospitals do not provide sufficient facilities, the poor are driven to private hospitals which makes them indebted forever. Or else they opt to die
- Women constitute about half the total population in India.
- They suffer many disadvantages as compared to men in the areas of education, participation in economic activities and health care.
- The deterioration in the child sex ratio in the country from 927 in 2001 to 914, as revealed by the census of 2011, points to the growing incidence of female foeticide in the country.
- Close to 3,00,000 girls under the age of 15 are not only married but have already borne children at least once.
- More than 50 per cent of married women between the age group of 15 and 49 have anaemia and nutritional anaemia caused by iron deficiency, which has contributed to 19 per cent of maternal deaths.
- Abortions are also a major cause of maternal morbidity and mortality in India.
- All citizens can get better health facilities if public health services are decentralised.
- Success in the long-term battle against diseases depends on education and efficient health infrastructure.
- It is, therefore, critical to create awareness on health and hygiene and provide efficient systems.
- The role of telecom and IT sectors cannot be neglected in this process.
- The effectiveness of healthcare programmes also rests on primary healthcare.
- The ultimate goal should be to help people move towards a better quality of life. There is a sharp divide between the urban and rural healthcare in India. If we continue to ignore this deepening divide, we run the risk of destabilising the socio- economic fabric of our country.
- In order to provide basic healthcare to all, accessibility and affordability need to be integrated in our basic health infrastructure.