Health Infrastructure in India

Infrastructure refers to all such activities, services, and facilities needed to provide different kinds of services in an economy. Simply put, it is the support system for the economic and social development of the country. The infrastructure facilities are crucial for the development of agriculture, industry, and now, increasingly, the services sector. Since India’s economic reforms in 1991, the government has placed a significant emphasis on infrastructure development. Infrastructure can be categorised into two parts; viz., Economic Infrastructure (Energy, Transport, and Communication), and Social Infrastructure (Education, Health, and Training)

Social Infrastructure 

The term social infrastructure refers to all of the facilities and institutions that improve the quality of human capital. Educational institutions, hospitals, nursing homes, and housing facilities are some examples of social infrastructure. The availability of this kind of infrastructure increases human productivity, which enhances the quality of living. In contrast to economic infrastructure, social infrastructure indirectly boosts productivity and the production of products and services. For Example, availability of better health care and medical facilities allows for a steady supply of healthy workers which will be further reflected in higher production levels.

Health: Social Infrastructure 

Health is defined as not only the absence of sickness but also the capacity to reach one’s full potential. It acts as a measure of one’s well-being. Health is a comprehensive process related to a country’s entire growth and development. Though the twentieth century witnessed a first-of-its-kind global transformation in human health, it may be difficult to describe a nation’s health condition in terms of a single set of criteria. Scholars generally analyze people’s health by taking into account indicators such as infant mortality and maternal mortality rates, life expectancy and nutrition levels, as well as the prevalence of communicable and non-communicable diseases.

Health Infrastructure consists of doctors, nurses, hospitals, and various paramedical professionals, equipment and beds needed in the hospitals and a well developed pharmaceutical industry. By developing health infrastructure, a country can ensure healthy manpower for the production of goods and services. It is possible only when the health infrastructure is available to all. 

State of Health Infrastructure (after Independence)

The government has a constitutional commitment to supervise and control all health-related concerns such as medical education, food adulteration, medications and poisons, medical profession, vital statistics, mental deficiency, and madness. The Central Council of Health and Family Welfare advises the Union Government on broad policies and goals for health infrastructure. It gathers information and provides financial and technical help to state governments, union territories, and other organisations for the implementation of important health programmes in the whole country. The status of Health Infrastructure of India after independence can be described as follows:

1. Since independence, there has been significant development in physical healthcare services and improvements in health indicators, but this is insufficient for India’s rapidly increasing population. 
2. The public health system and facilities are insufficient for the majority of the population. 
3. There is a significant disparity in healthcare utilisation between rural and urban regions as well as between the poor and the rich.
4. With reports of increased incidents of female foeticide and death, the health of women across the country has become a major issue.

However, over the last five decades, India has made considerable progress in the improvement of the health of the people by building up a good health infrastructure.

Expansion of Health Infrastructure (Public)

India has expanded its Health Infrastructure through manpower at different levels.

1. The government has set up various hospitals (known as Primary Health Centres or PHCs), at the village level.
2. Besides, a large number of hospitals are run by voluntary agencies and the private sector. Professionals and Para-medical Professionals who are trained in pharmacy, medical, and nursing colleges control these hospitals.
3. With the expansion of health infrastructure, deadly diseases like smallpox, and guinea worms have been eradicated and diseases like polio and leprosy have almost been eradicated from the country.
4. Since independence, the physical provision of health services has expanded significantly. During the period 1951-2018, the number of dispensaries and hospitals has increased from 9,294 to 53,729; allopathic doctors have increased from 62,000 to 11.5 lakh; and nursing personnel has increased from 18,000 to 30 lakh.
   This change can be seen with the help of the following table:

Source: National Commission on Macroeconomics and Health, Ministry of Health and Family Welfare, Government of India, New Delhi, 2005; National Health Profile for various years available on www.cbhidhs.nic.in

Role of Private Sector in Health Infrastructure

While the public health sector has struggled to deliver the goods, the private sector has grown by leaps and bounds. The private sector operates more than 70% of hospitals in India. They control about two-fifths of the hospital beds. The same private sector operates about 60% of dispensaries. They provide healthcare for 80% of outpatients and 46% of inpatients.

In recent years, the private sector has played an important role in medical education and training, medical technology and diagnostics, pharmaceutical manufacturing and distribution, hospital development, and medical service provision. In 2001-02, there were more than 13 lakh medical enterprises employing 22 lakh people and more than 80 per cent of them are single-person owned and run by one individual sometimes hiring a hired worker. Scholars point out that the private sector in India has evolved autonomously without substantial regulation. Some private practitioners are not even registered doctors and are referred to as quacks.

Indian Systems of Medicine (ISM)

India has its own well-developed healthcare alternate system. Ayurveda, Yoga, Unani, Siddha, Naturopathy, and Homoeopathy (AYUSH) are among the six systems represented. In India, there are currently 4,095 AYUSH hospitals; 27,951 dispensaries and up to 8 lakh registered practitioners.

Little has been done to establish a framework for standardising education or promoting research. However, as ISM is effective, safe, and inexpensive, it has enormous potential and can solve an extensive part of our healthcare problems.

Indicators of Health and Health Infrastructure

Indicators such as infant mortality and maternal mortality rates, life expectancy and nutrition levels, as well as the prevalence of communicable and non-communicable illnesses, can be used to assess a country’s health condition. Scholars think that the government’s role in the health sector should be expanded. For example, the data reveals that healthcare spending accounts for 3.7 per cent of total GDP. This is abysmally low when compared to other developed and developing countries.

1. India has around one-fifth of the world’s population, yet it carries a startling 20% of the Global Burden of Diseases (GBD). Experts utilise GBD to calculate the number of individuals who die prematurely as a result of a certain disease, as well as the number of years they spend in a state of ‘disability’ as a consequence of the illnesses.
2. In India, communicable diseases such as diarrhoea, malaria, and TB account for more than half of GBD. Every year, over five lakh children, die as a result of water-borne diseases. The threat of AIDS is also very serious. Every year, 2.2 million children die as a result of malnutrition and a lack of vaccinations.

Currently, less than 20% of the population uses public health facilities. According to one survey, just 38% of PHCs have the necessary number of doctors and only 30% of PHCs have an adequate quantity of medicines.

Source: World Development Indicators 2019, World Bank, Washington

Rural-Urban Divide

Despite the fact that 70% of India’s population lives in rural areas, only one-fifth of its hospitals (including private hospitals) are located in rural areas. Rural India has around half the number of dispensaries. Rural regions have around 30% of the 7.13 lakh beds in government hospitals. As a result, residents in rural regions lack sufficient healthcare infrastructure. This has resulted in disparities in people’s health status. In rural areas, there are just 0.36 hospitals for every one lakh inhabitants, whereas urban areas have 3.6 hospitals for the same number of people.

PHCs in rural areas do not even provide X-ray or blood testing services, which are considered vital medical services for city dwellers. States such as Bihar, Madhya Pradesh, Rajasthan, and Uttar Pradesh lag behind in terms of healthcare infrastructure. The percentage of persons in rural regions who do not have access to proper treatment has risen in recent years.

Villagers do not have access to specialised medical services such as paediatrics, gynaecology, anaesthesia, or obstetrics. Despite the fact that 530 recognised medical institutions produce around 50,000 medical graduates each year, rural areas are still facing a doctor shortage. While one-fifth of these doctor graduates leave the country for better financial opportunities, many others choose to work in private hospitals, which are mainly located in urban areas.

The poorest 20% of Indians in both urban and rural regions spend 12% of their income on healthcare, while the rich spend only 2%. 

What happens when the impoverished become ill?

Many people are forced to sell their land or even give up their children in order to afford treatment. Since government-run hospitals do not provide adequate facilities, the poor are forced to use private hospitals, leaving them indebted indefinitely. Alternatively, they can choose to die. 

State of Women’s Health 

Women constitute almost half of India’s entire population. They have several disadvantages when compared to males, including severe neglect in the fields of education, economic activities, and health care.

More than 50 % of married women in India between the ages of 15 and 49 have anaemia and nutritional anaemia caused by iron deficiency. This has led to 19% of maternal fatalities.

The sex ratio fell from 927 in 2001 to 919 in 2011 according to the 2011 census, a result of a growing incidence of female foeticide in the country. Approximately 3,00,000 girls under the age of 15 are not only married but have already given birth to at least one child. Abortions are also one of the biggest causes of maternal illness and death in India. It all suggests/indicates a social bias in healthcare against women in the country.

Health is both an essential public good and a fundamental human right. If public health services are decentralised, all residents will be benefited from improved healthcare services. Long-term success in the fight against illnesses is dependent on education and effective health infrastructure. It is consequently vital to raise health and hygiene awareness and provide efficient systems. The importance of the telecom and IT sectors in this process cannot be neglected. The efficacy of healthcare programmes is partly dependent on primary healthcare.

 Critical Assessment of Health Infrastructure

1. Inequitable allocation of Healthcare Services: The current healthcare system suffers from inequitable distribution of institutions and manpower. Rural areas are home to around 70% of India’s population, although only 20% of total hospitals are situated there. The majority of modern healthcare facilities are only available in urban areas.
2. Communicable Diseases: A greater focus is needed to avoid communicable illnesses such as AIDS (Acquired Immune Deficiency Syndrome), HIV (Human Immuno Deficiency Virus), and SARS (Severe Acute Respiratory Syndrome) by efficient control methods.
3. Poor Sanitation Systems: Both rural and urban sanitation systems are terrible. About 30% of houses in urban areas lack toilet facilities, and the situation is even worse in rural areas. Improving sanitary facilities is an essential need for people’s health.
4. Manpower Shortage: Despite the fact that India generates 50,000 medical graduates each year, there is an extensive shortage of manpower.
5. Malnutrition: Malnutrition is a severe danger to people’s lives, particularly children.
6. Role of Private Sector: The public sector has not been very effective in establishing an appropriate health framework. To address people’s healthcare requirements, the public and private sectors must work together more closely. The government should take strong measures to overcome these deficiencies, as improved health is vital for increased productivity and economic growth.