What Is Infrastructure?

Have you ever thought of why some states in India are performing much better than others in certain areas?

  • Why do Punjab, Haryana and Himachal Pradesh prosper in agriculture and horticulture?
  • Why are Maharashtra and Gujarat industrially more advanced than others?
  • How come Kerala, popularly known as ‘God’s own country’, has excelled in literacy, health care and sanitation and also attracts tourists in such large numbers?
  • Why does Karnataka’s information technology industry attract world attention?

It is all because these states have better infrastructure in the areas they excel than other states of India.

  • Some have better irrigation facilities.
  • Others have better transportation facilities, or are located near ports which makes raw materials required for various manufacturing industries easily accessible.
  • Cities like Bangalore in Karnataka attract many multinational companies because they provide world-class communication facilities.

All these support structures, which facilitate development of a country, constitute its infrastructure.

What then is infrastructure?

Infrastructure provides supporting services in the main areas of –

  • industrial and agricultural production,
  • domestic and foreign trade and commerce.

These services include –

    • roads,
    • railways,
    • ports,
    • airports,
  • dams,
  • power stations,
  • oil and gas pipelines,
  • telecommunication facilities,
  • the country’s educational system including schools and colleges,
  • health system including hospitals,
  • sanitary system including clean drinking water facilities and
  • the monetary system including banks, insurance and other financial institutions.

Some of these facilities have a direct impact on the working of the system of production while others give indirect support by building the social sector of the economy.

Some divide infrastructure into two categories — economic and social.

  • Infrastructure associated with energy, transportation and communication are included in the economic category;
  • whereas those related to education, health and housing are included in the social category.


Relevance Of Infrastructure

Infrastructure is the support system on which depends the efficient working of a modern industrial economy.

Modern agriculture also largely depends on it for speedy and large-scale transport of seeds, pesticides, fertilisers and the produce by making use of modern roadways, railways and shipping facilities. Modern agriculture also has to depend on insurance and banking facilities because of its need to operate on a very large-scale.

Infrastructure contributes to economic development of a country both by increasing the productivity of the factors of production and improving the quality of life of its people.

Inadequate infrastructure can have multiple adverse effects on health. Improvements in water supply and sanitation have a large impact by reducing morbidity (meaning proneness to fall ill) from major waterborne diseases and reducing the severity of disease when it occurs. In addition to the obvious linkage between water and sanitation and health, the quality of transport and communication infrastructure can affect access to health care. Air pollution and safety hazards connected to transportation also affect morbidity, particularly in densely populated areas.


The State Of Infrastructure In India

Traditionally, the government has been solely responsible for developing the country’s infrastructure. But it was found that the government’s investment in infrastructure was inadequate. Today, the private sector by itself and also in joint partnership with the public sector, has started playing a very important role in infrastructure development.

A majority of our people live in rural areas.

  • Despite so much technical progress in the world, rural women are still using bio-fuels such as crop residues, dung and fuel wood to meet their energy requirement. They walk long distances to fetch fuel, water and other basic needs.
  • The census 2001 shows that in rural India –
    • 56 per cent households have an electricity connection;
    • 43 per cent still use kerosene;
    • about 90 per cent of the rural households use bio-fuels for cooking;
    • tap water availability is limited to only 24 per cent rural households;
    • about 76 per cent of the population drinks water from open sources such as wells, tanks, ponds, lakes, rivers, canals, etc.
  • Another study conducted by the National Sample Survey Organisation noted that by 1996, access to improved sanitation in rural areas was only six per cent.

Above table shows the state of some infrastructure in India in comparison to a few other countries. Though it is widely understood that infrastructure is the foundation of development, India is yet to wake up to the call. India invests only 5 per cent of its GDP on infrastructure, which is far below that of China and Indonesia.

Some economists have projected that India will become the third biggest economy in the world a few decades from now. For that to happen, India will have to boost its infrastructure investment.

In any country, as the income rises, the composition of infrastructure requirements changes significantly.

  • For low-income countries, basic infrastructure services like irrigation, transport and power are more important.
  • As economies mature and most of their basic consumption demands are met, the share of agriculture in the economy shrinks and more service related infrastructure is required. This is why the share of power and telecommunication infrastructure is greater in high-income countries.

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

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

Obviously, if proper attention is not paid to the development of infrastructure, it is likely to act as a severe constraint on economic development.




Why do we need energy?

Energy is a critical aspect of the development process of a nation.

  • It is, of course, essential for industries.
  • Now it is used on a large-scale in agriculture and related areas like production and transportation of fertilisers, pesticides and farm equipment.
  • It is required in houses for cooking, household lighting and heating.


Sources of Energy

There are commercial and non-commercial sources of energy.

  • Commercial sources are coal, petroleum and electricity as they are bought and sold. They account for over 50 per cent of all energy sources consumed in India.
  • Non-commercial sources of energy are firewood, agricultural waste and dried dung. These are non-commercial as they are found in nature/forests.

While commercial sources of energy are generally exhaustible (with the exception of hydro-power), non-commercial sources are generally renewable. More than 60 per cent of Indian households depend on traditional sources of energy for meeting their regular cooking and heating needs.


Non-conventional Sources of Energy

Both commercial and non-commercial sources of energy are known as conventional sources of energy.

There are three other sources of energy which are commonly termed as non-conventional sources — solar energy, wind energy and tidal power.

Being a tropical country, India has almost unlimited potential for producing all three types of energy if some appropriate cost-effective technologies that are already available are used. Even cheaper technologies can be developed.


Consumption Pattern of Commercial Energy

At present, commercial energy consumption makes up about 65 per cent of the total energy consumed in India. This includes coal with the largest share of 55 per cent, followed by oil at 31 per cent, natural gas at 11 per cent and hydro energy at 3 per cent.

Non-commercial energy sources consisting of firewood, cow dung and agricultural wastes account for over 30 per cent of the total energy consumption. The critical feature of India’s energy sector, and its linkages to the economy, is the import dependence on crude and petroleum products, which is likely to grow to more than 100 per cent in the near future.

Above table shows the sectoral pattern of consumption of commercial energy.

  • The transport sector was the largest consumer of commercial energy in 1953-54.
  • However, there has been continuous fall in the share of the transport sector while the share of the industrial sector has been increasing.
  • The share of oil and gas is highest among all commercial energy economic growth, there has been a corresponding increase in the use of energy.



The most visible form of energy, which is often identified with progress in modern civilization, is power, commonly called electricity; it is one of the most critical components of infrastructure that determines the economic development of a country.

The growth rate of demand for power is generally higher than the GDP growth rate. Studies point that in order to have 8 per cent GDP growth per annum, power supply needs to grow around 12 per cent annually.

Electricity is a secondary form of energy produced from primary energy resources including coal, hydrocarbons, hydro energy, nuclear energy, renewable energy etc.

Primary energy consumption takes into account the direct and indirect consumption of fuels. It cannot give a complete picture in respect of the ultimate consumption of energy by consumers.

The secondary sources in India consist of coal, oil, electricity and natural gas.

In India, in 2003-04 –

  • Thermal sources accounted for almost 70 per cent of the power generation capacity.
  • Hydro, wind and nuclear sources accounted for 28 and 2.4 per cent respectively.

India’s energy policy encourages two energy sources — hydel and wind — as they do not rely on fossil fuel and, hence, avoid carbon emissions. This has resulted in faster growth of electricity produced from these two sources.

Atomic energy is an important source of electric power; it has environmental advantages and is also likely to be economical in the long run. At present, nuclear energy accounts for only 2.4 per cent of total primary energy consumption, against a global average of 13 per cent. This is far too low.


Challenges in the Power Sector

Electricity generated by various power stations is not consumed entirely by ultimate consumers; a part is consumed by power station auxiliaries. Also, while transmitting power, a portion is lost in transmission. What we get in our houses, offices and factories is the net availability.

Some of the challenges that India’s power sector faces today are –

  • (i) India’s installed capacity to generate electricity is not sufficient to feed an annual economic growth of 7 per cent. In order to meet the growing demand for electricity, between 2000 and 2012, India needs to add 1,00,000 MW of new capacity, whereas, at present, India is able to add only 20,000 MW a year. Even the installed capacity is under-utilised because plants are not run properly;
  • (ii) State Electricity Boards (SEBs), which distribute electricity, incur losses which exceed Rs 500 billion. This is due to transmission and distribution losses, wrong pricing of electricity and other inefficiencies. Some scholars also say that distribution of electricity to farmers is the main reason for the losses; electricity is also stolen in different areas which also adds to the woes of SEBs;
  • (iii) private sector power generators are yet to play their role in a major way; same is the case with foreign investors;
  • (iv) there is general public unrest due to high power tariffs and prolonged power cuts in different parts of the country;
  • (v) thermal power plants which are the mainstay of India’s power sector are facing shortage of raw material and coal supplies.

Thus, continued economic development and population growth are driving the demand for energy faster than what India is producing currently. More public investment, better research and development efforts, exploration, technological innovation and use of renewable energy sources can ensure additional supply of electricity. Though the private sector has made some progress, it is necessary to tap this sector to come forward and produce power on a large-scale. One also has to appreciate the efforts made in this regard. For example, India is already the world’s fifth largest producer of wind power, with more than 95 per cent investments coming from the private sector. Greater reliance on renewable energy resources offers enormous economic, social and environmental benefits.


Making a Difference

Thane city is acquiring a brand new image — an environment friendly make over. Large-scale use of solar energy, which was considered a somewhat far-fetched concept, has brought in real benefits and results in cost and energy-saving. It is being applied to heat water, power traffic lights and advertising hoardings. And leading this unique experiment is the Thane Municipal Corporation. It has made compulsory for all new buildings in the city to install solar water heating system.

(Appeared in the column, Making a Difference, Outlook, 01 August 2005).


Power Distribution: The Case of Delhi

Since independence, power management in the capital has changed hands four times. The Delhi State Electricity Board (DSEB) was set up in 1951. This was succeeded by the Delhi Electric Supply Undertaking (DESU) in 1958. The Delhi Vidyut Board (DVB) came into existence as SEB in February 1997. Now it rests with two leading power majors of the country following the privatisation of the DVB. Reliance Energy Ltd owned BSES manages power distribution in two-thirds of Delhi through its two companies (known as DISCOMS): south and west areas are handled by BSES Rajdhani Power Limited whereas BSES Yamuna Power Limited looks after central and east areas. The Tata Power-owned NDPL distributes power to the north and the north-west of the capital. Both the discoms further have 23 (220 KV) grids between them to supply power to the approximately 28 lakh consumers in the capital area. The tariff structure and other regulatory issues are monitored by the Delhi Electricity Regulatory Commission (DERC). Though it was expected that there will be greater improvement in power distribution and the consumers will benefit in a major way, experience shows unsatisfactory results.


Saving Energy : Promoting the Case of Compact Fluorescent Lamps (CFL)

According to the Bureau of Energy Efficiency (BEE), CFLs consume 80 per cent 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 can save 80 megawatt in power generation. This amounts to saving Rs 400 crore at 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.



Health is not only absence of disease but also the ability to realise one’s potential. It is a yardstick of one’s well being. Health is the holistic process related to the overall growth and development of the nation.

Though the twentieth century has seen a global transformation in human health unmatched in history, it may be difficult to define the health status of a nation in terms of a single set of measures.

Generally scholars assess people’s health by taking into account indicators like –

  • infant mortality and maternal mortality rates,
  • life expectancy and nutrition levels,
  • the incidence of communicable and non-communicable diseases.

Development of health infrastructure ensures a country of healthy manpower for production of goods and services. In recent times, scholars argue that –

  • People are entitled to health care facilities.
  • It is the responsibility of the government to ensure the right to healthy living.

Health infrastructure includes hospitals, doctors, nurses and other para-medical professionals, beds, equipment required in hospitals and a well-developed pharmaceutical industry.

  • It is also true that mere presence of health infrastructure is not sufficient to have healthy people: the same should be accessible to all the people.
  • Since, the initial stages of planned development, policy-makers envisaged that no individual should fail to secure medical care, curative and preventive, because of the inability to pay for it. But are we able to achieve this vision?


State of Health Infrastructure

The government has the constitutional obligation to guide and regulate all health related issues such as –

  • medical education,
  • adulteration of food,
  • drugs and poisons,
  • medical profession,
  • vital statistics,
  • mental deficiency and
  • lunacy.

The Union Government evolves broad policies and plans through the Central Council of Health and Family Welfare. It collects information and renders financial and technical assistance to state governments, union territories and other bodies for implementation of important health programmes in the country.

Over the years, India has built up a vast health infrastructure and manpower at different levels. At the village level, a variety of hospitals have been set up by the government. India also has a large number of hospitals run by voluntary agencies and the private sector. These hospitals are manned by professionals and para-medical professionals trained in medical, pharmacy and nursing colleges.

Since independence, there has been a significant expansion in the physical provision of health services. During 1951-2000, the number of hospitals and dispensaries increased from 9,300 to 43,300 and hospital beds from 1.2 to 7.2 million (see Table 8.3); during 1951-99, nursing personnel increased from 0.18 to 8.7 lakh and allopathic doctors from 0.62 to 5.0 lakh. Expansion of health infrastructure has resulted in the eradication of smallpox, guinea worms and the near eradication of polio and leprosy.


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 –

  • education concerning prevailing health problems and methods of identifying, preventing and controlling them;
  • promotion of food supply and proper nutrition and adequate supply of water and basic sanitation;
  • maternal and child health care;
  • immunisation against major infectious diseases and injuries;
  • promotion of mental health and provision of essential drugs.

Auxiliary Nursing Midwife (ANM) is the first person who provides primary healthcare in rural areas.

In order to provide primary health care, hospitals have been set up in villages and small towns which are generally manned by a single doctor, a nurse and a limited quantity of medicines. They are known as Primary Health Centres (PHC), Community Health Centres (CHC) and sub-centres. When the condition of a patient is not managed by PHCs, they are referred to secondary or tertiary hospitals.

Hospitals which have better facilities for surgery, X-ray, Electro Cardio Gram (ECG) are called secondary health care institutions. They function both as primary health care provider and also provide better healthcare facilities. They are mostly located in district headquarters and in big towns.

All those hospitals which have advanced level equipment and medicines and undertake all the complicated health problems, which could not be managed by primary and secondary hospitals, come under the tertiary sector.

The tertiary sector also includes many premier institutes which not only impart quality medical education and conduct research but also provide specialised 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, Bangalore and All India Institute of Hygiene and Public Health, Kolkata.

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


Private Sector Health Infrastructure

In recent times, while the public health sector has not been so successful in delivering the health infrastructure, private sector has grown by leaps and bounds

  • more than 70 per cent of the hospitals in India are run by the private sector;
  • they control nearly two-fifth of beds available in the hospitals.
  • nearly 60 per cent of dispensaries are run by the same private sector;
  • they provide healthcare for 80 per cent of out-patients and 46 per cent of in-patients.

In recent times, private sector has been playing a dominant role in –

  • medical education and training,
  • medical technology and diagnostics,
  • manufacture and sale of pharmaceuticals,
  • hospital construction and the provision of medical services.

In 2001-02, there were more than 13 lakh medical enterprises employing 22 lakh people; more than 80 per cent of them are single person owned, and operated by one person occasionally employing a hired worker.

Scholars point out that the private sector in India has grown independently without any major regulation; some private practitioners are not even registered doctors and are known as quacks.

Since the 1990s, owing to liberalisation measures, many non-resident Indians and industrial and pharmaceutical companies have set up state-of-the-art super-speciality hospitals to attract India’s rich and medical tourists. But since the poor can depend only on government hospitals, the role of government in providing healthcare remains important.


Medical Tourism — A great opportunity

You might have seen and heard on TV news or read in newspapers about foreigners flocking to India for surgeries, liver transplants, dental and even cosmetic care. Why? Because our health services combine latest medical technologies with qualified professionals and is cheaper for foreigners as compared to costs of similar health care services in their own countries. In the year 2004-05, as many as 1,50,000 foreigners visited India for medical treatment. And this figure is likely to increase by 15 per cent each year. Experts predicted that by 2012 India could earn more than 100 billion rupees through such ‘medical tourism’. Health infrastructure can be upgraded to attract more foreigners to India.


Indian Systems of Medicine (ISM)

It includes six systems – Ayurveda, Yoga, Unani, Siddha, Naturopathy and Homeopathy (AYUSH).

At present there are 3,004 ISM hospitals, 23,028 dispensaries and as many as 6,11,431 registered practitioners in India. But little has been done to set up a framework to standardise education or to promote research. ISM has huge potential and can solve a large part of our health care problems because they are effective, safe and inexpensive.


Indicators of Health and Health Infrastructure A Critical Appraisal

The health status of a country can be assessed through indicators such as infant mortality and maternal mortality rates, life expectancy and nutrition levels, along with the incidence of communicable and non-communicable diseases. Some of the health indicators, and India’s position, are given in below table.

Scholars argue that there is greater scope for the role of government in the health sector. For instance, the below table shows expenditure on health sector as five per cent of total GDP. This is abysmally low as compared to other countries, both developed and developing.

One study points out that India has about 17 per cent of the world’s population but it bears a frightening 20 per cent of the global burden of diseases (GBD). GBD is an indicator used by experts to gauge the number of people dying prematurely due to a particular disease as well as the number of years spent by them in a state of ‘disability’ owing to the disease. In India –

  • more than half of GBD is accounted for by communicable diseases such as diarrhoea, malaria and tuberculosis;
  • every year around five lakh children die of water-borne diseases;
  • the danger of AIDS is also looming large;
  • malnutrition and inadequate supply of vaccines lead to the death of 2.2 million children every year.

At present, less than 20 per cent of the population utilises public health facilities. One study has pointed out that only 38 per cent of the PHCs have the required number of doctors and only 30 per cent of the PHCs have sufficient stock of medicines.


Urban-Rural and Poor-Rich Divide

About 70 per cent of India’s population lives in rural areas, but –

  • Only one-fifth of its hospitals are located in rural areas;
  • Rural India has only about half the number of dispensaries.
  • Out of about 7 lakh beds, roughly 11 per cent are available in rural areas.
  • There are only 0.36 hospitals for every one lakh people in rural areas while urban areas have 3.6 hospitals for the same number of people.
  • The PHCs located in rural areas do not offer even X-ray or blood testing facilities which, for a city dweller, constitutes basic healthcare.

Thus, people living in rural areas do not have sufficient medical infrastructure. This has led to differences in the health status of people. States like Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh are relatively lagging behind in health care facilities. In the rural areas, the percentage of people who have no access to proper care has risen from 15 in 1986 to 24 in 2003.

Villagers have no access to any specialised medical care like pediatrics, gynaecology, anaesthesia and obstetrics.

Even though 165 recognised medical colleges produce 12,000 medical graduates every year, the shortage of doctors in rural areas persists –

  • One-fifth of these doctor graduates leave the country for better monetary prospects;
  • many others opt for private hospitals which are mostly located in urban areas.

The poorest 20 per cent of Indians living in both urban and rural areas spend 12 per cent of their income on healthcare while the rich spend only 2 per cent.

What happens when the poor fall sick? Many have to sell their land or even pledge their children to afford treatment. Since government-run hospitals do not provide sufficient facilities, the poor are driven to private hospitals which makes them indebted forever. Or else they opt to die.


Community and Non-Profit Organisations in Healthcare

One of the important aspects of a good healthcare system is community participation. It functions with the idea that the people can be trained and involved in primary healthcare system. This method is already being used in some parts of our country.

SEWA in Ahmedabad and ACCORD in Nilgiris could be the examples of some such NGOs working in India.

Trade unions have built alternative health care services for their members and also to give low-cost and rational care to people from nearby villages. The most well-known and pioneering initiative in this regard has been Shahid Hospital, built in 1983 and sustained by the workers of CMSS (Chhattisgarh Mines Shramik Sangh) in Durg, Madhya Pradesh.

A few attempts have also been made by rural organisations to build alternative healthcare initiatives. One example is in Thane, Maharashtra, where in the context of a tribal people’s organisation, Kashtakari Sangathan, trains women health workers at the village level to treat simple illnesses at minimal cost.


Women’s Health

Women constitute about half the total population in India. They suffer many disadvantages as compared to men in the areas of education, participation in economic activities and health care. The deterioration in the child sex ratio in the country from 945 in 1991 to 927, as revealed by the census of 2001, points to the growing incidence of female feticide in the country. Close to 3,00,000 girls under the age of 15 are not only married but have already borne children at least once. More than 50 per cent of married women between the age group of 15 and 49 have anaemia and nutritional anaemia caused by iron deficiency, which has contributed to 19 per cent of maternal deaths. Abortions are also a major cause of maternal morbidity and mortality in India.


Health is a vital public good and a basic human right. All citizens can get better health facilities if public health services are decentralised. Success in the long-term battle against diseases depends on education and efficient health infrastructure. It is, therefore, critical to create awareness on health and hygiene and provide efficient systems. The role of telecom and IT sectors cannot be neglected in this process. The effectiveness of healthcare programmes also rests on primary healthcare. The ultimate goal should be to help people move towards a better quality of life. Private-public partnership can effectively ensure reliability, quality and affordability of both drugs and Medicare. There is a sharp divide between the urban and rural healthcare in India. If we continue to ignore this deepening divide, we run the risk of destabilising the socio-economic fabric of our country. In order to provide basic healthcare to all, accessibility and affordability need to be integrated in our basic health infrastructure.


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