Introduction and the Relevance of Infrastructure

Introduction

The varying levels of development across Indian states can be largely attributed to differences in their infrastructure. States like Punjab and Haryana excel in agriculture due to better irrigation facilities. Maharashtra and Gujarat are industrially advanced because of superior transportation and port facilities. Kerala's high literacy and health standards attract tourists, while Bengaluru's world-class communication facilities make it a global IT hub.

These support structures, which facilitate the development of a country, are collectively known as infrastructure.

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What is Infrastructure?

Infrastructure provides the supporting services essential for the main areas of industrial and agricultural production, as well as domestic and foreign trade. It includes:

• Roads, railways, ports, and airports
• Dams, power stations, oil and gas pipelines
• Telecommunication facilities
• The country's educational system (schools, colleges)
• The health system (hospitals, sanitation, clean drinking water)
• The monetary system (banks, insurance, and other financial institutions)

Some of these facilities directly impact the production of goods and services, while others provide indirect support by strengthening the social sector of the economy. Infrastructure is often divided into two categories:

1. Economic Infrastructure: Associated with energy, transportation, and communication.
2. Social Infrastructure: Related to education, health, and housing.

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Relevance of Infrastructure

Infrastructure is the backbone of a modern industrial economy. Its relevance is multifaceted:

• Boosts Productivity: It increases the productivity of the factors of production (land, labour, capital). For instance, modern agriculture depends on irrigation for higher yields and on transport for the movement of seeds, fertilizers, and produce.
• Improves Quality of Life: It enhances the quality of life of the people. Improvements in water supply and sanitation reduce morbidity (proneness to illness) from waterborne diseases.
• Enhances Access to Services: The quality of transport and communication infrastructure affects access to healthcare and other essential services.

Inadequate infrastructure can have severe adverse effects on health and economic development. Conversely, a well-developed infrastructure is crucial for sustained economic progress.

The State of Infrastructure in India

Government and Private Sector Role

Traditionally, the government was solely responsible for developing the country's infrastructure. However, government investment proved to be inadequate. Today, the private sector, both independently and in joint partnership with the public sector (Public-Private Partnership or PPP), plays a very important role in infrastructure development.

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The Rural-Urban Divide in Infrastructure

A majority of India's population lives in rural areas, where there is a significant deficit in infrastructure.

• Energy: Rural women still heavily rely on biofuels (crop residues, dung, fuelwood) for their energy needs. The 2011 Census shows that only 56% of rural households have an electricity connection, and 43% still use kerosene for lighting.
• Water: Tap water availability is limited to only 31% of rural households. About 69% of the rural population drinks water from open sources like wells, ponds, and rivers.
• Sanitation: Access to improved sanitation in rural areas was only 30% in 2011.

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India in Global Comparison

India's investment in infrastructure lags behind that of many other developing nations.

Country	Investment in Infrastructure as % of GDP	% of people using safely managed Drinking Water Sources	% of people using safely managed Sanitation Services	Mobile Subscribers/100 People	Consumption of energy (ml. tonnes of oil equivalent)
China	44	96	72	115	3274
Hong Kong	22	100	92	259	31
India	30	94	40	87	809
South Korea	31	98	100	130	301
Pakistan	16	35	64	73	85
Singapore	28	100	100	146	88
Indonesia	34	87	61	120	186

India invests only about 30% of its GDP in infrastructure, far below China's 44%. For India to become one of the world's top economies, it will have to significantly boost its infrastructure investment. Economic development and infrastructure development go hand in hand, with the composition of infrastructure needs changing as a country's income rises.

Energy Infrastructure

The Importance of Energy

Energy is a critical aspect of the development process. It is essential for industries, agriculture (for producing fertilizers, pesticides, and running farm equipment), and households (for cooking, lighting, and heating).

Sources of Energy

Energy sources can be categorized as follows:

1. Commercial Sources: These are bought and sold. Examples include coal, petroleum, and electricity. They are generally exhaustible (except hydropower).
2. Non-Commercial Sources: These are found in nature and are not typically traded. Examples include fuelwood, agricultural waste, and dried dung. They are generally renewable. More than 60% of Indian households depend on these traditional sources.
3. Non-Conventional Sources: These are renewable sources like solar energy, wind energy, and tidal power. As a tropical country, India has immense potential for these energy sources.

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Consumption Pattern of Commercial Energy

In India, commercial energy consumption makes up about 74% of the total energy consumed. The sectoral pattern of consumption has changed over time.

Sector	1953-54	1970-71	1990-91	2017-18
Household	10	12	12	24
Agriculture	1	3	8	18
Industries	40	50	45	42
Transport	44	28	22	1
Others	5	7	13	15

While the transport sector was the largest consumer in 1953-54, its share has continuously fallen. The shares of the household and agriculture sectors have been increasing.

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Power/Electricity

Power, or electricity, is the most visible form of energy and is a critical component of infrastructure. The growth rate of demand for power is generally higher than the GDP growth rate. To achieve an 8% GDP growth per annum, power supply needs to grow at around 12% annually.

Sources of Power Generation in India (2018)

• Thermal Sources: Accounted for 82% of power generation capacity.
• Hydel Power: Accounted for 8.5%.
• Nuclear Power: Accounted for only 2.5%.

While India’s energy policy encourages renewable sources like solar, hydel, and wind, their growth has not been sufficiently fast.

Challenges in the Power Sector

1. Insufficient Installed Capacity: India's capacity to generate electricity is not sufficient to meet the demands of high economic growth. Currently, India is able to add only 20,000 MW per year.
2. Losses in Distribution: State Electricity Boards (SEBs) incur huge losses due to transmission and distribution losses, incorrect pricing of electricity, and theft.
3. Under-utilization of Capacity: Existing installed capacity is often under-utilized because plants are not run properly.
4. Limited Private and Foreign Investment: The private sector and foreign investors have yet to play a major role in power generation.
5. Shortage of Raw Materials: Thermal power plants often face a shortage of raw materials like coal.
6. Public Unrest: There is general public unrest due to high power tariffs and prolonged power cuts.

Health Infrastructure

The Concept of Health

Health is not merely the absence of disease but the ability to realize one's full potential. It is a yardstick of one's well-being and is a holistic process related to the overall growth and development of a nation. The health status of a nation is generally assessed using indicators like infant and maternal mortality rates, life expectancy, nutrition levels, and the incidence of communicable and non-communicable diseases.

A developed health infrastructure ensures a country has a healthy workforce for the production of goods and services. It is the responsibility of the government to ensure the "right to healthy living" for all its citizens.

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State of Health Infrastructure in India

The government has a constitutional obligation to guide and regulate all health-related issues. Over the years, India has built a vast health infrastructure at different levels.

The Three-Tier Health System

India's health infrastructure is made up of a three-tier system:

1. Primary Health Care: This includes Primary Health Centres (PHCs), Community Health Centres (CHCs), and sub-centres set up in villages and small towns. They are often manned by a single doctor and a nurse.
2. Secondary Health Care: This includes hospitals with better facilities for surgery, X-ray, etc. They are mostly located in district headquarters and big towns.
3. Tertiary Health Care: This includes hospitals with advanced equipment and medicines that handle complicated health problems. It also includes premier institutes that provide quality medical education and conduct research, such as AIIMS in New Delhi.

Since independence, there has been a significant expansion in health services. The number of government hospitals, beds, nursing personnel, and doctors has increased substantially.

The Private Sector's Role

In recent times, the private sector has grown by leaps and bounds.

• More than 70% of the hospitals in India are run by the private sector.
• They provide healthcare for 80% of out-patients and 46% of in-patients.
• The private sector plays a dominant role in medical education, medical technology, diagnostics, and pharmaceuticals.

Since the 1990s, liberalisation has led to the establishment of state-of-the-art super-specialty hospitals, attracting both India's rich and "medical tourists".

Indian Systems of Medicine (ISM) - AYUSH

ISM includes six systems: Ayurveda, Yoga, Unani, Siddha, Naturopathy, and Homeopathy (AYUSH). These systems have huge potential as they are effective, safe, and inexpensive. However, little has been done to standardize education or promote research in these areas.

A Critical Appraisal of Health Infrastructure and Conclusion

A Critical Appraisal

Despite progress, India's health sector faces significant challenges.

Low Public Expenditure and High Disease Burden

Government health spending in India is only 3.7% of the total GDP, which is abysmally low compared to other countries. India has about one-fifth of the world's population but bears a disproportionate 20% of the Global Burden of Diseases (GBD). GBD is an indicator used to gauge the number of people dying prematurely due to a particular disease and the number of years spent in a state of 'disability'.

Indicators	India	China	USA	Sri Lanka
Infant Mortality Rate/1,000 live births (2018)	30	7.4	5.6	6.4
Government health spending as a % of GDP (2016)	3.7	5.7	17.0	3.9
Out of pocket expenditure as a % of current health expenditure (2016)	65	36	11.1	50

The Urban-Rural and Poor-Rich Divide

• Rural Deficit: Although 70% of India's population lives in rural areas, only one-fifth of its hospitals are located there. Rural India has only half the number of dispensaries and 30% of hospital beds. This has led to a major difference in the health status of rural and urban populations.
• Shortage of Doctors: There is a persistent shortage of doctors in rural areas. Many medical graduates leave the country or opt for private hospitals in urban areas.
• Financial Burden on the Poor: The poorest 20% of Indians spend 12% of their income on healthcare, while the rich spend only 2%. The poor are often driven to private hospitals, which can push them into a cycle of debt.

Women's Health

Women's health is a matter of great concern.

• The child sex ratio has deteriorated, pointing to the growing incidence of female foeticide.
• A high percentage of young girls are married and have children.
• More than 50% of married women in the age group of 15-49 years suffer from anaemia and nutritional deficiencies.

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Conclusion

Infrastructure, both economic and social, is essential for a country's development. While India has made considerable progress in building infrastructure since independence, its distribution remains uneven, with rural areas still lagging significantly. As India modernizes, the demand for quality infrastructure will increase, and this must be addressed while considering the environmental impact.

An assessment of the energy and health sectors reveals a clear need for greater and more equitable access to these critical services. The reform policies aim to attract private and foreign investment, but it is crucial to ensure that this development is inclusive. To provide basic healthcare to all, accessibility and affordability must be integrated into our basic health infrastructure. The ultimate goal should be to help all citizens move towards a better quality of life.

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