SOCIAL INFRASTUCTURE-

Social infrastructure includes housing, educational, recreational and law and order facilities that support the community's need for social interaction

· It covers facilities such as health provision, early years provision, schools, colleges and universities, community, cultural, recreation and sports facilities, places of worship, policing and other criminal justice or community safety facilities, children and young people's play facilites

· Social infrastructure can also be described as a system of social services, networks and facilities that support people and communities. The scope of social infrastructure teams usually revolves around education, housing, health, income, safety, recreation and leisure and cultural expression. The right to health has so far not been accorded the status of a Fundamental Right to the Indian citizens. It is not even a statutory right, unlike education.

The Costs and Benefits of Social Infrastructure

Social and community infrastructure and services are provided in response to the needs of communities. They enhance the quality of life, equity, law and order, stability and social well-being through community support; safety and security; sports; recreation and culture; justice; housing; health and education.‘

The term “Social infrastructure” is often used to denote community infrastructure or social and community infrastructure. It includes both soft and hard infrastructure around services and processes that enhance the social capacity of communities. Social infrastructure can be broadly categorized as inclusive of services and facilities in:

 · health;

· individual, family and community support;

· education;

 · arts and culture;

· information;

· sport and recreation;

 · housing;

· community development;

· employment and training;

· legal and public safety;

· emergency services; and

· public and community transport.

In recent years the concept of ?”social capital” has received increasing attention as accumulating evidence demonstrates the dependence between social capital and a wide range of desirable outcomes: economic success, improved school performance, decreased crime, higher levels of voting and better health.

Viewing Social Infrastructure

Through a Gender Lens The importance of social infrastructure is undisputed. There is increasing evidence that we no longer view social infrastructure provision as gender-neutral or worse, gender-blind. Here is a set of questions that enable critical reflection, analysis and assessment:

· Who benefits from the provision of social infrastructure? Men, women or both?

· How much resource allocation is made for measures which focus on ?positive discrimination? in favour of women and girls?

 · Are the practical and strategic gender interests/ needs addressed by particular social

Policy Sphere

 • Health is a State subject as per our Constitution. About two-thirds of the total governmental expenditure on health coming from the State Governments and the balance one-third being provided by the Government of India.

• Despite this, the Central Govt. has significant influence in the policy space with pathbreaking schemes such as the National Health Mission, Ayushman Bharat and Pradhan Mantri Jan Arogya Yojana.

 • India is also a signatory to the 2030 Agenda for Sustainable Development, whereby it has committed as a nation to “ensure healthy lives and promote well-being for all”. Benchmarking: Addressing The Variations Across States

• There are huge variations across States in their health outcomes and health systems’ performance.

• In order to address the issue of variations across the states, NITI Aayoga, in collaboration with the Ministry of Health and Family Welfare and the World Bank, has crafted a Health Index.

Health Index covers the following domains - Neonatal Mortality Rate
(NMR), Under-five Mortality Rate (U5MR), Total Fertility Rate (TFR), Proportion of Low Birth Weight among newborns , (LBW among infants) Sex Ratio at Birth
(SRB), Sub domain - Full immunization coverage (%), Proportion of institutional deliveries, Total Case Notification Rate of TB, Proportion of people living with HIV (PLHIV) on antiretroviral therapy (ART)

 

About The Index

 • It is the first ever systematic exercise for tracking the progress on health outcomes and health systems’ performance across all the States and UTs on an annual basis.

• The Health Index is a weighted-composite Index based on select indicators in three domains:

a) Health Outcomes;

(b) Governance and Information; and

(c) Key Inputs and Processes, with the health outcomes carrying the most weight across the different category of States/UTs.

• For generation of ranks, the States are classified into three categories (Larger States, Smaller States and UTs) to ensure comparability among similar entities.

 • A range of indicators such as the neo-natal mortality rate (deaths occurring in the first 28 days of life), full immunisation coverage, treatment success rate of confirmed tuberculosis cases, stability administrators, of tenure of key vacancy of doctors and specialists in health facilities, and functionality of primary health centres, first referral units and cardiac care units, are included in the Index.

• In February 2018, the first round of the Health Index report on ranks and scores was released.

 Benefits

• The index will propel States towards undertaking multi-pronged interventions and drive efforts towards achievement of SDG Goal 3.

 • The State Governments will be able to identify parameters in which States have improved, stagnated, or declined.

• An analysis of this can help States in focusing attention on better targeting of interventions and improving the delivery of health services and also an opportunity of sharing best practices. Room For Improvement

• Health Index (June 2019) report on ranks of States and UTs indicates, even Kerala, Mizoram, and Chandigarh, the “healthiest” among large states, small states and UTs respectively, all have quite a distance from the frontier and have room for improving their performance.

• The Index is an innovative tool as it not only fosters competition among states by comparing similar states to each other but also nudges them to better their own performance in the previous year.

Scope For Improvement

 • Based on the composite Health Index scores range for the reference year (2017-18), the States are grouped into three categories: Achievers, Aspirants, and Front-runners.

• Aspirants are the bottom one-third States and six of the eight Empowered Action Group States fall in this category. Given the substantial scope for improvement, these States require concerted efforts.

• Achievers represent the middle one-third States.

COVID-19: The Novel Threat

Corona Viruses

 • All Coronaviruses are large (120-160 nm) enveloped RNA viruses which have single stranded genome.

 • The virus possesses a club shaped or crown like peplomer spikes giving appearance of solar corona. High rates of genetic mutations are shown by the corona viruses. Most of these infect animals and birds.

• Human infection is caused by only those which can adapt to human conditions. There are already known six corona viruses involved in human infections.

• In 2003 there was an outbreak of SARS-CoV (Severe Acute Respiratory Syndrome coronavirus). It originated from China. The source was believed to be monkeys, raccoon dogs, cats and rodents.

• MERS-CoV (Middle East Respiratory Syndrome coronavirus) emerged in 2012. First reported from Saudi Arabia; the source was thought to be camels and bats

• Front-runners, the States falling in top one-third score range are the best performing States. Shake Complacency And Nurture Hope

• It is envisaged that tracking progress on incremental performance will also help shake complacency among “Healthiest Large States” such as Kerala, Punjab, and Tamil Nadu that have historically done well.

• At the same time, it will nurture hope and optimism among large states such as Haryana, historically lagged in performance. Variable Progress Across States Towards Achieving SDG Goals

• Several States have made good progress towards achieving SDG goals included in the Index.

 • Kerala and Tamil Nadu have already reached the 2030 SDG goal for Nuclear Magnetic Resonance (which is 12 neonatal deaths per 1000 live births).

• Maharashtra and Punjab are also close to achieving the goal. Kerala, Tamil Nadu, Maharashtra and Punjab have already achieved the SDG goal on Under-Five Mortality Rate, which is 25 deaths per 1000 live births. Incentivising Incremental Performance

• The Health Index can shift the focus from budget spends, inputs and outputs to outcomes by shining the light on States that have shown most improvement.

• The MoHFW’s decision to link the Index to incentives under the National Health Mission sends a strong signal to States in the shift towards outcome based monitoring and performance linked incentives.

 • In 2019-20, it was decided to link 70% of the NHM incentives to the incremental performance of the states and UTs on the Health Index.

COVID 19

• It represents COrona VIrus Disease originated in 2019. First case of this virus was identified in December 2019 from Wuhan, Hubei province of China.

• WHO declared the 2019-20 coronavirus outbreak, a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 and a pandemic on 11 March 2020. Challenges Due To COVID 19

• It is a novel virus, very little is known about it. The transmission rate of SARS-CoV-2 is higher than SARS-CoV and the reason could be genetic recombination.

• Asymptomatic carriers as well as convalescent individuals can transmit the virus. No age group is spared. The progression of the disease is very unpredictable.

• Mortality rates are very high in some parts of the world compared to others.

Transmission

• There are two main routes of transmission: respiratory and contact. The virus is mainly spread by small droplets produced by coughing, sneezing or even talking to an infected person.

 • People may also become infected by touching a contaminated surface and then their face. The virus can survive on surfaces for a few hours to a few days, depending upon the nature of surface.

 • Spread is possible before symptoms appear and in later stages of the disease as well. That makes it more dangerous.

• There have been no reports of fecal−oral transmission of the COVID-19 virus.

HEALTH FINANCING IN INDIA

• The public expenditure on health accounts for nearly one third of the total expenditure at 1.2% of the GDP and remaining is met by Out-of-Pocket expenditure (OOPE).

• According to the latest National Health Accounts Estimates (2016-2017), the total spending on health in India is 3.8% of the GDP which has reduced from 4.2% in 2004-05.

• The Total Health Expenditure (THE) per capita has increased more than three times from 2004-05 to 201617. Out of this, 32.4% is Government Health Expenditure, 58.7% household as OOPE, 7.3% social security insurance and 4.7% private health insurance.

Artificial Intelligence in Healthcare

 Artificial Intelligence(AI), is intelligence demonstrated by machines, unlike the natural intelligence displayed by humans and animals. AI increases the ability for healthcare professionals to better understand the day-to-day patterns and needs of the people they care for, and with that understanding they would be able to provide better feedback, guidance and support.

• Reports of several NSSO Rounds show that the households largely depend on private providers for healthcare services but this dependence on private healthcare is declining. Catastrophic health expenditures have increased significantly in both rural and urban areas.

Challenges and Controversies Healthcare Industry Issues:

 • Traditional healthcare personnel may resist new innovations. • Patients may question AI-based decision-making.

• Medical staff could view the changes as disenfranchising them from their key roles and decision[1]making powers.

• The key challenge for policy makers is the engendering of confidence in the outcomes and trust that a human medical practitioner has an active role within the AI system.

• The challenge for the training of doctors is to address the transformational nature of AI-based healthcare, whilst not elongating the period for learning and qualification to integrate these new systems alongside everyday working practices. Technology-related Issues:

• AI systems and the underlying algorithms are reliant on the quality of data to perform the necessary processing and decision-making.

• The challenge within India is the disparate nature of health care related data. Each state has its own system and working process.

• This is complicated by the mass worker migration between states, and highlights the need for solutions at a national level.

Way Forward

• AI and its applications should be incorporated within curriculum for medical & paramedical training.

 • The technology design and implementation should take into account cultural practices and address the gender divide in India.

• Ethical guidelines regarding security and privacy of data should be protected. The data should be strictly used for clinical purposes only.

• The AI system must be explainable and auditable.

 • All decisions made in the context of diagnosis or recommendations can impact on human lives.

• Underlying algorithms must be transparent and explainable to ensure ease of audit rather than acting as a black-box based system.

• AI systems should not exhibit bias. It must not exhibit any racial, gender or such biased decision[1]making that disenfranchise or favour any population groups.

• AI healthcare systems must conform to human values and ethics

IoT in Healthcare

 The Internet of Things (IoT) is a scalable and automated solution that has seen exponential growth in other industries such as automated manufacturing, wearable consumer electronics, and asset management. The COVID-19 outbreak has shown the new emerging benefits of smart manufacturing, saying Industry 4.0 drives capabilities for remote operations, monitoring and maintenance of production lines and manufacturing plants.

What is Internet of Things (IoT)?

• The Internet of things is a system of interrelated computing devices, mechanical and digital machines provided with unique identifiers and the ability to transfer data over a network without requiring human-to-human or human-to-computer interaction.

• IoT consists of several functional components: data collection, transfer, analytics, and storage. Data is collected by sensors installed on mobile, end-user hardware like phones, robots, or health monitors.

• Then, the mobile data is sent to the central cloud server for analytics and decision-making, such as if a machine requires proactive maintenance to prevent unexpected breakdown or if a patient needs to come in for a check-up.

• The primary challenge is to integrate and streamline digital infrastructure at various stages of the public health response.

Global Trade In Health Services

 • The careful examination of global public healthcare system keeping the global trade in health services in view is the need of the hour.

• The WHO in association with WTO is drawing the attention of its members towards the global public healthcare system and promoting global trade in health services. o World Band and IMF can further identify ways to support this mechanism.

 • WTO has made provision for trade in services under general agreement on trade in services (GATS). o Serious discussions are going on at international level to bring healthcare under its ambit and promote global trade in health services.

 o They are working out strategy to promote global trade in health service covering medical education under different modes of general agreement on trade in services and to operate trade in health service of consumption abroad (Mode-1),

cross border consumption (Mode2),

commercial presence (Mode-3) and

presence of natural persons ( Mode-4).

Re-engineering of Healthcare System – the way forward:

• It is time to think of building a healthcare network with national buffer and global pump house for public health services.

• The proposed national buffer can be operated as a global pump house for healthcare and to save global population.

• The World Trade Organisation in association with its member countries can work out a plan to build national buffer for health service by supporting and standardising medical education