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 becomes a serious problem in India. Due to a cumulative effect of poverty, population load and climatic factors India’s population is seriously susceptible to diseases. 

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: At the lowest level, primary health centers (PHCs) were designed to provide basic medical care, disease prevention, and health education. The next tier, sub centers (SCs), were intended to provide public health services. A top tier of community centers and district hospitals offers specialist services. 

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 population growth rate has been 8.6% in 2010-2011and is expected to grow in the upcoming years fiscal years.

The following data obtained from National Health Profile 2010 shows condition of health infrastructure in India: 

Insufficiency of Hospital Beds: There are 12,760 hospitals having 576,793 beds in the country. Out of these 6795 hospitals are in rural area with 149,690 beds and 3,748 hospitals are in urban area with 399,195 beds. Average Population served per Government Hospital is 90,972 and average population served per government hospital 
bed is 2,012. This figure is far more dismal in states like Assam, Bihar and Jharkhand where there is only one bed for every 39,114,163 and 5,494 persons respectively. 

B). Dismal Number of Healthcare Centers: There are 1,45,894 Sub Centers, 23,391 Primary Health Centers and 4,510 Community Health Centers in India as on March 2009 (Latest). These figures are insufficient keeping in mind the model of 2005 National Commission on Macroeconomics and Health, which recommended a Sub Centre for every 5,000 population, a Primary Health Centre for every 30,000 population and a Community Health Centre for every 1,00,000 population. 

C). Insufficient Number of Blood Banks: Total number of licensed Blood Banks in the Country as on January 2011 is 2,445. States in North East India are severely low on availability of Blood Banks except for state of Assam; remaining six states only have 43 licensed Blood Banks. 

D). Urgent Need of more Medical Colleges: In terms of Medical education infrastructures the country has 314 medical colleges, 289 Colleges for BDS (Bachelor of Dental Surgery) courses and 140 colleges conduct MDS (Master of Dental Surgery) courses with total admission of 29,263 (in 256 Medical Colleges), 21,547 and 2,783 respectively during 2010-11. Population of the country during this period increased by about 1.3 % ( Approx. 1.5 crores), thus, e.g., presuming that all these new admissions would serve the increased population for the period 2010-11, each medical professional (from medical college) would be serving a population of more than 500 people. Nurses and midwives are not trained properly due to inadequate infrastructure, in several places nursing school were functioning more as appendages of the district hospitals. In 2004, 61.2% of nursing schools/colleges were found were found unsuitable for teaching. Public hospitals and clinics have been found to under staffed by 15-20% on average, which is more in the rural areas. 

Concentration of Healthcare in Metro-cities: Central Government Health Scheme (CGHS) has health facilities in 24 cities having 246 Allopath Dispensaries and Total 438 Dispensaries in the Country with 8, 47,081 registered cards/ families. This scheme shows wide discrepancies as majority (almost two-thirds) of these facilities are concentrated in four metro cities. 

F). Non-Availability of Urgently Needed Vaccines: The availability of life saving vaccines is also not up to the mark, e.g. the gap between demand and supply of DPT in 2009-10 was above 26%; for the same period the gap for TT was about 16%, for ASVS (Scorpion) the gap was 54%. Substandard drugs are also a concern for India, poor enforcement of regulations are due to weak and inadequate drug control infrastructure at the State and Central levels, only 17 of the 31 States and Union Territories have drug- testing facilities, this is coupled with lack of manpower for enforcement of the regulations. Infrastructure is also inadequate in the area of production for medical equipment because according to an estimate India imports about 65 % of its medical equipments. 

The following data obtained from National Health Profile 2019 shows condition of health infrastructure in India: 

India’s population, as per census 2011 stood at 12108.5 lakhs (6232.7 lakhs males and 5875.8 lakhs females). Out of the entire census till date, the Average Annual Exponential Growth Rate has been negative only for the decade 1911-21. During this interval, population declined marginally due to great influenza epidemic and two successive bad harvests in West Bengal. [Table No. 1.1.1]  

 

Health infrastructure is an important indicator for understanding the health care delivery provisions and welfare mechanism in a country. Infrastructure has been described as the basic support for the delivery of public health activities. It also signifies the investments and priority accorded to create the infrastructure in public and private sectors. 

This section on Health Infrastructure indicators is subdivided into two categories viz. educational infrastructure and service infrastructure. Educational infrastructure provides details of medical colleges, students admitted to M.B.B.S. course, post graduate degree/diploma in medical and dental colleges, admissions to BDS & MDS courses, AYUSH Institutes, nursing and pharmacy courses. Service infrastructure in health includes details of allopathic hospitals, hospital beds, Indian System of 

Medicine & Homeopathy hospitals, sub centers, PHC, CHC, blood banks, eye banks and mental hospitals. 

Medical education infrastructures in the country have shown rapid growth over the past few years. The country has 529 medical colleges, 313 Dental Colleges for BDS & 253 Dental Colleges for MDS. The total number of admissions for academic year 2018-19 in Medical Colleges is 58756. The Dental Colleges saw an admission of 26960 in BDS and 6288 in MDS in the academic year 2018-19. 

India has 1909 Institutions for ANM with an admission of 55263, 6861 Institutions with an admission of 267564 for Nursing and 1682 Pharmacy Institutions with an admission of 99145 as on 31st March, 2018. 

There are 4035 hospitals and 27951 dispensaries to provide Medical care facilities under AYUSH by management as on 1.4.2018. 

Health-care is the right of every individual. 60% of population lives in rural India. To cater the health needs of these rural populations there are 158417 Sub Centres, 25743 Primary Health Centres and 5624 Community Health Centres in India as on 31st March 2018. 

Total no. of licensed Blood Banks in the Country till December, 2018 is 3108. 

The country has 469 Eye Banks till January, 2019. 

The Central Government Health Scheme (CGHS) was started under the Ministry of Health and Family Welfare in 1954 with the objective of providing comprehensive medical care facilities to Central Government employees, pensioners and their dependents residing in CGHS covered cities. At present, CGHS has health facilities in 37 cities having 288 Allopathic Dispensaries and 85 AYUSH Dispensaries in the Country. There are 1141286 registered cards with total 3395453 number of beneficiaries.  Country. There are 1141286 registered cards with total 3395453 number of beneficiaries. 

  In State of Punjab vs. Ram Lubhaya Bagga23 the Supreme Court observed that the State had an obligation to provide health care facilities to government employees and to citizens, the obligation was however only to the extent of its financial resources for fulfilling the obligation. In regards to the constitutional obligation of the State, it is incumbent that it must provide for basic infrastructure for maintaining and improving public health. The State renders this obligation by opening Government hospitals and health centers, but in order to make it meaningful, it has to be within the reach of its people and provide all the facilities which are provided for in other hospitals. 

 The landmark case of, Paschim Banga Khet Mazdoor Samiti vs. State of W.B the issue before the Supreme Court was the legal obligation of the Government to provide facilities in government hospitals for treatment of persons who had sustained serious injuries and required immediate medical attention. The petitioner who had suffered brain haemorrhage in a fall from the train was denied treatment at various government hospitals because of non-availability of beds. The court held that, providing adequate medical facilities is an essential part of the obligation undertaken by the State in a welfare state. The Government discharges this obligation by running hospitals and health centers. Article 21 imposes an obligation on the State to safeguard right to life of every person. Preservation of human life is thus of paramount importance. Any failure on part of the government hospitals to provide timely medical treatment to a person would result in violation of the right to life. An Enquiry committee was set up in this case to investigate the problem, the committee recommended that proper medical aid with scope of equipment’s and facilities should be made available at all health centers and hospitals to cater to emergency patients, it also suggested other infrastructure improvement measures and issued directions to that effect which would be applicable to all the states. The Supreme Court observed that while financial resources would be required for the implementation of the above directions, the constitutional obligation of State to provide adequate medical services to the people cannot be ignored. 

  The Supreme Court has held that the failure to provide timely medical care amounts to violation of the right to life under Article 21. The state has an obligation to provide medical facilities in such circumstances, and financial inability or lack of infrastructure is no justification to avoid this obligation. Whenever the state fails to discharge its constitutional obligation, the patient or immediate kin may approach either the Supreme Court or the High court under Articles 32 or Devi vs. Tugutla Laxmi Reddy held that a hospital can be held guilty of negligence if it does not have adequate infrastructure, to deal with emergencies. This case thus introduced element of tortuous liability in regards to lacking infrastructure issue. 

1)    Mint: https://www.livemint.com/news/india/covid-2-0-lifts-lid-off-india-s-health-infrastructure-system-11618424294305.html

-       The resurgence of coronavirus cases has caught India’s creaking healthcare system flat-footed again, with reports of shortages in critical-care beds, oxygen, delays in testing and hospitals turning away critically ill patients pouring in from across the country.

-       Health experts had for long warned about the consequences of underfunding the country’s health infrastructure. 

-       There is no easy solution to address the shortage of health personnel at this stage. This is the result of decades of neglect of public health in the country. There is a shortage of all categories of staff. We need primary care doctors and nurses. We have to re-purpose the existing personnel," said Lalit Kant, a scientist and former head of epidemiology and communicable diseases at the Indian Council of Medical Research (ICMR).

-       Private diagnostic companies said they are witnessing a spike in the number of patients who are testing positive. “The requirement of negative RT-PCR reports for interstate travel has led to a surge in requests from travellers," said Dinesh Chauhan, chief executive of Core Diagnostics.

-       Experts have urged that only symptomatic patients should get the tests done to reduce the burden on laboratories. “Regulatory approvals that are needed for collection and testing are an added burden and a hurdle to build capacity quickly," said Ameera Shah, managing director, Metropolis Healthcare. “The demand for home visits has gone up and is difficult to scale up at the moment."

 

2)  https://www.expresshealthcare.in/news/india-pushes-forward-to-upgrade-critical-care-health-infrastructure-and-adoption-of-world-class-medical-technology/427565/

 

The COVID-19 induced pandemic revealed major creaks in healthcare systems across the globe. In India, the void of a limited number of hospitals, debilitating medical infrastructure and restricted access to healthcare was felt the strongest for 72 years of the country’s independence.

As state and central governments recognised the gaps, it can be sufficiently said that the pandemic completely changed the dynamics of the Indian healthcare ecosystem for years to come.

Ventilators and PPE kits became the face of the pandemic as the country scrambled to provide critical healthcare to its citizens.

According to data from the Center for Disease Dynamics, Economics and Policy and Princeton University, India had only 48,000 ventilators at the time of the pandemic’s outbreak against the requirement for 1,50,000 ventilators. This scenario now is undergoing a major change and at a rapid pace.

A number of domestic manufacturers like Bharat Electronics Limited (in collaboration Skanray Technologies), AgVa Healthcare (in collaboration with Maruti Suzuki), MedTech Zone, Mahindra & Mahindra, Hyundai Motor India have successfully manufactured and delivered ventilators to meet the need gap.

 

 

 

 

 

 

 

 

Abha Singh, 4/23/2021 12:00:00 AM


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