Chapter 8 INFRASTRUCUTR 23.01.06 version 4ncertbooks.prashanthellina.com/class_11.Economics... · Air pollution and safety hazards connected to transportation also affect morbidity,

After studying this chapter, the learners will

• understand the main challenges India faces in the areas of social andeconomic infrastructure

• know the role of infrastructure in economic development

• understand the role of energy as a critical component of infrastructure

• understand the problems and prospects of the energy and health sectors

• understand the health infrastructure of India.

INFRASTRUCTURE

8

140 INDIAN ECONOMIC DEVELOPMENT

8.1 INTRODUCTION

Have you ever thought of why some statesin India are performing much better thanothers in certain areas? Why do Punjab,Haryana and Himachal Pradesh prosperin agriculture and horticulture? Why areMaharashtra and Gujarat industriallymore advanced than others? How comeKerala, popularly known as ‘God’s owncountry’, has excelled in literacy, healthcare and sanitation and also attractstourists in such large numbers? Whydoes Karnataka’s information technologyindustry attract world attention?

It is all because these states havebetter infrastructure in the areas theyexcel than other states of India. Somehave better irrigation facilities. Othershave better transportation facilities, orare located near ports which makes rawmaterials required for variousmanufacturing industries easily

accessible. Cities like Bangalore inKarnataka attract many multinationalcompanies because they provideworld-class communication facilities.All these support structures, whichfacilitate development of a country,constitute its infrastructure. Howthen does infrastructure facilitatedevelopment?

8.2 WHAT IS INFRASTRUCTURE?

Infrastructure provides supportingservices in the main areas of industrialand agricultural production, domesticand foreign trade and commerce. Theseservices include roads, railways, ports,airports, dams, power stations, oil andgas pipelines, telecommunicationfacilities, the country’s educationalsystem including schools and colleges,health system including hospitals,sanitary system including clean

drinking water facili-ties and the monetarysystem includingbanks, insurance andother financial institu-tions. Some of thesefacilities have a directimpact on the workingof the system ofproduction whileothers give indirectsupport by buildingthe social sector of theeconomy.

“Many things we need can wait, the child cannot. To him, we cannot say,‘tomorrow’. His name is today.”

Gabrriella Mistral— Chilean poetSo is the Infrastructure.

Fig. 8.1 Roads are the missing link with growth

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Some divide infrastructure into twocategories — economic and social.Infrastructure associated with energy,transportation and communication areincluded in the former categorywhereas those related to education,health and housing are included in thelatter.

speedy and large-scaletransport of seeds,pesticides, fertilisersand the produce bymaking use of modernroadways, railways andshipping facilities.Modern agriculturealso has to depend oninsurance and bankingfacilities because of itsneed to operate on a verylarge scale.

Infrastructure contributes toeconomic development of a countryboth by increasing the productivity ofthe factors of production and improvingthe quality of life of its people.Inadequate infrastructure can havemultiple adverse effects on health.Improvements in water supply andsanitation have a large impact byreducing morbidity (meaningproneness to fall ill) from majorwaterborne diseases and reducing theseverity of disease when it occurs. Inaddition to the obvious linkage betweenwater and sanitation and health,the quality of transport andcommunication infrastructure canaffect access to health care. Air pollutionand safety hazards connected totransportation also affect morbidity,particularly in densely populated areas.

8.4 THE STATE OF INFRASTRUCTURE ININDIA

Traditionally, the government has beensolely responsible for developing the

8.3 RELEVANCE OF INFRASTRUCTURE

Infrastructure is the support system onwhich depends the efficient working ofa modern industrial economy. Modernagriculture also largely depends on it for

Work This Out

In your locality orneighbourhood you mightbe using a variety ofinfrastructure. List all ofthem. Your locality may alsobe requiring a few more.List them separately.

Fig. 8.2 Schools: an important infrastructure for a nation


country’s infrastructure. But it wasfound that the government’s investmentin infrastructure was inadequate.Today, the private sector by itself andalso in joint partnership with the publicsector, has started playing a veryimportant role in infrastructuredevelopment.

A majority of our people live in ruralareas. Despite so much technical progressin the world, rural women are still usingbio-fuels such ascrop residues, dungand fuel wood tomeet their energyrequirement. Theywalk long distancesto fetch fuel, waterand other basicneeds. The census2001 shows that inrural India only 56per cent householdshave an electricityconnection and 43per cent still usekerosene. About90 per cent of the

rural householdsuse bio-fuels forcooking. Tap wateravailability is limitedto only 24 per centrural households.About 76 per cent ofthe populationdrinks water fromopen sources suchas wells, tanks,ponds, lakes, rivers,canals, etc. Another

study conducted by the NationalSample Survey Organisation noted thatby 1996, access to improved sanitationin rural areas was only six per cent.

Look at Table 8.1 which shows thestate of some infrastructure in India incomparison to a few other countries.Though it is widely understood thatinfrastructure is the foundation ofdevelopment, India is yet to wake upto the call. India invests only 5 per cent

Fig. 8.3 Dams: temples of development

Fig. 8.4 Safe drinking water with pucca house: still a dream

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of its GDP on infrastructure, which isfar below that of China and Indonesia.

Some economists have projectedthat India will become the third biggesteconomy in the world a few decadesfrom now. For that to happen, India will

have to boost its infrastructureinvestment. In any country, as theincome rises, the composition ofinfrastructure requirements changessignificantly. For low-income countries,basic infrastructure services likeirrigation, transport and power aremore important. As economies matureand most of their basic consumptiondemands are met, the share ofagriculture in the economy shrinks andmore service related infrastructure isrequired. This is why the share of powerand telecommunication infrastructureis greater in high-income countries.

Thus, development of infrastructureand economic development go hand inhand. Agriculture depends, to aconsiderable extent, on the adequateexpansion and development of irrigationfacilities. Industrial progress dependson the development of power andelectricity generation, transport andcommunications. Obviously, if properattention is not paid to the developmentof infrastructure, it is likely to act as a

TABLE 8.1

Some Infrastructure in India and other Countries, 2003

Country Investment in Access to Access to Mobile Users/ Phone PowerInfrastructure Safe Improved 1000 Lines/ Generationas a % GDP Drinking Sanitation (%) People 1000 (kw 1000)

Water (%) People

China 20 75 38 66 113 230Hong Kong 4 100 100 817 560 1630

India 5 84 28 4 33 107

Korea 7 92 63 583 449 1067

Pakistan 2 90 62 2 20 109

Singapore 5 100 100 684 528 1887

Indonesia 14 76 66 18 28 97

Source: World Development Report 2005, The World Bank, Washington DC, 2004.

Work These Out

While reading newspapersyou will come across termslike Bharat nirman, SpecialPurpose Vehicle (SPV),Special Economic Zones(SEZ), Build OperateTransfer (BOT), PrivatePublic Partnership (PPP)etc. Make a scrapbook ofnews items containingthese terms. How are theseterms related to infras-tructure?

Using the references at theend of the chapter, collectthe details of other infras-tructure.


severe constraint oneconomic development. Inthis chapter the focuswill be on only two kinds ofinfrastructure —thoseassociated with energyand health.

8.5 ENERGY

Why do we need energy?In what forms is itavailable? Energy is acritical aspect of thedevelopment process of anation. It is, of course, essential forindustries. Now it is used on a large scalein agriculture and related areas likeproduction and transportation offertilisers, pesticides and farmequipment. It is required in houses forcooking, household lighting and heating.Can you think of producing a commodityor service without using energy?

Sources of Energy: There arecommercial and non-commercial

sources of energy. Commercial sourcesare coal, petroleum and electricity asthey are bought and sold. They accountfor over 50 per cent of all energy sourcesconsumed in India. Non-commercialsources of energy are firewood,agricultural waste and dried dung.These are non-commercial as they arefound in nature/forests.

While commercial sources of energyare generally exhaustible (with theexception of hydropower), non-

commercial sources aregenerally renewable.More than 60 per centof Indian householdsdepend on traditionalsources of energy formeeting their regularcooking and heatingneeds.

Non -convent iona lSources of Energy: Bothcommercial and non-commercial sources ofenergy are known as

Fig. 8.6 Bullock carts still play a crucial role in ruraltransportation market

Fig.8.5 Fuel wood is the major source of energy

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conventional sources ofenergy. There are threeother sources of energywhich are commonlytermed as non-conventionalsources — solar energy,wind energy and tidalpower. Being a tropicalcountry, India has almostunlimited potential forproducing all three types ofenergy if some appropriatecost effective technologiesthat are already availableare used. Even cheapertechnologies can be developed.

Consumption Pattern of CommercialEnergy: At present, commercial energyconsumption makes up about 65 per

cent of the total energy consumed inIndia. This includes coal with thelargest share of 55 per cent, followedby oil at 31 per cent, natural gas at 11per cent and hydro energy at 3 per cent.Non-commercial energy sourcesconsisting of firewood, cow dung andagricultural wastes account for over30 per cent of the total energyconsumption. The critical featureof India’s energy sector, and itslinkages to the economy, is the import-dependence on crude and petroleumproducts, which is likely to grow to morethan 100 per cent in the near future.

The sectoral pattern of consumptionof commercial energy is given in Table8.2. The transport sector was the largestconsumer of commercial energy in1953-54. However, there has beencontinuous fall in the share of thetransport sector while the share of theindustrial sector has been increasing.The share of oil and gas is highestamong all commercial energyconsumption. With the rapid rate ofFig. 8.7 Wind mill : another source of generating

power

Fig. 8.8 Solar energy has great prospects


economic growth, there has been acorresponding increase in the use ofenergy.

Power/Electricity: The most visibleform of energy, which is often identifiedwith progress in modern civilization, ispower, commonly called electricity; it isone of the most critical components ofinfrastructure that determines theeconomic development of a country. Thegrowth rate of demand for power isgenerally higher than the GDP growthrate. Studies point that in order to have8 per cent GDP growth per annum,

power supply needs to grow around 12per cent annually.

Electricity is a secondary form ofenergy produced from primary energyresources including coal, hydro-carbons, hydro energy, nuclear energy,renewable energy etc. Primary energyconsumption takes into account thedirect and indirect consumption of fuels.It cannot give a complete picture inrespect of the ultimate consumption ofenergy by consumers. The secondarysources in India consist of coal, oil,electricity and natural gas.

In India, in 2003-04, thermal sourcesaccounted for almost70 per cent of thepower generationcapacity. Hydro, windand nuclear sourcesaccounted for 28 and 2.4per cent respectively.India’s energy policyencourages two energysources — hydel andwind — as they do not relyon fossil fuel and, hence,

TABLE 8.2

Trends in Sectoral Share of Commercial Energy Consumption (in %)

Sector 1953-54 1970-71 1990-91 1996-97

Household 10 12 12 12

Agriculture 01 03 08 09

Industries 40 50 45 42

Transport 28 22 22 22

Others 5 07 13 15

Total 100 100 100 100

Chart 8.1: Different Sources of Engery

Source: Ninth Five year Plan, Vol. II Chapter 6, Planning Commission, Government of India, New Delhi.

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avoid carbon emissions. This hasresulted in faster growth of electricityproduced from these two sources.

Atomic energy is an importantsource of electric power; it hasenvironmental advantages and is alsolikely to be economical in the long run.At present, nuclear energy accounts foronly 2.4 per cent of total primary

energy consumption, against a globalaverage of 13 per cent. This is fartoo low.

Some Challenges in the PowerSector: Electricity generated byvarious power stations is notconsumed entirely by ultimateconsumers; a part is consumed bypower station auxiliaries. Also, whiletransmitting power, a portion is lost intransmission. What we get in ourhouses, offices and factories is the netavailability.

Some of the challenges that India’spower sector faces today are (i) India’sinstalled capacity to generate electricityis not sufficient to feed an annualeconomic growth of 7 per cent. In orderto meet the growing demand forelectricity, between 2000 and 2012,India needs to add 1,00,000 MW of newcapacity, whereas, at present, India isable to add only 20,000 MW a year.Even the installed capacity is under-utilised because plants are not runproperly (ii) State Electricity Boards(SEBs), which distribute electricity,incur losses which exceed Rs 500

Box 8.1: Making a Difference

Thane city is acquiring a brand new image — an environment friendly makeover. Large-scale use of solar energy, which was considered a somewhat far-fetched concept, has brought in real benefits and results in cost and energysaving. It is being applied to heat water, power traffic lights and advertisinghoardings. And leading this unique experiment is the Thane MunicipalCorporation. It has made compulsory for all new buildings in the city to installsolar water heating system. (Appeared in the column, Making a Difference,Outlook, 01 August 2005).

Can you suggest such other ideas to use non-conventional energy in a betterway?

Work These Out

Among other sources ofenergy, you would havenoticed that a marginal shareof energy comes from nuclearpower. Why? Scholars pointout that with rising oil andcoal costs, nuclear power isthe best option. Discuss ordebate in your class.

Solar energy, wind powerand power produced fromtides are going to be futuresources of energy. What aretheir comparative meritsand demerits? Discuss inthe class.


billion. This is due to transmission anddistribution losses, wrong pricing ofelectricity and other inefficiencies.Some scholars also say thatdistribution of electricity to farmers isthe main reason for the losses;electricity is also stolen in differentareas which also adds to the woes ofSEBs (iii) private sector powergenerators are yet to play their role in amajor way; same is the case with

Box 8.2: Power Distribution: The Case of Delhi

Since independence, power management in the capital has changed handsfour times. The Delhi State Electricity Board (DSEB) was set up in 1951.This was succeeded by the Delhi Electric Supply Undertaking (DESU) in1958. The Delhi Vidyut Board (DVB) came into existence as SEB in February1997. Now it rests with two leading power majors of the country following theprivatisation of the DVB. Reliance Energy Ltd owned BSES manages powerdistribution in two-thirds of Delhi through its two companies (known asDISCOMS): south and west areas are handled by BSES Rajdhani PowerLimited whereas BSES Yamuna Power Limited looks after central and eastareas. The Tata Power-owned NDPL distributes power to the north and thenorth-west of the capital. Both the discoms further have 23 (220 KV) gridsbetween them to supply power to the approximately 28 lakh consumers in thecapital area. The tariff structure and other regulatory issues are monitored bythe Delhi Electricity Regulatory Commission (DERC). Though it wasexpected that there will be greater improvement in power distribution and theconsumers will benefit in a major way, experience shows unsatisfactory results.

Box 8.3: Saving Energy : Promoting the Case of Compact FluorescentLamps (CFL)

According to the Bureau of Energy Efficiency (BEE), CFLs consume 80 percent less power as compared to ordinary bulbs. As put by a CFL manufacturer,Indo-Asian, replacement of one million 100-watt bulbs with 20 watt CFLs cansave 80 megawatt in power generation. This amounts to saving Rs 400 croreat the rate of institution cost of Rs 5 crore per megawatt.

Source: Use Common Sense to Solve Power Crisis, by Naresh Minocha in Tehelka,01 October 2005.

foreign investors (iv) there is generalpublic unrest due to high power tariffsand prolonged power cuts in differentparts of the country (v) thermal powerplants which are the mainstay of India’spower sector are facing shortage of rawmaterial and coal supplies.

Thus, continued economicdevelopment and population growthare driving the demand for energy fasterthan what India is producing currently.

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More public investment, better researchand development efforts, exploration,technological innovation and use ofrenewable energy sources can ensureadditional supply of electricity. Thoughthe private sector has made someprogress, it is necessary to tap thissector to come forward and producepower on a large scale. One also has toappreciate the efforts made in thisregard. For example, India is already

the world’s fifth largest producer ofwind power, with more than 95 per centinvestments coming from the privatesector. Greater reliance on renewableenergy resources offers enormouseconomic, social and environmentalbenefits.

8.6 HEALTH

Health is not only absence of diseasebut also the ability to realise one’s

Work These Out

What kind of energy do you use in your house? Find out from your parentsthe amount they spend in a month on different types of energy.Who supplies power to you and where is it generated? Can you think ofother cheaper alternative sources which could help in lighting your houseor cooking food or for travelling to far away places?Look at the following table. Do you think energy consumption is an effectiveindicator of development?

Country Per Capita Income Per Capita Consumption of(in US dollars) in Energy (kg of oil equivalent)

2003 (ppp) in 2001

India 2,880 515

Indonesia 3,210 729

Egypt 3,940 737

U.K. 27,650 3982

Japan 28,620 4099

U.S.A. 37,500 7996

Source: World Development Report 2005 and World Development Indicators 2004.

Find out how power is distributed in your area/state. Also find out the totalelectricity demand of your city and how it is being met.

You might notice people using variety of methods to save electricity andother energy. For instance, while using the gas stove, some suggestions aremade by gas agencies for using the gas efficiently and economically. Discussthem with your parents and the elderly, note down the points and discussthem in class.


potential. It is a yardstick of one’s wellbeing. Health is the holistic processrelated to the overall growth anddevelopment of the nation. Though thetwentieth century has seen a globaltransformation in human healthunmatched in history, it may bedifficult to define the health status of anation in terms of a single set ofmeasures. Generally scholars assesspeople’s health by taking into accountindicators like infant mortality andmaternal mortality rates, life expectancyand nutrition levels, along with theincidence of communicable and non-communicable diseases.

Development of health infrastructureensures a country of healthy manpowerfor production of goods and services. Inrecent times, scholars argue that peopleare entitled to health care facilities. It isthe responsibility of the government to

ensure the right to healthy living. Healthinfrastructure includes hospitals,doctors, nurses and other para-medicalprofessionals, beds, equipment requiredin hospitals and a well-developedpharmaceutical industry. It is also truethat mere presence of healthinfrastructure is not sufficient to havehealthy people: the same should beaccessible to all the people. Since, theinitial stages of planned development,policy-makers envisaged that noindividual should fail to secure medicalcare, curative and preventive, because ofthe inability to pay for it. But are we ableto achieve this vision? Before we discussvarious health infrastructure, let usdiscuss the status of health in India.

State of Health Infrastructure: Thegovernment has the constitutionalobligation to guide and regulate all

Fig. 8.9 Health infrastructure is still lacking in large parts of the country

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health related issues such as medicaleducation, adulteration of food, drugsand poisons, medical profession,vital statistics, mental deficiencyand lunacy. The Union Governmentevolves broad policies and plansthrough the Central Council of Healthand Family Welfare. It collects informationand renders financial and technicalassistance to state governments, unionterritories and other bodies forimplementation of important healthprogrammes in the country.

Over the years, India has built up avast health infrastructure andmanpower at different levels. At thevillage level, a variety of hospitals havebeen set up by the government. Indiaalso has a large number of hospitals runby voluntary agencies and the privatesector. These hospitals are manned byprofessionals and para-medicalprofessionals trained in medical,pharmacy and nursing colleges.

Since independence, there has beena significant expansion in the physicalprovision of health services. During1951-2000, the number of hospitalsand dispensaries increased from 9,300to 43,300 and hospital beds from 1.2to 7.2 million (see Table 8.3); during1951-99, nursing personnel increasedfrom 0.18 to 8.7 lakh and allopathicdoctors from 0.62 to 5.0 lakh.Expansion of health infrastructure hasresulted in the eradication of smallpox,guinea worms and the near eradicationof polio and leprosy.

Private Sector Health Infrastructure:In recent times, while the public healthsector has not been so successful in

delivering the goods about which wewill study more in the next section,private sector has grown by leaps andbounds. More than 70 per cent of thehospitals in India are run by the privatesector; they control nearly two-fifth ofbeds available in the hospitals. Nearly60 per cent of dispensaries are run bythe same private sector. They providehealthcare for 80 per cent of out-patients and 46 per cent of in-patients.

In recent times, private sector hasbeen playing a dominant role in medicaleducation and training, medicaltechnology and diagnostics, manufactureand sale of pharmaceuticals, hospitalconstruction and the provision ofmedical services. In 2001-02, therewere more than 13 lakh medicalenterprises employing 22 lakh people;more than 80 per cent of them are singleperson owned, and operated by one

TABLE 8.3

Public Health Infrastructure in India,1951-2000

Item 1951 1981 2000

Hospitals 2694 6805 15888

Hospital/ 117000 504538 719861dispensarybeds

Dispensaries 6600 16745 23065

PHCs 725 9115 22842

Subcentres - 84736 137311

CHCs - 761 3043

Source: National Commission on Macroeconomicsand Health, Ministry of Health andFamily Welfare, Government of India,New Delhi, 2005.


Box 8.5: 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 educationconcerning prevailing health problems and methods of identifying, preventingand controlling them; promotion of food supply and proper nutrition andadequate supply of water and basic sanitation; maternal and child healthcare; immunisation against major infectious diseases and injuries; promotionof mental health and provision of essential drugs.

Auxiliary Nursing Midwife(ANM) is the first person whoprovides primary healthcare inrural areas. In order to provideprimary health care, hospitalshave been set up in villages andsmall towns which are generallymanned by a single doctor, anurse and a limited quantity ofmedicines. They are known asPrimary Health Centres (PHC),Community Health Centres(CHC) and sub-centres. Whenthe condition of a patient is notmanaged by PHCs, they arereferred to secondary or tertiary hospitals. Hospitals which have better facilitiesfor surgery, X-ray, Electro Cardio Gram (ECG) are called secondary health

care institutions. They function both as primary healthcare provider and also provide better healthcare facilities.They are mostly located in district headquarters and inbig towns. All those hospitals which have advanced levelequipment and medicines and undertake all thecomplicated health problems, which could not bemanaged by primary and secondary hospitals, comeunder the tertiary sector.

The tertiary sector also includes many premierinstitutes which not only impart quality medicaleducation and conduct research but also providespecialised 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, Bangaloreand All India Institute of Hygiene and Public Health, Kolkata.

Source: Report of the National Commission on Macroeconomics and Health, 2005.

Polio drops beinggiven to an infant

A health awareness meeting in progress

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Box 8.6: Medical Tourism — A great opportunity

You might have seen and heard on TV news or read in newspapers aboutforeigners flocking to India for surgeries, liver transplants, dental and evencosmetic care. Why? Because our health services combine latest medicaltechnologies with qualified professionals and is cheaper for foreigners ascompared to costs of similar health care services in their own countries. Inthe year 2004-05, as many as 1,50,000 foreigners visited India for medicaltreatment. And this figure is likely to increase by 15 per cent each year. Expertspredict that by 2012 India could earn more than 100 billion rupees throughsuch ‘medical tourism’. Health infrastructure can be upgraded to attractmore foreigners to India.

person occasionally employing a hiredworker. Scholars point out that theprivate sector in India has grownindependently without any majorregulation; some private practitionersare not even registered doctors and areknown as quacks.

Since the 1990s, owing toliberalisation measures, many non-resident Indians and industrial andpharmaceutical companies have set upstate-of-the-art super-specialty hospitalsto attract India’s rich and medical tourists

Box 8.7: Community and Non-Profit Organisations in Healthcare

One of the important aspects of a good healthcare system is communityparticipation. It functions with the idea that the people can be trained andinvolved in primary healthcare system. This method is already being used insome parts of our country. SEWA in Ahmedabad and ACCORD in Nilgiriscould be the examples of some such NGOs working in India. Trade unionshave built alternative health care services for their members and also to givelow-cost and rational care to people from nearby villages. The most well-knownand pioneering initiative in this regard has been Shahid Hospital, built in1983 and sustained by the workers of CMSS (Chhattisgarh Mines ShramikSangh) in Durg, Madhya Pradesh. A few attempts have also been made byrural organisations to build alternative healthcare initiatives. One exampleis in Thane, Maharashtra, where in the context of a tribal people’sorganisation, Kashtakari Sangathan, trains women health workers at the villagelevel to treat simple illnesses at minimal cost.

(see Box 8.6). But since the poor candepend only on government hospitals,the role of government in providinghealthcare remains important.

Indian Systems of Medicine (ISM):It includes six systems: Ayurveda,Yoga, Unani, Siddha, Naturopathy andHomeopathy (AYUSH). At present thereare 3,004 ISM hospitals, 23,028dispensaries and as many as 6,11,431registered practitioners in India. Butlittle has been done to set up a


framework to standardise education orto promote research. ISM has hugepotential and can solve a large part ofour health care problems because theyare effective, safe and inexpensive.

Indicators of Health and HealthInfrastructure—A Critical Appraisal:As pointed out earlier, the health statusof a country can be assessed throughindicators such as infant mortality andmaternal mortality rates, life expectancyand nutrition levels, along with theincidence of communicable and non-communicable diseases. Some of thehealth indicators, and India’s position,are given in Table 8.4. Scholars arguethat there is greater scope for the roleof government in the health sector. Forinstance, the table shows expenditureon health sector as five per cent of totalGDP. This is abysmally low ascompared to other countries, bothdeveloped and developing.

One study points out that India hasabout 17 per cent of the world’spopulation but it bears a frightening 20per cent of the global burden of diseases(GBD). GBD is an indicator used byexperts to gauge the number of peopledying prematurely due to a particulardisease as well as the number of yearsspent by them in a state of ‘disability’owing to the disease.

In India, more than half of GBD isaccounted for by communicable diseasessuch as diarrhoea, malaria andtuberculosis. Every year around five lakhchildren die of water-borne diseases. Thedanger of AIDS is also looming large.Malnutrition and inadequate supply ofvaccines lead to the death of 2.2 millionchildren every year.

At present, less than 20 per cent ofthe population utilises public healthfacilities. One study has pointed outthat only 38 per cent of the PHCs havethe required number of doctors and

TABLE 8.4

Indicators of Health in India in Comparison with other Countries

Indicator India China USA Sri Lanka

Infant Mortality Rate/1,000 live births 68 30 2 8

Under-5 mortality /1,000 live-births 87 37 8 15

Birth by skilled attendants 43 97 99 97

Fully immunised 67 84 93 99

Health expenditure as % of GDP 4.8 5.8 14.6 3.7

Government share of total 21.3 33.7 44.9 48.7expenditure (%)

Government health spending to 4.4 10 23.1 6total government spending (%)

Per capita spending in international dollars 96 261 5274 131

Source: World Health Report 2005

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only 30 per cent of the PHCs havesufficient stock of medicines.

Urban-Rural and Poor-Rich Divide:Though 70 per cent of India’spopulation lives in rural areas, onlyone-fifth of its hospitals are located inrural areas. Rural India has only abouthalf the number of dispensaries. Out

of about 7 lakh beds, roughly 11 percent are available in rural areas. Thus,people living in rural areas do not havesufficient medical infrastructure. Thishas led to differences in the healthstatus of people. As far as hospitals areconcerned, there are only 0.36hospitals for every one lakh people inrural areas while urban areas have 3.6

Work These Out

Visit the primary hospitals located in your area or neighbourhood. Alsocollect the details of the number of private hospitals, medical laboratories,scan centres, medical shops and other such facilities in your locality.

Debate in the class on the topic — ‘Should we build an army of tais (mid-wives) to take care of the poor, who cannot afford the services of the thou-sands of medical graduates who pass out of our medical colleges every year?’

A study estimates that medical costs alone push down 2.2 per cent of thepopulation below the poverty line each year. How?

Visit a few hospitals in your locality. Find out the number of childrenreceiving immunisation from them. Ask the hospital staff about the numberof children immunised 5 years ago. Discuss the details in class.

Two students — Leena Talukdar (16) and Sushanta Mahanta (16) of Assam —have developed a herbal mosquito repellent ‘jag’ using a few locally availablemedicinal plants — paddy straw, husk and dried garbage. Their experimenthas been successful (Shodh Yatra (innovation), Yojana, September 2005). Ifyou know anyone whose innovative methods improve the health status ofpeople or if you know someone who has a knowledge of medicinal plantsand heals the ailments of people, speak to them and bring them to class orcollect information about why and how they treat ailments. Share this withyour class. You can also write to local newspapers or magazines.

Do you think Indian cities could be provided with world-class healthinfrastructure so that they will become attractive for medical tourists? Orshould the government concentrate on providing health infrastructure forpeople in rural areas? What should be the priority of the government?Debate.

Find out NGOs working in your area in the field of healthcare. Collectinformation about their activities and discuss in the classroom.


hospitals for the same number ofpeople. The PHCs located in rural areasdo not offer even X-ray or blood testingfacilities which, for a city dweller,constitutes basic healthcare. States likeBihar, Madhya Pradesh, Rajasthan andUttar Pradesh are relatively laggingbehind in health care facilities. In therural areas, the percentage of peoplewho have no access to proper care hasrisen from 15 in 1986 to 24 in 2003.

Villagers have no access toany specialised medical care likepaediatrics, gynaecology, anaesthesiaand obstetrics. Even though 165recognised medical colleges produce

12,000 medical graduates every year,the shortage of doctors in rural areaspersists. While one-fifth of these doctorgraduates leave the country for bettermonetary prospects, many others optfor private hospitals which are mostlylocated in urban areas.

The poorest 20 per cent of Indiansliving in both urban and rural areasspend 12 per cent of their income onhealthcare while the rich spend only 2per cent. What happens when the poorfall sick? Many have to sell their landor even pledge their children to affordtreatment. Since government-runhospitals do not provide sufficient

Fig.8.10 Despite availing of various healthcare measures, maternal health is cause for concern

Work These Out

The overall health status of the country has certainly improved throughthe years. Life expectancy has gone up, infant mortality rate has come down.Small pox has been eradicated and the goal to eradicate leprosy and poliolooks achievable. But these statistics seem good only when you look at themin isolation. Compare these with the rest of the world. What do you find?

Observe your class for a month and find out why some students remainabsent. If it is due to health problems then find out what kind of medicalproblem they had. Collect the details of the problem, the nature of treatmentthey took and the amount of money their parents spent on their treatment.Discuss the information in class.

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facilities, the poor are driven to privatehospitals which makes them indebtedforever. Or else they opt to die.

Women’s Health: Women constituteabout half the total population in India.They suffer many disadvantages ascompared to men in the areas ofeducation, participation in economicactivities and health care. Thedeterioration in the child sex ratio in thecountry from 945 in 1991 to 927, asrevealed by the census of 2001, pointsto the growing incidence of femalefoeticide in the country. Close to3,00,000 girls under the age of 15 arenot only married but have already bornechildren at least once. More than 50 percent of married women between the agegroup of 15 and 49 have anaemia andnutritional anaemia caused by irondeficiency, which has contributed to 19per cent of maternal deaths. Abortionsare also a major cause of maternalmorbidity and mortality in India.

Health is a vital public good and abasic human right. All citizens can getbetter health facilities if public healthservices are decentralised. Success inthe long-term battle against diseasesdepends on education and efficienthealth infrastructure. It is, therefore,critical to create awareness on healthand hygiene and provide efficientsystems. The role of telecom and ITsectors cannot be neglected in thisprocess. The effectiveness of healthcareprogrammes also rests on primaryhealthcare. The ultimate goal shouldbe to help people move towards a

better quality of life. Private-publicpartnership can effectively ensurereliability, quality and affordability ofboth drugs and medicare. There is asharp divide between the urban andrural healthcare in India. If wecontinue to ignore this deepeningdivide, we run the risk of destabilisingthe socio- economic fabric of ourcountry. In order to provide basichealthcare to all, accessibility andaffordability need to be integrated inour basic health infrastructure.

8.7 CONCLUSION

Infrastructure, both economic and social,is essential for the development of acountry. As a support system, it directlyinfluences all economic activities byincreasing the productivity of the factorsof production and improving the qualityof life. In the last six decades ofindependence, India has madeconsiderable progress in buildinginfrastructure, nevertheless, itsdistribution is uneven. Many parts of ruralIndia are yet to get good roads,telecommunication facilities, electricity,schools and hospitals. As India movestowards modernisation, the increase indemand for quality infrastrucutre,keeping in view their environmentalimpact, will have to be addressed. Thereform policies by providing variousconcessions and incentives, aim atattracting the private sector in general andforeign investors in particular. Whileassessing the two infrastructure — energyand health — it is clear that there is scopefor equal access to infrastructure for all.


Recap

Infrastructure is a network of physical facilities and public servicesand with this social infrastructure is equally important to support it.It is an important base for economic development of the country.

Infrastructure needs to be upgraded from time to time to maintainhigh economic growth rate. Better infrastructural facilities haveattracted more foreign investments and tourists to India recently.

It is important to develop rural infrastructural facilities.

Public and private partnership is required to bring in huge funds forinfrastructural development.

Energy is very vital for rapid economic growth. There is a big gap betweenconsumer demand and supply of electricity in India.

Non-conventional sources of energy can be of great support to meetshortage of energy.

The power sector is facing a number of problems at generation,transmission and distribution levels.

Health is a yardstick of human well-being, physical as well as mental.

There has been significant expansion in physical provision of healthservices and improvements in health indicators since independence.

Public health system and facilities are not sufficient for the bulk of thepopulation.

There is a wide gap between rural-urban areas and between poor andrich in utilising health care facilities.

Women’s health across the country has become a matter of greatconcern with reports of increasing cases of female foeticide andmortality.

Regulated private sector health services can improve the situation and,at the same time, NGOs and community participation are veryimportant in providing health care facilities and spreading healthawareness.

Natural systems of medicine have to be explored and used to supportpublic health. There is a great scope of advancement of medical tourismin India.

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1. Explain the term ‘infrastructure’.

2. Explain the two categories into which infrastructure is divided. Howare both interdependent?

3. How do infrastructure facilities boost production?

4. Infrastructure contributes to the economic development of a country.Do you agree? Explain.

5. What is the state of rural infrastructure in India?

6. What is the significance of ‘energy’? Differentiate between commercialand non-commercial sources of energy.

7. What are the three basic sources of generating power?

8. What do you mean by transmission and distribution losses? How canthey be reduced?

9. What are the various non-commercial sources of energy?

10. Justify that energy crisis can be overcome with the use of renewablesources of energy.

11. How has the consumption pattern of energy changed over the years?

12. How are the rates of consumption of energy and economic growthconnected?

13. What problems are being faced by the power sector in India?

14. Discuss the reforms which have been initiated recently to meet theenergy crisis in India.

15. What are the main characteristics of health of the people of ourcountry?

16. What is a ‘global burden of disease’?

17. Discuss the main drawbacks of our health care system.

18. How has women’s health become a matter of great concern?

19. Describe the meaning of public health. Discuss the major public healthmeasures undertaken by the state in recent years to control diseases.

20. List out the six systems of Indian medicine.

21. How can we increase the effectiveness of health care programmes?

EXERCISES


1. Did you know that to bring a megawatt of electricity to your homes,30-40 million rupees are spent? Building a new power plant wouldcost millions. Isn’t this reason enough for you to begin conservingenergy in your house? Electricity saved is money saved; in fact, it isworth much more than electricity generated. Every time yourelectricity bill reaches home, you realise there is no need for so manylights and fans around you. All you have to do is be slightly morealert and careful. And the best thing is, you can start right away.Involve the rest of your family in this effort and see the difference.Note down the monthly consumption of electricity in your house. Seethe difference in the bill amount after you apply energy saving tactics.

2. Find out what infrastructure projects are in progress in your area.Then, find out

(i) The budget allotted for the project.(ii) The sources of its financing.

(iii) How much employment will it generate?(iv) What will be the overall benefits after its completion?(v) How long will it take to be completed?

(vi) Company/companies engaged in the project.

3. Visit any nearby thermal power station/hydro-power station/nuclearpower plant. Observe how these plants work.

4. The class can be divided into groups to make a survey of energy usein their neighbourhood. The aim of the survey should be to find outwhich particular fuel is most used in the neighbourhood and thequantity in which it is used. Graphs can be made by the differentgroups and compared to find out possible reason for preference ofone particular fuel.

5. Study the life and work of Dr Homi Bhaba, the architect of modernIndia’s energy establishments.

6. Hold a classroom discussion or debate on — ‘warring nations makefor an unhealthy world, so do warped attitudes and closed mindsmake for mental ill-health’.

Books

JALAN, BIMAL (Ed.). The Indian Economy — Problems and Prospects. PenguinBooks, Delhi, 1993.

SUGGESTED ADDITIONAL ACTIVITIES

REFERENCES

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KALAM, A.P.J. ABDUL WITH Y.S. RAJAN. 2002. India 2020: A Vision for the NewMillennium. Penguin Books, Delhi.

PARIKH, KIRIT S. AND RADHAKRISHNA (Eds.). 2005. India Development Report2004-05. Oxford University Press, Delhi.

Government Reports

The World Health Report 2002. Reducing Risks, Promoting Healthy Life,World Health Organisation, Geneva.

Report of the National Commission on Macroeconomics and Health, Ministryof Health and Family Welfare, Government of India, New Delhi, 2005.

Tenth Five Year Plan, Vol.2, Planning Commission, Government of India,New Delhi.

The India Infrastructure Report: Policy Imperatives for Growth and Welfare1996. Expert Group on the Commercialisaton of Infrastructure Projects.Vols.1, 2 and 3 Ministry of Finance. Government of India, New Delhi.

World Development Report 2004. The World Bank, Washington DC.

India Infrastructure Report 2004. Oxford University Press, New Delhi.

Economic Survey 2004-2005. Ministry of Finance, Government of India.

WebsitesOn energy related issues:www.pcra.orgwww.bee-india.comwww.edugreen.teri.res.inhttp://powermin.nic.in

On health related issues:

http://www.aiims.eduhttp://www.whoindia.orghttp://mohfw.nic.inwww.apollohospitalsgroup.com

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