Date: July 26, 2021
HOW HEALTH AND INFRASTRUCTURE AFFECTS THE ECONOMIC DEVELOPMENT OF THE
COUNTRY?
ABSTRACT:-
The main objective of the study is to empirically examine the relationship between health
infrastructure, health outcome and economic growth for India at national level and for major states at sub-
national level. Major health outcomes like Life expectancy at birth and infant mortality rate depend on
available health facilities like hospitals, beds, and trained health professionals. Life expectancy in India has
increased and IMR declines over the years, except few states like Bihar, Jharkhand, Madhya Pradesh, Uttar
Pradesh. India has achieved considerable progress in providing health infrastructure and its access to
health care services to the mass population. However, less developed states like Uttar Pradesh and Bihar
need more attention to improve health infrastructure and distribution of health facilities. Today the health
infrastructure of India is in pathetic condition, it needs radical reforms to deal with new emerging challenges.
On the one hand the role of private players is continuously increasing in healthcare sector, simultaneously
healthcare facilities are getting costly, and becoming non-accessible for the poor. The government hospitals
are facing the problem of lack of resources and infrastructure; there are inadequate number of beds, rooms,
and medicines. In this research paper the authors have discussed the present scenario of healthcare facilities
and personnel. On the part of government there is lack of monitoring of the funds and resources, which are
devoted towards the improvement of healthcare sector. The authors have suggested a model healthcare plan
which revolves around preparing a long term strategy for qualitative as well as quantitative improvements in
our healthcare infrastructure by focusing on workforce capacity and competency, information and data
systems, and organizational capacity. In this regard the authors have discussed the health plans of United
States, and have suggested that India can also be inspired by them. The government is required to take an
integrated approach, which must take into consideration meeting the regional differences with the help of the
local people; it must prepare a decentralized structure which would be district based, involving active role
for the local level institutions like Panchayats. It has been further observed by the authors that every year
many people die because of the spread of different epidemics, and till now the government has failed to create
a proper strategy which can prevent the spread of these epidemics and can provide for emergency measures
in the affected areas. The authors have suggested that the government must prepare a comprehensive
strategy to deal with epidemics, which must include a universal vaccination policy (in affected areas),
the establishment of special medical care centers, emergency response.
ABOUT THE AUTHOR:-
This research paper is written by Saumya Garg student of the Delhi Public School, Greater Noida. She is a class 12th student.
INTRODUCTION:-
Good health is a state of physical and mental wellbeing necessary to live a meaningful and
productive life. Long healthy life is the basic aspiration of human development. Hence,
health has become an important indicator of human development. It is true that a healthy
person is an asset for himself and for the economy also. To achieve ‘good health for all’
the country should promote health care services, prevent diseases and help people to make
their healthy choices. In a society, ‘good health for all’ ensures economic progress. Good
health promotes efficiency in workforce, enhances their skills and aptitude and is
necessary for high life expectancy. Good health is absence of disease and also it represents
both physical and mental capability to enjoy life. Good health is achievable under the
condition of deliverable effective health care services which is possible only if good health
infrastructures are available.
Health infrastructures are “the basic services or social capital of a country, or part of it,
which make economic and social activities possible” structures that support public health,
having both tangible and intangible aspects and existing inside and outside the government
sector. Health infrastructure is an important indicator for understanding the health care
policy and welfare mechanism in a country.
Health care is a social determinant which is influenced by social policies. To achieve
good health for people, especially the poor and the under privileged, the Government of
India has focused on improving primary health services and ready to provide more
accessibility and affordable to the poor people. In last few decades, India has achieved
considerable progress in providing access to health care services to the people. Recently,
the health infrastructure of the country has expanded manifold. Now, the question arises
whether health infrastructure is sufficient and properly distributed in India. So, the basic
research question is on the distribution of health infrastructure in India.
1. Is this health infrastructure adequate in India?
2. How is it distributed across India?
3. How does it affect economic development in India?
The disparity in health exists in India because of the uneven distribution of health infrastructure
across the Indian States. Now we examine the disparity in health infrastructure in India
focusing on three major channels – a) Institution, b) Knowledge capacity and c) health
care service. All these connect the issues of economic development – with special focus on
India.
This study is organized as follows: next section provides a brief review of literature.
After spell out of the objective of the study, Data and methodology section describe data
and provide primary observations. Analysis section explains the results and finally this
study concludes with remarks.
Health infrastructure is an important indicator for understanding the health care policy
and welfare mechanism in a country. It signifies the investment priority with regards to
the creation of health care facilities. India has one of the largest populations in the
world; coupled with this wide spread poverty 1 becomes a serious problem in India. The
country is geographically challenged; this is due to its tropical climate which acts both
as a boon and a bane, a Sub Tropical Climate is conducive to agriculture however it
also provides a ground for germination of diseases 2 . Due to a cumulative effect of
poverty, population load and climatic factors India’s population is seriously susceptible
to diseases.
Infrastructure has been described as the basic support for the delivery of public health
activities. 3 Five components of health infrastructure can be broadly classified as: skilled
workforce; integrated electronic information systems; public health organizations,
resources and research. When we talk about health infrastructure we are not merely
talking about the outcomes of health policy of a particular country, but the focus is
upon material capacity building in the arena of public health delivery mechanisms.
The Government of India’s 1946 Report on the Health Survey and Development
Committee (also known as Bhore Committee) had declared “the inadequacy of existing
medical and preventive health organization” as one of reasons for India’s poor health
condition in its report. Moreover, the recommendations included an infrastructure plan
for a three-tier health care system 4 at the district level to provide preventive and
curative health care to dwellers in both rural and urban areas. The Bhore committee
report stressed on access to primary health care as a basic right, which subsequently
became the basis of national health care system. Since the Bhore Committee nine other
committees have been formed, to examine the challenges faced by the healthcare sector
in the post-independence period, the latest being the National Commission on
Macroeconomics and Health, 2005. The report highlighted the problem of lack of
resources which have made the health system unaccountable and disconnected to public
health goals, and inadequately equipped to address peoples growing expectations. The
estimated total investment of Rs 74,000 crore consists of a whopping projected Rs
33,000 crore for capital investment required for building up the battered health
infrastructure alone. The commission recommended that an institutional infrastructure
which constitutes of a number of autonomous and self- financed bodies is a bare
minimum to cope up with the health situation in India. Thus in the period of about 60
years the problem of health infrastructure has remained unresolved.
HEALTH INFRASTRUCTURE AND DEVELOPMENT
Human health is important for economic growth and development. Importance of health
for socio-economic development has gained recognition in recent time. There is a strong
relation between population, health and development. According to Banerjee, Duflo and
Deaton (2004) better provision of health care is the key to improve health condition and
also economic growth and development in poor countries like India. India’s health
challenges are not only huge in magnitude due to its large population but they are complex
due to its diversity and the chronic poverty and inequality. There is little information
available regarding the quality of health care delivery in developing countries. However,
health care services are improving slowly with developing health infrastructure which is
not properly recorded. Health infrastructure in the most of the developing economy is poor
and so society need for the betterment of health service. Health care service providers
could be either private or government; otherwise, jointly they can serve for bet- terment of
the society. However, only the government can provide proportionately health
infrastructure for whole population in poor country like India. Creation and distribution of
health infrastructure is the first priority in a developing economy that it ensures good
health.
IMPORTANCE OF HEALTH INFRASTRUCTURE IN INDIA
India is at the point of an exciting and challenging period in its history. India today
enjoys as never be- fore, a sophisticated arsenal of interventions, technologies and
knowledge required for providing health care to her people. Yet the gaps in health
outcomes continue to widen. On the face of it, much of the ill health, disease, premature
death, and suffering we observed on such a large scale are needless, given the
availability of effective and affordable interventions for prevention and treatment.
Making healthcare affordable and accessible for all its citizens is one of the key focus
areas of the country today. Health infrastructure is an important indicator to understand
the health care delivery provisions and signify the investment and priority accorded to
creating the infrastructure in a region.
SUGGESTIONS FOR BETTER INFRASTRUCTURE
1. Geocoding: It involves the introduction of data systems for monitoring health
status. Such systems would allow entities at all levels to have a geographic
information system capable of showing diseases portrayed through maps, risk of
spread of diseases, environmental hazard and service delivery.
2. Health Policy budgets should include and integrate infrastructure plans. Mere
request for infrastructure funding may face opposition because they are generic
in nature and do not have the effect of directly addressing health problems
which are overt in nature such as prevention of spread of infectious diseases,
maternal and child health etc.
3. Reduce urban bias: Health facilities should be developed in the rural sector by
public authorities and incentives for the same should be provided to private
bodies.
4. Most public health facilities have poor infrastructure as regards to equipment
used for medical tests (e.g. X-ray, blood tests, and other complicated tests).
Such equipment which is mostly imported is very costly. Government can solve
this problem by reducing or complete waiver of import duties and taxes. The
equipment should be made available to the public at large by public-private
cooperation and by encouraging indigenous production of such equipment by
both public and private bodies at competitive prices.
5. A substantial increase is needed in the number of medical education institutions
and the government should make provisions for better quality of medical
professionals to serve the masses.
MODEL HEALTH PLAN
An appropriate health model should be consisting of various elements which ensure that
the health department of a country is fully prepared to deal with challenges relating to
health of its citizens. The status report on Public Health Infrastructure prepared by the
Department of Health and Human Services (Centers for Disease Control and
Prevention) 27 provides a helpful model through its recommendations. Although these
recommendations have been prepared keeping in mind the problems existing in United
States of America, certain aspects of the recommendations can be helpful in providing
answers to the Indian Health Problems as the report is based on global health factors
and International Health Communities. As per the report the issue of health is no longer
a localized concern, in today’s globalised society diseases and health problems have
crossed all boundaries and this is a matter of great concern as diseases continue to
become more radical the means of fighting them are still primitive and insufficient.
According to the report (at pg 6), “the three components of the basic public health
infrastructure are:
Workforce Capacity and Competency: the expertise of the professionals who work in
Federal, State, and local public health agencies to protect the public’s health.
Information and Data Systems: up-to-date guidelines, recommendations, and health
alerts and modern, standards-based information and communication systems that
monitor disease and enable efficient communication among public and private health
organizations, the media, and the public.
Organizational Capacity: the consortium of local and State public health departments
and laboratories, working side-by-side with private partners, to provide the essential
services of public health.”
The above three essentials have been considered to be interrelated and any adverse
effect on one has a ripple effect on the others. Thus, all three elements need to be given
equal consideration at all times. The elements of Public Health Infrastructure provide a
background as to the areas which need attention and improvement.
In terms of Workforce Capacity and competency the report recommends that the
workforce should be professionally qualified. There is also a requirement on behalf of
the Professional Agencies (like Indian Medical Association) for drawing up a list of
core competencies for public health professionals so that specific competencies
required for individual fields can be identified and developed. A list of competencies 28
has been provided with the report which broadly includes: Analytical skills,
Communication Skills, Policy and Development/ Program Planning Skills, Cultural
Skills and Public Health Science Skills. These competencies need to be continually
strengthened through a system of lifelong learning to ensure a workforce ready to meet
the latest demands.
Information and Data Systems, provide support when emergency response to diseases is
required. As the old saying goes, “A stitch in time saves nine”, the same is applicable to
the use of data systems which are the least expensive and most effective tool in
preventing the spread of diseases. Timely communication between health professionals
can go a long way in saving lives. Thus, there needs to be a strong and responsive
communication system which is evenly distributed in all areas (urban and rural). 29 In the
United States, a national Health Alert Network (HAN), consisting of a network of
Centre and State funded websites had been established which provided basic
implantation of Internet Connectivity, broadcast communications and distance
learning capacity at local level. As per recommendations provide by the report all
health care departments must have immediate access to current public health
recommendations, health and medical data, treatment guidelines, and information on
effectiveness of public health interventions.
In the view of some observers, the private hospital chains have become the primary
consumers and financiers of Health Information Technology Infrastructure in India,
also it is forecasted that privatization of Medical Insurance will become a major driver
of Information Technology adoption in the future, this would result in comprehensive
patient information databases and the development of Information Technology
infrastructure in the field of health to accommodate such data and create individual
health profiles. 30
The information and data systems are also helpful in an international scenario. In the
view of some authors two regimes exist in the contemporary world which provides
necessary intervention in the field of Global Health 31 , they include:
Global Health Security: It deals with emerging infectious diseases that threaten
wealthy countries. The reason for such diseases is primarily social and economic
transformations caused due to globalization.
Humanitarian Biomedicine: It targets diseases which affects the poorer nations of the
world. Its main goal is to alleviate the suffering of individuals, regardless of national
boundaries. Intervention is thus necessary from International Organizations and States
which can take up the burden of dealing with the problems of the poor countries. Such
intervention becomes necessary as in these countries; public health infrastructure in
national-state level is in poor condition or non-existent. It is a socio-technical project
and it aims at providing medical assistance both through technical assistance and
development of new medication meant to deal with “neglected
diseases”, they are medicines which are not produced by commercial pharmaceuticals
and biotech industries because of low demand in the developed world.
There is a need to base health model on information sharing; the International Health
Regulations (IHR) is an important instrument in the global disease surveillance system.
It puts a legal obligation on nation-states to accept global intervention and regulation to
check rapidly moving pathogens which can easily cross borders in a globalised world.
Any disease which is classified as, “Public Health Emergency of International
Concern” would be covered by IHR regulations and would come under the ambit of
public health information which has to be shared by member states for the purposes of
early detection. Thus there is a need for the creation of permanent national level
surveillance programs which can coordinate with its international counterpart and thus
facilitate necessary intervention as and when it is required to effectively redress the
health issues as and when they arise. This would require relaxation of strict adherence
to sovereignty principles and thus seek for external intervention for public welfare. An
important role in this regard has to be played by media and non-governmental agencies
to disclose all forms of information which the government is hesitating to disclose. This
information sharing can be effectively achieved through effective information and data
systems.
Organizational Capacity is a multi-layer system in which performance has to be
delivered from State and Local Public Health Organizations simultaneously. A situation
in which one level outperforms the other will be detrimental to public health as a
patchwork system cannot effectively handle health issues as and when they arise
because uncoordinated work merely amounts to wasted resources and efforts. In
response to this the United States has introduced National Public Health Performance
Standards Program; the purpose of this program is to develop clear and measurable
performance standards which can be used at the different levels for setting goals and
measuring performance based on the standards and goals set over a period of time. It is
aimed at strengthening state and local partnerships and thus provides an effective response
to day-to-day problems and emergency situations. It improves organizational
communication and collaboration as officials at different levels frequently hold joint
meetings to report their status, this helps in saving time and resources.
NEED TO STRENGTHEN RURAL HEALTH INFRASTRUCTURE
The rural infrastructure of India is in a very sad state of affairs. Although the
government-initiated National Rural Health Mission Programme (NRHM) aims to bring
qualitative and quantitative changes in the rural infrastructure, however the goal to
provide universal access to healthcare facilities remains a distant dream in rural India.
Under the NHRM some steps have been taken for the transformation of rural health
infrastructure, and undoubtedly some changes have been ushered in. NRHM provides
different standards of healthcare institutions at different levels, namely Community
Healthcare Centre (CHC) for a population of 80,000 to 120,000 people; a Primary
Healthcare Centre (PHC) for a population of 30,000 (20,000 in hilly areas); and sub-
centers at the lowest for a population of 5,000 people (2,000 in hilly areas) 42. At the
ground level it has been realized that the funds which have been created for the NHRM
are hardly sufficient to meet its stated objectives namely to provide affordably,
equitable, and good quality healthcare service to rural poor 43.
There are also variations in the levels of implementation of NHRM 44; it has been
observed that those states which have a good infrastructure even before the
inauguration of NHRC, are implementing the NHRM in a better way with regard to
utilization of funds, and others are lagging behind 45 . Uttar Pradesh has been provided
around one-third of the total allocation of NHRC, but unfortunately, around 40% of this
allocation has remained unutilized by the state government 46. Moreover, in most of the
states, there is a lack of detailed data with regard to the utilization of finances under
NHRM, and its consequent impact in improving the delivery of health care services,
which make it extremely difficult to assess the success or failure of NRHM. There
have also been cases of grave mismanagement and irregularities in the implementation
of NRHM as like non-appointment of personnel.
The impact of the success of the NRHM mission is accessed only through the deployment
of healthcare personnel and by establishing medical care centers at different levels, but
this criterion is faulty as it does not tell us the impact of NHRM on the poor people; to
know the ground reality we have to access the impact of the infrastructure created by
NHRC in terms of the reduction of medical expenses bared by people 47. It has been
reported that most of the Indians spend around 70% of their out of pocket income on
medicines and healthcare services 48, hence to bring
substantial changes in the health infrastructure, the government must strive to reduce
the expenditure on healthcare 49. It has been argued by K S Jacob (Faculty, Christian
Medical College, Vellore) that greater financial inputs for governance and a coordinate
the approach between the NRHM and state medical services is crucial for the
improvements in health infrastructure 50.
NRHM, even with all its inherent lacunae, has proved to an extraordinary tool to
improve the rural health, although the program would end in 2012. If the program is not
extended by the Union Government it would be too much to expect from the state
government to continue the schemes which have been started under the NRHM, and
maintain the infrastructure created under it. Therefore it is imperative that the central
government must not stop the funding for the NHRC; it must continue through the 12 th
five year plan, and further. The central government must focus on the integration of the
state health services, NHRC, and other related schemes/programs. There is greater need
for continuous monitoring of the implementation of plans and utilization of funds
allocated. Moreover, the central government must also focus on some issues of the non-
medical expenditure, which is nevertheless related to the good health of citizens as
like making people aware about the hygienic practices, sanitation, cleanliness; creation
of infrastructure for availability of safe drinkable water for rural India 51 , etc.
CONCLUSION
Today the public infrastructure in India is becoming more and more inaccessible to the
public at large, because of the inadequate government healthcare services and high cost
of treatment at private medical institutions. The Central Government should
increase the share of healthcare expenditure from one percent of GDP to around
three percent of GDP; the state governments should also increase their share of funds
allotted for healthcare. To provide equitable access to
healthcare services and to continuously raise the standards of healthcare services
must be the twin goals of the government.
It has to be remembered that education and healthcare are two sectors which must be
given more and more importance by the government because of our dependence on
the service sector. The prospect of the service sector would depend upon the human capital
(professionals), and better health among the general populace would definitely have a
positive impact on the service sector. There are no ready-made solutions or exact steps
which can guide us to improve the healthcare facilities and nutritional level of people,
but rather there is a need to take action from different angles. Diversion of more
monetary resources towards healthcare is an extremely necessary but insufficient
step unless there is a motivation among the healthcare professionals towards serving
the people even the diverted funds would not yield extraordinary results. 52 The
government must focus on the healthcare infrastructure both qualitatively as well as
quantitatively.
Many times there have been outbreaks of different diseases in one country, and the
same was actually not disclosed by it at the international level. But in this globalized world,
there are chances that disease may be transmitted to other nations, hence it must be
provided by WHO that the States should be obliged to share information about the
outbreak of diseases. Moreover, an international surveillance network must also be
created to take appropriate steps to take preventive measures to stop the transmission of
disease 53. Although the step may involve cooperation among the countries yet, the
Indian government must take an initiative in this regard and present such a plan before
the international community.
Many scholars have suggested Public-Private Partnership as a solution to the problem to
deal with budgetary constraints which the government faces frequently while
implementing different healthcare plans and schemes. But it has to be remembered that
with the advent of private players the cost of services is increased considerably, and in
India where the majority of the population is poor it may lead to inaccessibility to
healthcare services. The government must rather focus on the better utilization of the
funds and the resources employed by it in the healthcare services.
The government must also review its health policy at regular intervals, possibly every
two years to assess the impact of different schemes and programs which are run by it.
The government must identify the areas which are lagging behind in healthcare
services, and special focus must be provided for such areas. Special attention must also
be given to the areas which are hit by epidemics, floods, and other natural disasters
because the chances of the spread of disease are greater in such areas. Suitable
preventive measures must also be taken by the government in the form of vaccination
and the creation of better sanitation facilities to stop the occurrences of diseases.
The National Rural Health Mission is a wonderful program that has brought many
changes in the quality of healthcare services in rural areas. But the mission must
also include in its ambit the urban poor and especially the people who live in slums. The
mission can be more effective if there would be a better utilization of resources; a better
monitoring and auditing system would further expand the horizons of the mission.
There is also a need for better coordination among the different actors who are working
directly or indirectly in the areas of healthcare namely Central Government, State
Government, and the Civil Society. A more comprehensive, coordinated, and integrated
the approach would yield more fruitful results and bring radical changes in our healthcare
system.
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