SOCIOLOGY OF MODERNIZATION

AND DEVELOPMENT

NIDHI SHARMA

MAHARSHTRA AND BIHAR

(HEALTH SECTOR)

MA PART-2

PRO.VAISHALI MISS
2020-21
Introduction

Modernization portrays the cycles that increment the measure of specialization and
separation of construction in social orders bringing about the move from a lacking
society to grew, mechanically determined society (Irwin 1975). By this definition, the
degree of innovation inside a general public is decided by the complexity of its
innovation, especially as it identifies with foundation, industry, and so forth.
Nonetheless, it is critical to take note of the natural ethnocentric predisposition of such
appraisal. For what reason do we expect that those living in semi-fringe and fringe
countries would discover it so superb to turn out to be more similar to the centre
countries? Is modernization consistently certain. One inconsistency of a wide range of
innovation is that they frequently guarantee efficient advantages, however some way
or another neglect to convey. How frequently have you ground your teeth in
dissatisfaction at an Internet webpage that would not load or at a dropped approach
your cell? Regardless of efficient gadgets like dishwashers, clothes washers, and,
presently, controller vacuum cleaners, the normal measure of time spent on
housework is a similar today as it was fifty years prior. Furthermore, the questionable
advantages of every minute of every day email and quick data have basically
expanded the measure of time workers are required to be responsive and accessible.
While once organizations needed to go at the speed of the U.S. postal framework,
sending something off and holding up until it was gotten before the following stage,
today the instantaneousness of data move implies there are no such breaks. Further,
the Internet got us data, however at an expense. The slough of data implies that there
are as much helpless data accessible as dependable sources. There is a sensitive line
to walk when centre countries look to carry the expected advantages of modernization
to more customary societies. For one, there are clear precapitalist inclinations that go
into such endeavours, and it is shallow for western governments and social
researchers to expect any remaining nations try to emulate their example. Moreover,
there can be a sort of neo-liberal guard of rustic societies, disregarding the frequently
smashing destitution and infections that exist in fringe countries and zeroing in just on
a nostalgic folklore of the cheerful worker. It takes a cautious hand to comprehend
both the requirement for social character and safeguarding just as the expectations
for future development.
Modernization is a persistent and open-finished interaction. Truly, the range of time
over which it has happened should be estimated in hundreds of years, in spite of the
fact that there are instances of sped up modernization. Regardless, modernization isn't
an unequivocally time accomplishment. There is by all accounts a powerful guideline
incorporated into the actual texture of present-day cultures that doesn't permit them to
settle, or to accomplish harmony. Their advancement is consistently unpredictable and
lopsided. Whatever the degree of improvement, there are consistently "in reverse"
districts and "fringe" gatherings. This is a persevering wellspring of strain and struggle
in current cultures. Such a condition isn't bound to the interior advancement of
individual states. It very well may be seen on a worldwide scale, as modernization
broadens outward from its unique Western base to take in the entire world. The
presence of unevenly and inconsistent created countries presents a central
component of flimsiness into the world arrangement of states.

Modernization appears to have two primary stages. In a measured way in its course,
it conveys the foundations and upsides of society alongside it, in what is by and large
viewed as a reformist, up development. Starting protection from modernization might
be sharp and drawn out, however it is for the most part bound to disappointment. Past
some point, in any case, modernization starts to raise discontent on an expanding
scale. This is expected to some extent to rising assumptions incited by the early
victories and dynamism of present-day culture. Gatherings will in general set raising
expectations for the local area, and these requests become progressively hard to
meet. All the more genuinely, modernization on an increased level and on a world,
scale brings new friendly and material strains that may compromise the very
development and extension on which current culture is established. In this subsequent
stage, present day cultures wind up confronted with a variety of new issues whose
arrangements frequently appear past the ability of the conventional country state.
Simultaneously, the world remaining parts overwhelmed by an arrangement of simply
such sovereign country conditions of inconsistent qualities and clashing interests. Yet
challenge and reaction are the quintessence of current culture. In thinking about its
inclination and advancement, what stands apart at first in any event isn't such a lot of
the troubles and risks as the remarkable accomplishment with which present day
culture has dominated the most significant and expansive upset in mankind's set of
experiences. The cycles of modernization and industrialization from an extremely
broad and essentially sociological perspective. It does so likewise, it ought to be
recollected, from a situation inside the very cycles it portrays. The marvels of
industrialization and modernization that are taken to have started over two centuries
prior and that were not until a lot later distinguished as particular and novel ideas have
not yet shown up at any unmistakable conclusion. The finish of the story, if there is
one, is consequently not in sight, and the topic of an extreme judgment on the nature
and worth of this immense authentic development is unanswerable.

The Indian interaction of modernization during the Freedom Movement introduced a

novel political culture because of the character of Mahatma Gandhi and his adoration
for custom. In the post-pilgrim time frame, the cycle of modernization, in India has
gone through a crucial change from its prior frontier design. Contact with the west,
especially the British, started the interaction of modernization of Indian custom. This
contact brought about an assortment of changes in Indian culture and social design.
Albeit the primary focal point of this contact was coordinated towards modernization,
it, by the by, fortified an assortment of customary establishments. "This shows the
shortcoming of accepting a flawless contrariety among custom and advancement. This
extremity might be more heuristic than genuine." But present-day social foundations
and types of social design must be presented after the foundation of British standard
in India. The demeanour of the British rulers in India were framed in a social foundation
of changed separation, deliberate social reconstruction, rise of Protestantism,
aggregate chain of advancements in science and innovation and a judicious
independence in the economy and society in Europe. Such a mentality of the rulers
and chairmen decided the course and nature of modernization in India generally. To
them, Indian culture seemed a piece of "discrete plural practices of standings, sub-
ranks and clans without deliberate restricting power of a widespread sort" Therefore
the commitment of the provincial head during the time spent modernization lay in the
production of such organizations of social construction and culture which were
"Current and container Indian".

At the underlying stage, principally during the seventeenth century, modernization of

the sub-culture started with the socialization of a little core of merchant cum-go
between in the western way. Later on, it prompted the organization of a modernization
of Great practice. Spread of new methods for correspondence and transport,
urbanization and industrialization, social changes, extension of western instruction,
and a universalistic overall set of laws were interpreted as the regulating parts of
modernization in India. As respects primary modernization, judicious regulatory
frameworks of organization and legal executive, mechanical administration and armed
force arose. Alongside them a class of political tip top and a patriot administration
additionally appeared. That separated, a class of modern specialists and the
association of worker's guilds in the western example appeared. Notwithstanding the
uniform character verbalization of patriot yearning all through the country, the
development of this modernizing interaction was specific and segmental. It neglected
to penetrate the miniature Indian social design, like family station or town local area
because of the arrangement of least obstruction of the Britishers. In the 20th century,
because of the energy assembled by the patriot development and presentation of
public electorate framework the possibility customary foundations were expanded.
The Indian process of modernization during the Freedom Movement ushered in a
novel political culture due to the personality of Mahatma Gandhi and his love for
tradition. This demonstrates the weakness of assuming a neat contrariety between
tradition and modernity. To them, Indian society appeared a composition of "discrete
plural traditions of castes, sub-castes and tribes devoid of systematic binding force of
a universal nature" Therefore the contribution of the colonial administrator in the
process of modernization lay in the creation of such networks of social structure and
culture which were "Modern and pan-Indian”. In the post-colonial period, the process
of modernization, in India has undergone a fundamental transformation from its earlier
colonial pattern. "They are: (I) The economic system (ii) The social structure (iii) The
family (iv) The role of the individual (v) The cultural system (vi) The political system.

(https://www.yourarticlelibrary.com/india-2/process-of-modernization-in-india/47428)

It is occupied with an interaction of advancement that, a long way from enhancing the
existences of its bunch native societies, compromises them with interruption, mastery
and annihilation. With a state-arranged thought of culture, the Indian improvement
measure has gotten progressively connected with state dictatorship and suppression.
This has been met with mainstream disagree, communicated in the rise of social
developments. Improvement and the State The advancement cycle in India has been
impacted, to a limited extent, by the trans nationalization of capital inside the world
economy, which has empowered both global subsidizing offices (e.g., the World Bank)
and private worldwide enterprises (e.g., Union Carbide) to convey capital and work
inside India. The Indian economy relies upon unfamiliar innovation and money to help
capital-escalated methods of mechanical and horticultural turn of events. For instance,
somewhere in the range of 1964 and 1970 India paid Rs 742 million (US $62 million)
for unfamiliar innovation; in 1979/1980 $1 billion was acquired from the World Bank to
help country and metropolitan turn of events and industrialization by predominant
Indian companies like the Birla’s and the Tatas. Therefore, the Indian state has
amassed a sizeable unfamiliar obligation with both the US and USSR and has
encouraged an improvement cycle that significantly impacts the connection between
the state and the different native societies inside its limits. The state, obviously, is
certifiably not a free reality. It is comprised of the establishments that are, thusly,
identified with the worldwide economy. Thus, notwithstanding certain outside
monetary and innovative reliance, native advancement in India is coordinated by the
prevailing classes of India's state industrialist framework, to be specific the
administrative tip top and a decision alliance of the public bourgeoisie (enormous
personal business), the military, well off worker ranchers, little merchants and cash
loan specialists. The philosophical model of improvement embraced by the state has
been extraordinarily impacted by Western methods of advancement, development and
modernization, which, partially, see country advancement as an issue of sectoral
advancement, subject to a mechanical metropolitan economy. Indian advancement
has, subsequently, followed a way of entrepreneur industrialization that has
concentrated business, assembling and development inside India's biggest urban
areas and exacerbated country destitution, prompting mass relocation to the urban
communities. For instance, Bombay's migration represents 35-40 percent of its yearly
populace development. Provincial awkward nature has accordingly been made by the
predominance of the Indian city over the locale or state where each is found. Because
of its reliance on unfamiliar innovation and money and its appropriation of Western
advancement models, India has become (like such a large amount of the Third World)
the object of a modernization interaction that has effectively unfurled in the West. The
inconsistent financial trade that exists between the high-level entrepreneur countries
and the agricultural countries has been joined by a lopsided social trade that
underlines Western qualities and debases native frameworks of information. This
Western inclination is apparent in the significance set upon innovation inside the
advancement cycle in India; it compares present day logical judiciousness and
innovation with a fruitful improvement interaction and debases non-current societies
and their customary frameworks of information. State-supported and - coordinated turn
of events and state-possessed logical information and innovation are viewed rather
than "informal" and "nonsensical" ways of life of the conventional societies of India. In
fact, as indicated by Nandy (1984), the three essential explanations behind the
presence of the advanced state in India have become the upkeep of public safety, the
execution of improvement and the securing of and resulting the executives of present-
day science and innovation. Together, these capacities have modernized and
changed the Indian economy and society. They have additionally worked with the
state's getting authority over characteristic and monetary assets; combined the force
of those coordinating and profiting with the state device; and unfeelingly obliterated
native societies with their own ethnic science and innovation, characterizing protection
from advancement as "social slack" or "bogus cognizance." The Indian advancement
measure reflects, to some degree, the connection among state and culture. Culture is
made to add to the food and development of the state as opposed to the state being
made to address the issues of the endurance and enhancement of culture. This cycle
has been highlighted as world class Indian culture has gotten progressively
Westernized, and as an exceptionally concentrated, present day country state with a
Brahminic maxim, has tried to force its vision of advancement and improvement upon
the variety of Indian culture.

Advancement as Cultural Ethnocide

The guide of India gives inauspicious demonstration of the attack on conventional

networks that the advancement interaction has induced. The Narmada River Valley
Project - a plan to assemble 30 significant dams, 135 medium dams and 3,000 minor
water system plans, extending from the Sardar Sarovar Dam in Gujarat to the
Narmada Sagar in Madhya Pradesh - will involve the submergence of 375,000 ha of
woodlands and around 80,000 ha of ripe farming and brushing lands. Not exclusively
will this lead to an irreversible loss of uncommon wild greenery yet because of the
undertaking more than 1 million individuals will be uprooted. In Orissa, the Bali pal
National Missile Testing Range will dislodge an expected 40,000 individuals. The
Bengali Dam has effectively evacuated in excess of 11,000 individuals. In Bihar, the
Koel Karo hydroelectric task undermines the vocation of around 15,000 Adivasi
families in around 100 towns. To completely grasp the ecological and social effect on
nearby networks of such uprooting, I will consider exhaustively the Bengali Dam
project, which traverses the provinces of Andhra Pradesh, Maharashtra and Madhya
Pradesh, and the Singable modern advancement program in Madhya Pradesh.
Situated in the Gachibowli region of eastern Maharashtra, the Incapably Dam project
has been embraced by both the focal and the state legislatures of Andhra Pradesh,
Maharashtra and Madhya Pradesh. This uneven, dry, intensely forested region is
occupied by ancestral societies - as indicated by the 1981 evaluation, 41.5 percent
(250,000) of the complete populace is contained planned clans. There is no
industrialization in this region and most of the populace is subject to resource farming
and the backwoods for its vocation. The structure of the dam and water system project
(in addition to the feeder dam at Bharatanatyam) will require the submergence of
100,858 ha of land (counting 40,000 ha of woodland) and 143 towns in the three
states, will give water system offices to 131,400 ha and produce around 1,885
megawatts of force. The water system offices will just monetarily profit the individuals
who own property. The clans in this locale have neither huge property to benefit from
the utilization of the water system offices nor the ability to pay for them. The majority
of the gifted and untalented work for the dam's development is being gotten from
outside the district to forestall unionization. Nearby tribals have just been nonchalantly
and briefly utilized.

Naturally and socially, the venture will cause the deficiency of incredible spans of
timberland and its related widely varied vegetation, the customary living space of the
ancestral networks. The woodlands are possessed by different clans - Madias, Raj
Gonds, Darshans and Kolam. The greater part of them practice settled development,
however a segment of the Madias, possessing the distant lots of the Barraged region,
actually work on moving development regardless of government plans to compel them
to rehearse furrow development. They are all, nonetheless, woodland inhabitants who
have occupied the backwoods for quite a long time, their financial and social life being
inseparably connected to the timberland. Improvement and modernization have
influenced the ancestral culture toy. In the first place, the exercises of business
ventures, for example, the Maharashtra Forest Development Corporation and
Ballarpur Paper Mills have carried the tribals into contact-with a money economy and
shady connections. Expanded backwoods guidelines have diminished their previous
admittance to the timberland and its items; their way of life, in view of settled
development in relative separation, has gotten progressively underestimated,
constrained by outcasts and the directs of a compensation work economy. Second,
the assessed removal of 66,000 individuals by the advancement plans will require the
evacuating of the ancestral networks and their restoration outside their customary
countries into non-backwoods’ region, for example, the Nanded area. Modernization,
in human science, the change from a customary, provincial, agrarian culture to a
common, metropolitan, mechanical society. Current culture is mechanical society. To
modernize a general public is, most importantly, to industrialize it. Verifiably, the
ascent of present-day culture has been inseparably connected with the development
of mechanical society. Every one of the highlights that are related with innovation can
be demonstrated to be identified with the arrangement of changes that, exactly 250
years prior, brought into being the mechanical kind of society. This proposes that the
terms industrialism and mechanical society infer definitely more than the financial and
innovative segments that make up their centre. Industrialism is a lifestyle that includes
significant financial, social, political, and social changes. It is by going through the
exhaustive change of industrialization that social orders become present day.
History of modernization in India

Indian society till the first part of the 20th century has been defined as a traditional
company. Following the foundation of British administration in India, modern cultural
institutions and social structures were implemented. The Western rule 'prepared the
stage' and laid down to a considerable degree the prerequisites for modernising Indian
society. The people who came in touch with the British accepted the process of
modernity in India and the contemporary social ideals. The western dominance laid
the foundation for the modernization of Indian society and provided some
preconditions.

asunder Singh says that the British leader brought about major cultural and social
changes in Indian society. Modernizing the subculture has started with the
socialisation in the west of a tiny commerce district, he said. It resulted in a
modernising institution that extended communications and transport means, industry,
social changes and a universal legal system. The timeline of Indian modernity spans
from India in the pre-colonial period to India after independence, when India became
a potential modern country. It was not until the first half of the 20th century that Indian
society was described as a traditional society. Social interaction and behaviour are
based on social values. Every change in social structure or social system also occurs
with changes in social values. Therefore, to understand the modernization process in
India, one must understand the traditional social values in the Indian context. The
patriarchal society in India was considered from the beginning and has undoubtedly
been accepted for centuries. The power of social and religious life. Under equal
conditions, women are regarded as inferior and unequal. Utilitarian customs and
traditions. Literacy and ignorance are the main characteristics of Indian society. The
economy is simple and the economic productivity is relatively low. Indian society
originated from agricultural activities. India's Modernization Process and
Contemporary Social Values With the arrival of the British, they began the
modernization process in India, and people accepted them. Since the beginning of the
17th century, India has been under Western influence. After the establishment of
British rule, modern cultural systems and social structures were introduced into India.
The British rulers in India led to social class changes, social reforms, The cumulative
innovation chain of Protestantism, science and technology, and the "individual" rulers
and managers of economic and social rationality determine the process and nature of
India's modernization. Requirements for modernization of Indian society. The British
rulers brought profound changes to the cultural and social structure of Indian society.
India’s modernization process and contemporary social values. Since the beginning
of the 17th century, India has been continuously influenced by the West. After the
establishment of British rule, modern cultural systems and social structures were
introduced into India. The relationship of the British rulers in India was formed under
the social background of class change, social reform, the emergence of Protestantism,
the cumulative chain of technological innovation, and the rational "individualism" in the
economy. This attitude of rulers and managers largely determines the process and
nature of India’s modernization. The cultural and social structure of Indian society in
the initial stage of modernization, the 17th century in the 20th century, the
modernization of subculture began with the socialization of Western-style small
middleman centres. This later led to modernization, expanding the means of
communication and transportation, industrialization, social reforms, and Western
expansion. Education and the general legal system are considered to be the normative
components of India’s modernization. The national bureaucracy of government and
justice, industrial bureaucracy, and military emerged, known as the understanding of
Western education has created a new political culture and nationalist tradition;
administrative and national defines needs have become more complex, leading to an
increase in bureaucracy and a modern army; and cultivation techniques; education
has created a new technology and profession for the middle class and knowledge
structure. These modern structures are unified throughout the country. The country
has gone through a difficult stage of economic and political development.
Impacts of modernization on health sector

The public health system in India despite growing investments in every national 5-year
plan and even after over 65 years of its functioning, has not yet delivered universal
primary healthcare to the citizens of India. This article argues that it is necessary to
urgently reform the content of public health system and make it more pluralistic.
Medical pluralism in India is especially relevant because of the richness of India's
Medical Heritage which offers a unique opportunity to integrate across 5 traditional
systems of healthcare. A new national policy 2015 to replace the last policy formulated
in 2002 is on the anvil. The 3 tiers operate through a large number of Government,
that is, taxpayer financed, primary secondary and tertiary healthcare institutions and
a larger number of private institutions and a much smaller number of private
organizations. At the base of the pyramid of the health system, are the primary
healthcare institutions in the form of dispensaries and small-sized general hospitals.
A substantial number of them are in the government-sector, but they have a larger
presence in the private sector. Higher up the pyramid are the secondary institutions
(like district and private hospitals) and at the top are the tertiary services provided by
few well-equipped medical college hospitals and mostly by corporate super specialty
establishments. Experts have identified a host of operational issues and gaps that
plague the public health system. These relate to inadequate infrastructure, financing,
human resources, drugs, HR policies, health information system, insurance and
governance.[1] It is therefore in need of radical reform. The government is aware of
the gaps in the functioning of the public health system as is evident from official
reviews prepared by the Planning Commission. While the gaps do get addressed from
time to time, through various schemes, the reform happens in the typical piece-meal
fashion that characterizes government interventions. The officially declared goal of the
public healthcare system is free and universal primary healthcare. However, even after
66 years around 70% of the population do not receive satisfactory or free primary
healthcare and they are therefore forced to seek help from private providers and thus
pay out of their own pocket.[2] Public health experts in recent times have observed
that safe drinking water, sanitation, nutrition, lifestyle, and the environment are key
determinants of health and that the health system must address these basic needs. In
practice however, the health system does not appear to have any influence,
mechanism or programs, to address these key determinants of health because water,
sanitation, nutrition, environment are domains managed by ministries other than the
health ministry. The "content" of India's post-independence health system is mono-
cultural. In fact, 97% of the national health budget, since 1947 has been allocated to
Allopathy. Post-independence, the idea of integrating and mainstreaming seven other
legally sanctioned health systems with Allopathy has been mentioned in the
introductory paragraphs, of all national 5 years plan and policy documents. In practice
the eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Sowa-ripe, Unani,
Yoga, Naturopathy, and Homeopathy function in silos. The seven AYUSH systems
receive only 3% of the national health budget and the departments of AYUSH across
all Indian states operate with this meagre funding.[3] The AYUSH department despite
their limited funding, operate a parallel national health service, unconnected to the
mainstream 3 tier health system, with around 24,000 dispensaries and 3000 small
general hospitals, across 30 states.[2] The AYUSH public health services are planned
and managed by the departments/directorates of AYUSH at the centre and states. The
planning and administrative machinery for AYUSH is distinct from the Departments of
Health and Family Welfare that plan and administer the mainstream public health
system, and thus AYUSH services are not aligned to national health priorities. They
are mostly at the level of primary care. The official AYUSH budget has sub-critical
allocation for extramural research, education and for regulation of safety and quality.
This is the reason why the AYUSH systems during the last 60 years have hardly
generated any evidence-based clinical, pharmacological or pharmaceutical outputs
and also the reason why the regulatory system is ineffective. The reason for doubt is
because the mainstream schools of sociology have posited the modern and traditional
as opposites. In fact, historical analysis of European modernity as a case study, clearly
reveals that the roots of modernity lie in tradition (just as the roots of the present lie in
the past) and that in effect modernity is evolving tradition. Due to the recent history of
colonialism, the colonized nations were led to believe that they needed to import
modernity from their colonizers. But the colonial era is long over and in modern,
independent nations it is essential for civil society and polity to realize that
modernization of all societies must derive inspiration from their own traditional roots.
While import and knowledge exchange, across different cultures, is desirable in a
globalized world, neglect of one's own knowledge traditions, when they are of
contemporary value is suicidal. India can be a world leader in this new emerging field
of "integrative healthcare" because we have over the last century or so assimilated
and achieved a reasonable degree of competence in biomedical and life sciences and
we possess an incredibly rich medical heritage of our own. The reason for doubt is
because the mainstream schools of sociology have posited the modern and traditional as
opposites. In fact, historical analysis of European modernity rooted in classical Greek tradition,
clearly reveals that the roots of modernity lie in tradition (just as the roots of the present lie in
the past) and that in effect modernity is evolving tradition. Due to the recent history of
colonialism, the colonized nations were led to believe that they needed to import modernity
from their colonizers. But the colonial era is long over and in independent nations it is essential
for civil society and polity to realize that modernization of all societies must derive inspiration
from their own traditional roots. Despite massive investments over the last almost 65 years, it
has not delivered even universal primary healthcare.[1] Health seeking behaviour studies
reveal that the citizens of the world also recognize the limitation of a mono-cultural health
system and are therefore exercising alternative choices.[14] The moot question before the
Indian polity is, should the country further increase investment into a singular system of
healthcare or should at this point of time India innovate and diversify its health system by
evolving a new integrative healthcare system in the 21st century. It makes sense, in the 21st
century fora national government sensitive to social realities of public health seeking behaviour
which is already exercising pluralistic choices, to expand the scope of the wholly western
medicine content of health care and refine it by deriving strategies, content and form, from our
own traditional knowledge systems. India has had rich experience in managing healthcare for
centuries in the longest surviving, and evolving health tradition in the world. The total global
estimate of Allopathic formulation is of the order of 4000. In the short run, it is necessary to
shed unrealistic demands for immediate presentation of a large amount of clinical evidence
about AYUSH systems. The reason evidence is not available is that the State has for the last
200 years not invested in the creation of such evidence. The budget estimates for 2014 2015
of AYUSH Department of Government of India suggest that even in 2014 the extramural
research budget of AYUSH is < Rs. We need to select prioritized interventions, selected by
AYUSH experts for introduction into the newly named National Health Assurance Mission and
into the 3-tiered public health system. Thus, the first step towards extending the social reach
of healthcare in India is to urgently reform the existing 3 tiers of the public health system by
infusing AYUSH content and Hrs. This is a complex exercise as can be seen from the fact that
although NRHM had the plan and strategy of co-location and co-posting, it has not worked
because no homework was done to bring about the integration of health content derived from
the different Indian systems of medicine.[16] The lesson to be learnt from 9 years of NRHM is
that a new national integrative, public healthcare system not only needs logistical moves like
co-location and co-posting but serious clinical exercises for identifying specific AYUSH
interventions, orienting medical personnel in their use, developing protocols and cross referral
guidelines and such operational details. The AYUSH interventions have to be selected for
health services at primary, secondary and tertiary levels. In the 21st century, an integrative
model for public health needs a 10-year budget, a detailed action plan, and strategy, in order
to achieve this complex goal. A second radical step toward modernization of health care in
India is to invest in and use its heritage to restore two more traditionally available tiers at the
bottom of the pyramid to enrich the health system and demonstrate the efficacy of a uniquely
Indian, participatory public health system. These community-based and supported layers were
existing until the beginning of the 20th century and are still functioning in eroded fashion. They
have been overlooked and neglected in India since the country embraced the western model
of public health. They will add millions of new health providers to the public health system at
zero recurring cost. These tiers are to be managed, as was the case for centuries, by millions
of households and traditional community-based health workers. Traditionally, the Indian
households were carriers and providers of healthcare to the family. Till recently, the Indian
households possessed knowledge of at least a 100 home herbal remedies, nondrug health
practices and food and nutrition. The creation of this household tier to the public health system
will require critical investment in a creatively designed, Information and Communications
Technology enabled health education strategy, for reaching millions of rural and urban
households. The second additional tier to be introduced in a modern Indian healthcare system
is also a noninstitutional tier managed by community-based and community supported
traditional health workers. These workers are based in the villages of India. The momentum
of these part-time traditional health workers needs to be restored. The first step for restoration
is to certify, accredit, and enrich the knowledge and skills of existing folk healers. The
community support base of the 1 million traditional health workers needs to be reinforced and
care taken to avoid making them dependent on government support for their services to the
community. The next step will be to motivate a new generation of folk healers to replace the
older and ageing currently available generation.

(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4395927/)
Health sector of Maharashtra

Maharashtra is a State which occupies a significant chunk of the Deccan plateau in

the western peninsular area of India. It is the second-biggest nation and the third
biggest by region in India. The State covers the entire territory in India of 307,731 km2
or 9,84 percent (118,816 sq. mi). It is also the second-largest subnational entity in the
world. Maharashtra is surrounded by the Arab Sea in the western part of Slovenia,
Nagesh and Dares in the northwest, Nagar Haveli in the northern part by the Indian
states of Karnataka and Goa in the south, Telangana and Chhattisgarh in the east.
On 1 May 1960, Maharashtra Day remembers the development of the Bombay State
division in Maharashtra. Maharashtra Day is often connected with parades and
political addresses as well as with services which cannot resist many private and
public events adulterating Maharashtra history and customs.
Maharashtra is one of the largest states in the country and is also among the best
economically developed states.

Healthcare Scenario of Maharashtra

A variety of medical and paramedical institutes have been established to satisfy the
needs of healthcare workers, including Ayurveda, Yoga & Naturopathy, Unani, Siddha
and Homeopathy (AYUSH). Maharashtra consists of 10,580 subscribers, 1,814 PHC,
360 CHC. On the basis of data from registered physicians, the estimated population
in the State of the physician is 1:1.365. Reproductive and Child Health Program (RCH)

In order to improve child health, and stabilise the population, the MMR, infant mortality
and total fertility rates are being cut down (TFR). Under the scheme, 453,20 crore
expenses during 2015-16, 459,01 crore expenses during 2016-17 and 207,86 crore
costs during 2017-18 were incurred up to December.

In Maharashtra for the prevention, diagnosis, treatment and control of vector illnesses,
national Vector Borne Disease Control Program is being implemented. No. In 2017-
18, fatalities were recorded as follows:
Challenges
Based on the increasing costs of medical attention, Maharashtra needs to boost its
expenditure on health to around Rs 74 billion by 2018. With the increasing
urbanisation, however, the expanding healthcare expenditures must also be taken into
account. In order to overcome public health and medical facilities and to cover the
gaps in skills of vacant workers in rural hospitals and other centres as well as PHCs,
Maharashtra's health budget has to be a bit more ambitious.
Top Government Hospitals in Maharashtra
King Edward Memorial Hospital
The King Edward Memorial Hospital (KEM), located in Mumbai, is the earliest medical
education and healthcare institutions in India. The hospital has 1800 beds, 400 staff
doctors, over a lakh hospital and 2 million external patients built someplace in 1926.
Service is free for most disadvantaged persons in society. The Municipal Corporation
of Mumbai principally supports the hospital, offering students, postgraduates and
super specialised courses for young health enthusiasts. In India, the King Edward
Memorial Hospital is India's first full-service Indians' Medical College.
Lokmanya Tilak Municipal General Hospital
Lokmanya Tilak Municipal General Hospital is a 1462 bedded hospital located at Sion,
Mumbai. This hospital was established in 1947 & Lokmanya Tilak Municipal Medical
College was started in 1964. It is affiliated by Medical Council of India.
Sasson General Hospital
Sasson General Hospital was established in 1867 and is located in Pune. The B. J.
Medical College is located at the hospital. There are 1296 beds at the hospital. The
hospital meets the requirements of urban and rural patients in Pune. It is also an
important centre for reference in many neighbourhoods.
Deenanath Mangeshkar Hospital
Hospital and Research Centre Deenanath Mangeshkar is a multi-speciality, charity
hospital in the centre of Pune. The hospital was established in 2001 and is presently
one of the biggest in Pune. It has 6 acres with 800 sleeping accommodations.
Wadia Hospital
Nowrasteh Wadia Maternity Hospital is a 305-bedded Mumbai hospital. The
Nowrasteh Wadia Maternity Hospital focuses on providing women in all areas of
society with inexpensive obstetric and gynaecological treatment. The best promising
maternity hospital is honoured in 2015 and the Maternity Care International Quality
Achievement Award 2016.

Bombay hospital
The 725 Bedded Hospital in Mumbai is Bombay Hospital. Shri Nowrasteh Birla was
established in 1950.

Jaslok Hospital
Jaslok Hospital is a private, full-service 364 bed hospital. The Philanthropist Seth
Liposomal Chanara and Surgeon Shantell Jamadars Mehta created Jaslok Hospital
and Research Centre in Mumbai. On 6 July 1973, the hospital was officially opened.
It is accredited by NABH, too

Nanavati Super speciality Hospital

The 350 bedded hospitals in Mumbai are Nanavati Super speciality Hospital. The
Hospital of Nanavati features state-of-the-art systems. Actually, around 350
consultants, 100 physicians, 475 staff members.

Lilavati Hospital
Lilavati Hospital and Research Centre is a private hospital located in Mumbai. The
hospital was established in 1978 by the Lilavati Kirill Mehta Medical Trust. The hospital
was started functioning in 1997 with 10 beds and initially had only 22 doctors. Today,
it boasts of 323 beds with one of the largest Intensive Care Units (ICUs), most
advanced 12 Operation Theatres, more than 300 consultants and manpower of nearly
1,800.
Fortis Hospital
Fortis Hospital, Mulund is a JCI accredited, 300 bedded Theatres tertiary care hospital
providing a range of diagnostic and treatment services. They provide service across
India including Mumbai, Navi Mumbai, Mumbai Suburban’s etc.

Top Diagnostic Centres in Maharashtra

Thorofare General Diagnostics
Thorofare Technologies Limited, Navi Mumbai, is a chain of precautionary diagnostic
laboratories. There are 1,122 stores in India and portions of Nepal, Bangladesh and
the Middle East. A former scientist of Bhabha Atomic Research Centre (BARC),
Mumbai, Maharashtra, created Thorofare in 1996.

Metropolis Labs
With its MBAI central laboratory in Maharashtra, Metropolitan Labs is a chain of
diagnostic enterprises. There are 106 clinical laboratories in Metropolis Healthcare
and 1130 collectibles across seven countries including India. The firm was established
in 1980. Dr Sushil Manubhai Shah established Metropolis in 1980

SRL Diagnostics
SRL Diagnostics is an India based diagnostic firm providing pathological and
radiological diagnostic services. With its operations in Mohali, New Delhi, and Mumbai,
SRL Diagnostics has its head headquarters in Gurugram. The organisation has over
368 network laboratories, including four reference laboratories, four centres of
excellence, 26 radiology/imaging centres, 39 NABL accredited laboratories, four CAP
certified laboratories and more than 5600 collection sites throughout India. It also has
huge laboratories in Dubai, Sri Lanka and Nepal and over 70 collecting stations in
different nations in other nations outside India.
Medicare Institute of Diagnostics
Four decades of experience in the health business is at Medicare Institute of
Diagnostics. The newest technology in the areas of PET-CT, nuclear medicine,
radiology and pathology is adequately equipped. It is the sole facility of this type
between Parel and Pune in which a person may perform simple blood tests for the
entire body to more specific examinations such as PET-CT. The Medicare Institute of
Diagnostics as members of the faculty include some of the best internationally
qualified doctors from Mumbai's premier hospitals. It is a patient-friendly facility with
enough parking space and more than 10,000 ft2.
(https://hhbc.in/healthcare-scenario-of-maharashtra/)

In the primary sector (food grains, irrigation etc.)

In physical infrastructure (roads, banks, communication etc.)
Despite this, in terms of income, Maharashtra is close to the top now with its per capita
income nearly equal to that of Punjab (we are not counting Delhi and Goa), this is
largely due to Mumbai’s contribution.
As a consequence, the Infrastructure Development Index score (CMIE) is not among
the highest in the country, well behind Punjab, Kerala, Tamil Nadu and Haryana.
The literacy rate is 77.3 per cent (86.3 percent for males and 67.5 per cent for
females), which is higher than the national average.
Maharashtra State has played a leading role in the development of health care in India.
Facilities in the healthcare industry range from basic to advanced healthcare services,
both public, commercial and voluntary. The purpose of public health services is to
provide the population with dependable, accountable, appropriate, quality and
preventative health care with a focus on better mother and child health. In addition,
facilities of public health, especially for tribal and rural populations, are supplied in
response to local demands. Healthcare has become one of India's largest sector, both
in terms of revenue and employment. The Government, i.e., public healthcare system,
comprises limited secondary and tertiary care institutions in key cities and focuses on
providing basic healthcare facilities in the form of primary healthcare centres in rural
areas. The cost of surgery in India is about one-tenth of that in the US or Western
Europe. With increasing demand for affordable and quality healthcare, penetration of
health insurance is poised to expand in the coming years. 5% share in the total gross
written premiums earned in the country. Some of the recent initiatives in the Indian
healthcare industry are as follows: As of May 04, 2021, >15. 100 crore debts in 1mg,
the online medicine start-up, and was in the final stages of acquiring a controlling stake
in the company. In April 2021, the Ministry of Aayush and Council of Scientific &
Industrial Research completed multi-centre clinical trial of a AYUSH 64 and found it
useful for treatment of mild-to-moderate COVID-19 infections. 75 million in February
2021 in March 2021, Union Health Minister Harsh Vardhan informed the Rajya Sabha
that 157 medical colleges are under various stages of implementation across India. Of
this, 58 colleges are in the first phase of implementation, 24 in the second phase and
75 are in the third phase. In March 2021, gross written premiums of health insurance
companies in the non-life insurance sector increased by 41% YoY to Rs. In March
2021, Virchow Biotech, a Hyderabad-based firm, and the Russian Direct Investment
Fund announced a collaboration to manufacture up to 200 million doses of the
Sputnik V vaccine in India. In February 2021, India approved the commercial supply
of 24 million doses of COVID-19 vaccines to 25 countries, more than 2x the 10. In
February 2021, the Competition Commission of India approved acquisition of Varian
Medical Systems, Inc.by Siemens Healthiness Holding I Gab. In February 2021, the
Minister for Commerce and Industry of India, Mr. The Ministers also welcomed
enhancement of bilateral health cooperation between the two countries, such as on
vaccines, which is allowing India to serve as a global source of strength in overcoming
COVID-19-imposed challenges. Government Initiatives Some of the major initiatives
taken by the Government of India to promote Indian healthcare industry are as follows:
In March 2021, various states and UTs started implementation of the 'Intensified
Mission Indradhanush 3. This is aimed to accelerate the full immunisation of children
and pregnant women through a mission mode intervention. In March 2021, the
Parliament passed the National Commission for Allied, Healthcare Professions Bill
2021, which aims to create a body that will regulate and maintain educational and
service standards for healthcare professionals. In the Union Budget 2021, investment
in health infrastructure expanded 2. 64,180 crores outlay for the healthcare sector
over six years in the Union Budget 2021-22 to strengthen the existing 'National Health
Mission' by developing capacities of primary, secondary and tertiary care, healthcare
systems and institutions for detection and cure of new & emerging diseases. In Union
Budget 2021-22, the government announced its plans to launch 'Mission Poshan 2.
The Government of India approved continuation of 'National Health Mission' with a
budget of Rs. In the Union Budget 2021, the Ministry of AYUSH was allocated Rs.
Road Ahead India is a land full of opportunities for players in the medical devices
industry. With the increase in the competition, businesses are looking to explore for
the latest dynamics and trends which will have positive impact on their business. The
hospital industry in India is forecast to increase to Rs.8. The Government of India is
planning to increase public health spending to 2. India's competitive advantage also
lies in the increased success rate of Indian companies in getting Abbreviated New
Drug Application approvals. To sum up, there are vast opportunities for investment
in healthcare infrastructure in both urban and rural India.
Health sector of Bihar

In 1950, after Uttar Pradesh, Bihar was also classified as India's second largest
administered state. 2 Since then, the situation in Bihar has deteriorated for a number
of reasons, but a few silver linings have been seen in recent years. Its performance in
every human development category has decreased substantially in recent decades
(IIPS 2007-08; NFHS-3). It is now one of India's most undeveloped countries. Most of
Bihar's socio-economic metrics such as income per capita, health public spending,
literacy, the ratio of gross enrolled females to age, pregnant women's vaccinations and
new born baby’s Institutional delivery rates, child malnutrition, proportion of people
with access to the bathroom etc are much below the national norm (Government of
India 2011; PFI 2007; World Bank 2005). The low level of socio-economic variables
tends to impact the available health provisions and their accessibility that in turn
influences health conditions and the behaviour of the people searching for health. On
the one hand, Bihar has the largest population increase (Indian government 2011) in
the country, and therefore demands are on the rise for all services, including crucial
health care. If the system of public health does not offer essential healthcare. Some
regions of India (for example, Kerala) have achieved human development indicators
close to that of the developed western world, while a few states like Bihar still have
their human development indica-tors closer to the underdeveloped regions of the
world.
and a population of 103.8 million (Government of India 2011) in which the male and
female populations are 54,185,347 and 49,619,290 respectively.
Bihar is divided into nine admin-iterative divisions, 38 districts, 101 sub divisions, 534
blocks and 44,874 revenue villages.
The decadal population growth rate of Bihar was 25.1 per cent against 17.6 per cent
for the country and therefore, the population of the state continues to grow at a much
faster rate than the national rate (Government of India 2011) Though the number of
statutory/can-sus towns in Bihar increased from 130 to 199 during 2001 and 2011, the
rate of urbanization in Bihar increased by only 0.8 per cent, from 10.5 per cent to 11.3
per cent. Poor urbanization data speaks volumes about the underdevelopment of a
State, especially about poor rate of industrialization resulting in very small dependence
on organized manufacturing and service sectors and therefore heavy dependence on
agriculture mostly in the form of under employment and hidden unemployment. As far
as higher education is concerned, Gross Enrolment Ratio (GER)4 of Bihar is among
the lowest in India.Other than the inter-regional dichotomy in the developmental
process of the state, the social category wise developmental indicators and health
status are also the poorest among the eastern states. The State of Bihar, after
Jharkhand being carved out of it in 2001, has an area of 94,163 skyman a population
of 103. For the first time in 2011 Bihar's density of population reached highest among
all the 28 states of India. 6 per cent for the country and therefore, the population of the
state continues to grow at a much faster rate than the national rate. 3 per cent of the
total population in Bihar. Though the number of statutory/can-sus towns in Bihar
increased from 130 to 199 during 2001 and 2011, the rate of urbanization in Bihar
increased by only 0. This gets reflected in the per capita income of the State and
population living below poverty line. Another very important indicator of human
development, that is, literacy rate, in the 2001 census Bihar had only 47 per cent
literacy, which increased to 64 per cent in 2011, while for India it was 65 per cent and
74 per cent respectively during the reference period. Bihar has the lowest number of
educational institutions per million population in the country. In terms of degree
colleges for science, arts and commerce, Bihar has just 73 institutions per million
population, whereas at the all-India level it the average is 105 institutions.
. The state of health in India is not adequate and satisfactory even after six decades
of independence. The National Commission on Microeconomics and Health reported
that out of the total expenditure on health, households undertook nearly three-fourths
of all the health spending in the country. In the case of Bihar, the condition is even
worse, which is mostly indicative by look-Ing at the health-related indicators of the
state and comparing the same with the national average. Though the status of health
services in Bihar is still inadequate, substantial improvements have been recorded in
this sector in recent years. One of the 'neglected diseases' of the world, kala-azar,
which is preventable with a little focus on health educational practices and economic
upliftment, makes heavy sickness, loss of active human resources and mortality take
its toll in Bihar. The incidence of kala-azar in India is among the highest in the world.
As per the World Health Organization estimates some 350 million people in 88
countries are at the risk of developing kala-azar and about 500,000 people suffer from
it, out of which 165 million people are estimated to be at risk in India; the reported
number of cases is around 20,000 and the number of deaths is about 200 per year.
About 90 per cent of these patients are poor and live in the rural areas of Bihar. CBR
in Bihar was recorded considerably higher than the national average, and contrary to
that CDR in the State was margin-ally better than the national average by 2009.
Therefore, having more births and less deaths as compared with the national average
is the basic reason of high population growth in Bihar. In spite of being the
Development in Bihar 419Journal of Health Management, 15, 3: 415 430poorest state
in the terms of per capita income and having the least literacy rate, the IMR in Bihar
was 52 per thousand live births in 2009, close to the national average of 50 per
thousand live births. This pace of decline was higher for Bihar, as the IMR for Bihar
decreased from 61 in 2005 to 52 in 2009. In the case of Total Fertility Rate, which is
the average number of children expected to be born per woman during her
reproductive period, Bihar lags far behind the national average. TFR of Bihar is the
highest in India, though it has improved from 4. Nearly two-thirds of women in the
child-bearing age are malnourished in the State, the highest in the country. These
indicators are closely related to and dependent on literacy of women and their
awareness levels, as mentioned in the first section; female literacy is also the lowest
in Bihar. As in Bihar female literacy is the lowest in India the obvious effect is reflected
in the current contraception use. According to the District Level Household Survey
(DLHS-3, Government of India 2008), some of the primary health indicators of Bihar
are alarming when compared with the national average. Nearly 46 per cent girls were
married in Bihar before they attain 18 years of age and nearly 65 per cent of the
currently married women in the state were illiterate. As the female literacy rate of Bihar
is already the lowest in Table 2. 7 per cent and only 41 per cent children in the 12 23-
month age had received full immunization. The Coverage Evaluation Survey
conducted at the national level revisited some of the key indicators which were
covered in the DLHS-2 and DLHS-3 surveys, and it found a marginal to considerable
improvement in the maternal and child health indicators of Bihar. Defecation of human
excreta in the open leads to serious health risks in the form of Table 3. As per DLHS-
3 data, in Bihar only 17 per cent of the population had toilet facilities, while the rest
were defecating in open. Because of the poorest availability of toilet facilities and the
highest population density among any state.in Bihar, health risks related to the same
are apparent from the large-scale cases of diarrhoea deaths among infants. Bihar
records one of the highest sickness and deaths among infants due to diarrhoea, as
the Bihar Health Society Table 4. Similar is the situation as far as the health status of
the people in Bihar is concerned. The primary causes of poor health and health-related
daily practices in Bihar are poverty and social deprivation, low literacy rate especially
female literacy, and structural inequalities in terms of class, caste and sex. It may take
few decades before Bihar catches up with the rest of the country, when the high growth
in GDP is maintained and translated into better health status of its population and
human development. To achieve comparable human development in Bihar, the
provision of better availability and accessibility of public health care facilities will need
special attention.Health is a subject in the concurrent list of Indian constitution, which
means that the union and the state governments both exercise their legislative,
executive and financial authority over the health subjects. The Indian Public Health
Standards is the nodal system followed by the Government of India and state
governments to regulate and strengthen the public health delivery network in India.
IPHS is a set of standards envisaged to improve the quality of health care delivery in
the country under the National Rural health Mission which started in 2005 for a period
of seven years till 2012. The Ministry of Health and Family Welfare, Government of
India recognized that the health care system in India had expanded considerably over
the last decade. Hence, the Mohawk introduced the IPHS in order to improve the
quality of public health levels, with the commencement of the NRHM when the state
expenditure on health was to increase considerably at the recommendations of the
National Health Policy 2002. The sub-centre is the most peripheral health institution
catering for the health care needs of the rural population. In practice two-thirds of the
PHCs in Bihar are in fact APHCs, and they are no better than a sub-centre. APHCs
are attached with the PHC of a particular block and subdivision and there is no
separate appoint-mint of doctors and paramedics for the APHCs. A part of the existing
human resources at the PHC is deputed to provide a few hours of their service to the
APHCs without having sufficient infrastructure in place. Growth of public health
infrastructure in Bihar has not been in congruence with the growth in population and
demand for public health services especially in the last few decades. The
infrastructural and human resource gap is huge, which is reflected in the periodical
reports published by the Rural Health Statistics Division of the Mohawk, Government
of India. The required estimation of health infrastructure is based on the population
estimates of the 2001 census, where the shortfall of sub-centres, PHCs and CHCs
was 41 per cent, 34 per cent and 89 per cent respectively. The gap is substantial in
sub-centres, PHCs, and very large in the case of CHCs along with a shortage of
human resources, drugs and equipment for primary health care in the state. The
information in Table 7 gives a detailed picture of the requirement, availability and
shortfall in health infrastructure and human resources employed for managing the
health services as per IPHS norms. There is a shortfall of nearly a half to three-fourth
of doctors, technicians and paramedical staff at the referral hospitals in the state. On
government records usually most of the mentioned services are shown available, but
in reality, adequate and timely availability and accessibility of these services for the
ordinary population remains in question. A good number of sub-centres and APHCs
run-in far-flung areas and from rented rooms without having any facilities for the
accommodation of support staff. The above structure of the public health delivery
system is a standard one throughout India, though its actual implementation has varied
from state to state. For example, the IPHS has no guidelines about Additional PHCs,
and in practice all APHCs should have all standards and facilities of a PHC. In practice
two-thirds of the PHCs in Bihar are in fact APHCs, and they are no better than a sub-
centre. APHCs are attached with the PHC of a particular block and subdivision and
there is no separate appoint-mint of doctors and paramedics for the APHCs. A part of
the existing human resources at the PHC is deputed to provide a few hours of their
service to the APHCs without having sufficient infrastructure in place. Growth of public
health infrastructure in Bihar has not been in congruence with the growth in population
and demand for public health services especially in the last few decades. The
infrastructural and human resource gap is huge, which is reflected in the periodical
reports published by the Rural Health Statistics Division of the Mohawk, Government
of India. \There is a shortfall of nearly a half to three-fourth of doctors, technicians and
paramedical staff at the referral hospitals in the state. On government records usually
most of the mentioned services are shown available, but in reality, adequate and timely
availability and accessibility of these services for the ordinary population remains in
question. A good number of sub-centres and APHCs run-in far-flung areas and from
rented rooms without having any facilities for the accommodation of support staff.

https://www.researchgate.net/publication/274990930_Development_in_Bihar_Predic
aments_and_Prospects_of_Health_Indice)
Bihar's failure to provide decent health facilities is due to a variety
of factors.

A joint study published by the health society and UNICEF argues that the health
services in Bihar are distressing. The research states that the infrastructure of health
institutions is significantly weaker and that the health services are in disarray. Rural
residents are struggling to even obtain fundamental health services. The health
secretary has stated that some years ago funding was given, but they were not
delivered to the Building Construction Corporation. The number of primary health
centres in the state necessary is 2489 but now only 533. There is a deficit of 78
percent. Similarly, 622 hospitals are necessary but only 70 hospitals are available. A
Although 101 subdivisional hospitals are required, only 22 are available in the state.
In the joint report, there is a district hospital not all 38 districts and just 25 districts. In
the event of additional health centres, the situation is not better, while only 1,243 are
required in 2 787 such centres. Bihar only has 6 medical universities but at least 18
medical universities are needed. Bihar also has an extreme scarcity of medical and
paramedical staff, with a severe deficit. Doctors are 46% deprived, 30% of ANMs, 54%
for nurses and 57% for healthy woman visitors in various depots.

In what could be perceived as a disturbing trend, vaccination in rural Bihar has been
adversely affected due to casteism. According to the recent survey report, which was
prepared after an on-the-spot study in 14 villages of Bihar's nine districts, several
instances of "caste discrimination" have come to fore. For instance, such was the
social divide in a Rotas village that vaccinations could not take place either in
Brahmin's tola or Paswan's tola simply because the Brahmins refused to go to the
Paswan tola, or allowed them to enter their area. All this, when the vaccination had to
take place at the angina centre. Equally disturbing was the trend at Chamaun village
in the Madhubani district where Paswan children were summoned only when there
was an inspection, although the head count was regularly maintained. Similarly, the
cast of "Asha workers" (accredited social health activist) too played a role in non-
inclusion of poorer groups in the social welfare programmes. While, the Asha workers
are key functionaries and integral part of the rural health system related to deprived
sections of the society, it was found in the study that they received cooperation
depending on their own caste. Surprisingly, in the Chamaun village, upper caste
Rajput and Yadav women had no inhibitions in admitting that they did not cooperate
with the Asha workers because they belonged to lower castes. Notably, it's the Asha
workers who, of late, have replaced village mid-wives and play a crucial role in child
delivery. The report, prepared by the Institute for Development Research, however,
has something positive to suggest. Villagers now look for institutional deliveries and
believe that hospitals are much safer place to give birth. Under the Centre's ambitious
scheme - "Janani Suraksha Yojana", institutional deliveries have escalated from 8,
38,481 in 2007-08 to 11, 43,039 in 2008-09. The saving grace, as per the report, is
that there is no caste discrimination at the primary health centres.

(https://www.sociologyguide.com/surveys-and-reports/status-of-healthcare-services-
in-bihar.php)
Conclusion

For the poor health status of Bihar, availability, accessibility and affordability of the
public health service delivery system for common people holds prime importance.
Second, the most important factors are lack of general education and awareness of
health concerns in the community, especially among women who are the primary care
givers in the family. The awareness level of men is also a concern, given the fact that
they often control household finances and determine whether and which kind of health
treatment is sought. The NFHS-3 revealed that in general, only a minority of fathers
with a child less than three years of age were provided information related to maternal
care. Only one-third were told about the importance of proper nutrition for the mother
during pregnancy and one-fourth were told about the importance of delivering the baby
in a health facility. Therefore, education is understood to be closely linked with a
community's health concerns and awareness of preventable health challenges.
Communities with poor education levels are likely to have lower awareness about
public health challenges, which may result in a higher incidence of preventable
diseases. Bihar constitutes nearly 10 per cent of the national population and with
higher population growth as compared with other states; this percentage would be
going up in successive census. Hence, the case of Bihar is a very significant one as
its poor performance on most of the socio-economic indicators would eventually keep
on affecting the national developmental indicators. Though India is likely to be more
numerous, better educated, healthier and more prosperous than at any time in history,
a vibrant India with comparable regional development will be only possible when a
poor performing state like Bihar gets its share of adequate opportunity, investment and
innovation. When high population growth would not mean burden on resources, rather
it will open up new vistas for trained human resources who will further contribute to the
developmental process of the State and the nation. As Amartya Sen says that
development in real sense should mean expansion of opportunity to every citizen in
education, food security, health, sanitation, water and other services with equity and
justice irrespective of gender, caste, religion or language. To achieve the desired
health status in Bihar, it is necessary that a multi-faceted approach of develop-mint is
adopted. It includes developing physical infrastructure for providing health services as
per rising population and growing demand for quality services. Physical infrastructure
has two components, one is the opening up new health facilities and reviving and
maintaining the dilapidated ones, another is providing adequate equipment, laboratory
facilities and other support services especially at the first level of referral hospitals and
24x7 PHCs. Appointing adequate and quality human resources in the existing and
new health infrastructure coming up, which is at present grossly mismatched and
sanctioned positions are vacant from 50 per cent up to 80 per cent that includes
doctors, technicians, paramedical staff and other support staff. The service approach
should be brought into the health care delivery system and dependable services
should be provided through static health facilities, mobile and outreach health facile-
ties, and also through latest IT enabled services like telemedicine. The state should
also play a key role in bringing behavioural changes related to health through health
educational programmes. It needs a right blend of a targeted approach through an
information education communication means, which should involve health specific
curriculum at the level of schools, behavioural change communication strategy for
social mobilization at various levels for better health outcomes involving Panchayati
Raj Institutions, civil society, public health institutions and other stake holders. As we
know public expenditure on health care in India is only 25 per cent of the total
expenditure and in case of Bihar it is even lower. Hence, the private sector health care
has a larger share in the health infrastructure and reach. Therefore, the state should
exercise its regulatory approach to ensure that patients get a fair treatment and service
at the hands of private service providers. As a matter of fact, there are only a few
states in India which have made statutory provisions under the Clinical Establishment
Act for registration and regulation of private health care facilities, as suggested by the
Government of India from time to time. Since such a legislation was not coming up in
most of the states, the Government of India enacted the Clinical Establishments Act,
2010 and made it oblige-tory for the state governments to have similar legislation
passed by their respective state legislatures. Unfortunately, till date Bihar does not
have such a statutory provision, while its neighbouring state, West Bengal, had such
a provision as early as 1951 (West Bengal Clinical Establishment Rules 1951). In the
absence of such a provision, private health care facilities run in Bihar the way it suits
them economically without caring about ethical standards and any check from the
state government. And therefore, one can hardly find more than a few hospitals and
pathological laboratories in Bihar which are accredited by the National Accreditation
Board for Hospitals and Healthcare Providers and the National Accreditation Board
for Testing and Calibration Laboratories respectively. Therefore, looking at the above
needs and structural constraints in Bihar, it seems that it will take miles to go when
one can see a nationally comparable development in the health indices and health
status in Bihar. The recent growth and spurt in Bihar show a ray of hope and a light at
the end of the tunnel for achieving this phenomenal task of improving the health status
in Bihar. All it needs is a coordinated and consistent effort at every level of governance,
planning and execution of health targets with extensive community participation.