Chapter 8 – Infrastructure

(Indian Economic Development)

Notes

Infrastructure

Infrastructure can be defined as a supporting structure that provides supporting services in the main areas of industrial and agricultural production, domestic and foreign trade and commerce.

Infrastructure refers to all such services and facilities, which are needed to provide different kinds of services in an economy and which are essential in raising the pace of economic growth of a country.

 

Infrastructural services include:

• Roads, railways, ports, airports, dams, power stations, oil and gas pipelines, telecommunication facilities, etc.
• The country’s educational system including schools and colleges.
• Health system including hospital.
• Sanitary system including clean drinking water facilities.
• The monetary system including banks, insurance and other financial institutions.

 

Types of Infrastructure

Types of

Infrastructure

 

ECONOMIC INFRASTRUCTURE is associated with energy, transportation and communication.

 

SOCIAL INFRASTRUCTURE  is associated with education, health and housing.

 

 

Economic Infrastructure	Social Infrastructure
It directly supports the economic system from inside. It improves the productivity level in productive sectors like agriculture and industry by providing support services/ facilities directly.	It indirectly supports the economic system from outside. It improves the quality of human resources by increasing their productivity and efficiency by providing support services/ facilities indirectly.
It includes infrastructure associated with energy, transportation and communication.	It includes infrastructure related to education, health and housing.
It improves the physical capital stock of the economy.	It improves human capital stock/ social sector of the economy.

 

Note:

• Infrastructure, both economic and social, is essential for the development of a country.
• Both Economic and Social Infrastructure are interdependent and complementary to each other. Economic infrastructure improves the quality of economic resources and raises production.
• It cannot be possible until the population is literate and healthy to use them efficiently.
• Thus, both economic and social infrastructure are necessary for growth and development of a country.

 

Importance of Infrastructure

How does infrastructure contribute to development of a country?

Infrastructure, both economic and social, is essential for the development of a country. As a support system, it directly influences all economic activities by increasing the productivity of the factors of production and improving the quality of life.

 

The importance of infrastructure is explained in following points:-

 

1. Agricultural development: The development of modern agriculture depends on the infrastructural facilities like modern roadways, railways and shipping facilities for speedy and large-scale transport of seeds, pesticides, fertilisers and the produce It also depends to a considerable extent on the adequate expansion, and development of irrigation facilities. In recent times, agriculture also depends on insurance and banking facilities because of its need to operate on a very large scale.

 

2.  Economic development: 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.

Thus, development of infrastructure and economic development go hand in hand.

• • Agriculture depends, to a considerable extent, on the adequate expansion and development of irrigation facilities.
  • Industrial progress depends on the development of power and electricity generation, transport and communications.

 

3. Better quality of life: Well developed infrastructure leads to better quality of life.

• • 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.
  • The quality of transport and communication infrastructure can affect access to health care. However, air pollution and safety hazards connected to transportation also affect morbidity, particularly in densely populated areas.

 

4. Generates employment: Infrastructure help in generating employment as many people get employment in infrastructural projects like construction and maintenance of roads, railways, electricity plants etc.

 

The state of infrastructure in India

 

Traditionally, the government has been solely responsible for developing the country’s infrastructure. However, due to inadequacy of government’s investment in infrastructure, the private sector by itself and also, in joint partnership with the public sector, has started playing a very important role in infrastructure development.

1. A majority of people in India live in rural areas. Despite so much technical progress in the world, rural women are still using bio-fuels such as crop residues, dung and fuel wood to meet their energy requirement. About 85 per cent of the rural households use bio-fuels for cooking.
2. Rural people walk long distances to fetch fuel, water and other basic needs.
3. As per the census 2011 shows that in rural India only 56 per cent of rural households have an electricity connection and 43 per cent still use kerosene.
4. Tap water availability is limited to only 31per cent rural households. About 69 per cent of the population drinks water from open sources such as wells, tanks, ponds, lakes, rivers, canals, etc.
5. Access to improved sanitation in rural areas was only 30 per cent.

 

It is widely understood that infrastructure is the foundation of development, India is yet to wake up to the call. India invests very less i.e. only 30 per cent of its GDP on infrastructure, which is far below that of China and Indonesia. Some economists have projected that India will become the third biggest economy in the world a few decades from now. For that to happen, India will have to boost its infrastructure investment. if proper attention is not paid to the development of infrastructure, it is likely to act as a severe constraint on economic development.

• India has made considerable progress in building infrastructure, nevertheless, its distribution is uneven.
•  Many parts of rural India are yet to get good roads, telecommunication facilities, electricity, schools and hospitals.
• As India moves towards modernisation, the increase in demand for quality infrastructure, keeping in view their environmental impact, will have to be addressed.

 

Infrastructural requirements change with development level of countries 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. This is why, the share of power and telecommunication infrastructure is greater in high-income countries.

 

Health

In the words of WHO. ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’

Important points about Health

• 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.
• It may be difficult to define the health status of a nation in terms of a single set of measures. The health status is usually measured by taking into account indicators like infant mortality and maternal mortality rates, life expectancy and nutrition levels, along with the incidence of communicable and noncommunicable diseases.
• Development of health infrastructure ensures a country of healthy manpower for the production of goods and services.
• It is the responsibility of the government to ensure the right to healthy living. Health facilities are accessible to all the people of the country.

 

Health infrastructure

• 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. It should be accessible to all people.

• Since, 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 in India

Role of Government

• 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 the implementation of important health programmes in the country.

 

Expansion / Growth of public health infrastructure in India

Over the years, India has built a vast health infrastructure and manpower at different levels.

1. At the village level, a variety of hospitals, technically known as Primary Health Centres (PHCs), have been set up by the government.
2. India also has a 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.
3. Since Independence, there has been a significant expansion in the physical provision of health services.

 

During 1951–2018,

 

• • The number of government hospitals and dispensaries together increased from 9,300 to 53,800 and hospital beds from 1.2 to 7.1 lakhs.

• • Nursing personnel increased from 18,000 to 30 lakh and  Allopathic doctors from 62,000 to 11.5 lakhs.
  • The expansion of health infrastructure has resulted in the eradication of smallpox, guinea worms and the near eradication of polio and leprosy.

 

Role of Private Sector in Health Infrastructure

In recent times, the role of private sector, in providing health services, has considerably grown.

1. More than 70 per cent of the hospitals in India are run by the private sector. They control nearly two fifth of the beds available in the hospitals.
2. Nearly 60 per cent of dispensaries are run by the private sector.
3. Private sector provides healthcare for 80 per cent of out-patients and 46 per cent of in-patients.
4. 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. In 2001-02, there were more than 13 lakh medical enterprises employing 22 lakh people.
5. More than 80 % of them are single person owned and operated by one person occasionally employing a hired worker.

 

Medical Tourism in India

 

• Since the 1990s, owing to liberalisation measures, many non-resident Indians and industrial and pharmaceutical companies have set up state-of-the-art super-specialty hospitals to attract India’s rich and medical tourists.
• Foreigners come to India for surgeries, liver transplants, dental and even cosmetic care because India’s health services combine the latest medical technologies with qualified professionals and are cheaper for foreigners as compared to costs of similar healthcare services in their own countries.
• In 2016, as many as 2,01,000 foreigners visited India for medical treatment. This figure is likely to increase by 15 per cent each year.
• Experts predict that by 2020 India could earn more than 500 billion rupees a year through such ‘medical Tourism’.

 

However, 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. The role of government in providing healthcare is still very important as poor people can depend only on government hospitals, due to huge expenses in private health services

 

Health System in India (Three-tier system of Health Infrastructure) 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, Primary Health Centres (PHC), Community Health Centres (CHC) and sub-centres hospitals have been set up in villages and small towns. They are generally manned by a single doctor, a nurse and a limited quantity of medicines. When the condition of a patient is not managed by PHCs, they are referred to secondary or tertiary hospitals.   Secondary health care includes hospitals which have better facilities for surgery, X-ray, Electro Cardio Gram (ECG) which are called secondary health care institutions.

They function both as primary health care provider and also provide better healthcare facilities. They are mostly located in district headquarters and in big towns.   3. Tertiary health care includes 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. The tertiary sector also includes many premier institutes which not only impart quality medical

education and conduct research but also provide specialised health care. For example, 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.
• SEWA in Ahmedabad, ACCORD in the Nilgiris could be the examples of some such NGOs working in India.

• Trade unions have built alternative healthcare services for their members and also to give low-cost healthcare 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.

• In the rural areas, initiatives like 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.

 

Indian Systems of Medicine (ISM)

India has its own well-developed system of health care, namely – AYUSH. It includes six systems— Ayurveda, Yoga, Unani, Siddha, Naturopathy and Homeopathy.

• At present, there are 4,095 AYUSH hospitals and 27,951 dispensaries and as many as 8 lakh registered practitioners in India.
• ISMs have huge potential and can solve a large part of our healthcare problems because they are effective, safe and inexpensive.

 

AYUSH MINISTRY

The Ministry of AYUSH was formed on 9th November 2014 to ensure the optimal development and propagation of AYUSH systems of health care.

Objectives:

1. To upgrade the educational standards of Indian Systems of Medicines and Homoeopathy colleges in the country.
2. To strengthen existing research institutions and to ensure a time-bound research programme on identified diseases for which these systems have an effective treatment.
3. To draw up schemes for promotion, cultivation and regeneration of medicinal plants used in these systems.
4. To evolve quality and safety standards for Indian Systems of Medicine and Homoeopathy drugs.

 

Indicators of health

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 noncommunicable diseases

 

Trends in health in comparison with other countries

 

1. Infant Mortality/1000 live births is quite high in India (30) as compared to China (7.4), Sri Lanka (6.4) and USA (5.6).
2. Same holds true for Under-5 mortality/1000 live births reflecting poor child healthcare facilities in India. India (37), China (8.6), USA (6.5) and Sri Lanka (7.4).
3. This is despite the 89% of children being immunised for diseases like DTP etc. almost at par with China (89%) but far behind Sri Lanka (99%) and USA (94%) in this regard.
4. However, expenditure on health sector in India is 3.7 % of the total GDP. This is abysmally low as compared to other countries, both developed and developing.
5. Though India is the second most populated country in the world, but the health status of a great majority of the people is far from satisfactory as compared to China and other developed countries.
6. However, over the last five decades, India has built a vast health infrastructure and made considerable progress in improving the health of its people.

 

Challenges facing health sector in India

In India public health system and facilities are not sufficient for the bulk of the population.

 

1. India has about one-fifth (17%) 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.

 

Reasons for high GBD

• 1. A 2017 study shows nearly two thirds of GBD, now known as Total Burden of Disease was caused by non-communicable diseases associated with heart, respiratory system – lungs, kidney, obesity and lifestyle.
  2. Diarrhoea, lower respiratory system and other common infectious diseases account for one-sixth of total deaths in India.
  3. Out of 4.1 million early deaths occurring globally due to air pollution, 1.1 million deaths occur in India alone.
  4. The proportion of deaths occurs due to cancer (8 per cent) injuries (11 per cent) also has been increasing over the last two decades.

 

 Poor State of PHC

At present, less than 20 per cent of the population utilises public health facilities. 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.

 

1. Urban-Rural and Poor-Rich Divide

People living in rural areas do not have sufficient health infrastructure. This has led to differences in the health status of people.

• 1. Though 70 per cent of India’s population lives in rural areas, only one-fifth of its hospitals (including private hospitals) are located in rural areas.
  2. Rural India has only about half the number of dispensaries. Out of about 7.13 lakh beds in government hospitals, roughly 30 per cent are available in rural areas.
  3. 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.
  4. The PHCs located in rural areas do not even offer X-ray or blood testing facilities, which for a city dweller, constitutes basic healthcare.
  5. Villagers have no access to any specialised medical care, like paediatrics, gynaecology, anaesthesia and obstetrics.
  6. Even though 530 recognised medical colleges produce about 50,000 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.
  7. In rural areas, the percentage of people who have no access to proper healthcare facilities has increased over the last few years.

There is a sharp divide between 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.

 

Rich Poor Divide

• 1. One study points out that 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.
  2. Since government-run hospitals do not provide sufficient facilities, the poor are driven to private hospitals, which make them indebted forever, else they opt to die.
  3. Many have to sell their land or even pledge their children to afford treatment.

 

Inter-State Disparities

 States, like Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, are relatively lagging behind in healthcare facilities.

 

1. Women’s Health

(Why is women’s health important?)

Women constitute about half of the total population in India. Yet they suffer many disadvantages as compared to men in the areas of education, participation in economic activities and healthcare.

 

Women’s health across the country has become a matter of great concern as:

• 1. The deterioration in the child sex ratio in the country from 927 in 2001 to 919 in 2011 points to the growing incidence of female foeticide.
  2. Five per cent of girls aged between 15-19 years are not only married but have already borne children at least once.
  3. More than 50 per cent of married women in the age group of 15–49 years have anaemia and nutritional anaemia caused by iron deficiency, and this has not declined since 2005.
  4. The GBD Study 2017 reports that premature deaths due to neonatal disorders tops in both the years 2007 and 2017 and this has not declined since 2005.

 

Measures for improving health infrastructure

Health is a vital public good and a basic human right. All citizens can get better health facilities if public health services are decentralised.

1. 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.

1. Telecom and IT can play an important role in improving the health process in the economy.
2. The effectiveness of healthcare programmes also rests on primary healthcare So, serious steps should be taken to improve them.
3. The ultimate goal should be to help people move towards a better quality of life.
4. There is a sharp divide between urban and rural healthcare in India i.e. there is a wide gap between rural-urban areas and between poor and rich in utilising health care facilities. So serious measures should to be taken to provide basic healthcare to all, accessibility and affordability needs to be integrated in our basic health infrastructure.