Social Infrastructure

Citizens often have strong opinions on areas that shouldremain within the exclusive competence of the govern-ment. The provisioning of drinking water and sanitation,education, and health defines the quality of life of citi-zens. These services affect day-to-day life of people andhave long-term impact in terms of longevity and earningcapacity. There are many issues in each sector, as interface with people is direct; the methodologies used to deal withsome of the intractable issues are quite diverse. We havechosen to include, in each sector, a few models which areillustrative but replicable and affordable anywhere inthe country.

W

ATER

, S

ANITATION

, SWM

Water and SWM models given in this chapter offer hopethat drinking water and a clear environment can be provided to almost all citizens at competitive prices. Pipeddrinking water which is treated and transported to house-holds is an expensive commodity and more so in a sparselypopulated villages. However, villagers need good qualitypotable water as much as anyone else in the country. PrasadRaju describes in his paper, the Byrraju Foundation’s 4Pmodel of quality drinking water, how the foundation hasturned handicaps into opportunities in providing drink-ing water to villagers. Interestingly, many villages andmultilateral aid agencies have adopted this model withsuccess. Organizations which may be required to back these solutions may not be available everywhere but thereis no reason why that role cannot be played by an NGO. Where there is water, there will be waste water. Peoplegenerally do not care about health hazards which waste water can pose. Sonia Sethi in her paper on Maharashtra’scommunity-based model for water and wastewater man-agement highlights the integration of water supply and

7

SOCIAL INFRASTRUCTURE

sanitation projects in the state. A notable aspect of themodel is that it can be easily replicable in other statesas well. Almost all local authorities spend large sums of moneyin wastewater treatment. Wastewater services generally arecontracted out, but infrastructure is owned by local authori-ties. Anupam Rastogi and Shreemoyee Patra describe theDelfand Water Treatment model where the local authorityuses a financial model which is most economical withoutcompromising on the services. Competitive bidding of thismodel has ensured that the local authority gets value formoney while financial instruments are used to ensurecompetitive O&M contracts as well.Until 2000, solid waste management in India was ac-corded low priority by local authorities. The interventionof the Supreme Court changed the scenario and variousmodels are used by different local authorities to handleSWM in their areas. Vivek Agarwal and Neeraj Guptadescribe these models in their paper and highlight howthese models are implemented in various cities and howlocal authorities have been able to save money by usingcompetitive bidding.

H

EALTHCARE

The Pradhan Mantri Swasthya Suraksha Yojna (PMSSY)is a project to develop six AIIMS-like apex health careinstitutes over the next three years. Given the experienceof service delivery in the public sector, it is useful to ex-plore alternative procurement methods to ensure betterservice to the people. This is especially so for a premiermedical institution, where education and research haveequally high priority. These cannot be jeopardized by theday-to-day management issues of a large general hospitalserving the general public.

182India Infrastructure Report 2008Partha Mukhopadhyay argues for a PPP approach toPMSSY based on working domestic and internationalmodels. It decomposes the apex health care institute intoa General Hospital similar to a large public hospital, andan Institute responsible for referral care, teaching, andresearch. A private concessionaire will be responsiblefor the building, operating, and maintaining the GeneralHospital while the government will be responsible forthe Institute. The General Hospital will share diagnosticfacilities and extend whatever assistance is required to theInstitute for teaching, such as internships. This approachis expected not only to complete the project faster andensure better service delivery during the operational phasein a cost-effective manner, but also to provide better con-ditions for education and research. The author argues forimplementing PMSSY in a PPP mode, to complete theproject faster and to ensure better and cost-effective service delivery during the operational phase.Some studies argue that PPPs are not suited for thedelivery of clinical and schooling services as the quality of outputs provided by a profit-driven private operator arelikely to be lower than what would be achieved by thepublic sector. Without appropriate and credible means of control and quality indicators from the public party,political opposition to extending PPPs to core areas of public service provision will certainly arise.Primary Health Centres (PHCs) are important linksin providing health care in villages but these centres re-main underutilized due to non-availability of trained staff.Ratna Devi and Rama Raju in their paper on the ByrrajuFoundation’s PPP model for village PHC describe howthe foundation has handled these roadblocks and providedquality services at a price which villagers can afford.Indiresan, on the other hand, describes an inclusive de- velopment model for health care in his paper whichcan be applied anywhere in the country. He illustrates hismodel using the examples of Vellore Medical College, Vellore and Narayana Hridalaya of Bangalore.Nevertheless, health care for a large number of usremains a challenge. Only 84 million people are coveredby CGHS and other government, employer, or commer-cial insurance. Out of these only 11 million are coveredby commercial insurance. Ashoke Bhattacharjya andPuneet Sapra reckon that financing health care for India’slarge uninsured population poses a complex health policychallenge with fundamental economic developmentimplications. While a one-size-fits-all solution is not ananswer, a combination of successful financing modelsis likely to address current financing limitations. Amongthese models, private health insurance offers a viable healthcare financing solution for a large segment of India’s popu-lation. The paper underscores the potential role and sig-nificance of various forms of health insurance as anenabling mechanism for promoting affordability andaccess to health care. In particular, it emphasizes thecritical role that could be played by a well-designed androbust private health insurance system to expand healthcare coverage and access to a substantial chunk of the popu-lation that does have some ability to pay for insurance butcannot bear the financial shock of catastrophic illnesses.Bhattacharjya and Sapra suggest that private healthinsurance has an important role to play in a country likeIndia, which faces enormous public health challenges andhas a very large number of citizens who will continue torely on public funded programmes for basic health care.

E

DUCATION

Whereas graduates from IITs and IIMs are a common sightin Silicon Valley of the US, Wall Street, London, HongKong, Singapore, and are the envy of many developingcountries, primary, secondary and vocational training formajority of Indians remain in shambles. The base of oureducation pyramid is very weak. Reddy and Jacob in theirpaper on the Byrraju Foundation’s PPCP Model for Edu-cation describe how this base can be made stronger by usingnew ways of teaching children. Anupam Rastogi and Shreemoyee Patra criticallylook at the primary education system in their paper on Education Vouchers and One Campus and Many SchoolsModels to deliver primary education in remote areas. Theysuggest that primary education in the country can beimproved if an element of competition is brought intothe system at the primary level. Vocational education has been a feeble sector in India.Partha Mukhopadhyay’s paper outlines a PPP approach toupgrading existing Industrial Training Institutes (ITIs) toenable the exploitation of the benefits of private delivery incraftsmen training which requires a high level of initialinvestment. It will also enhance linkages between these ITIsand industry. The performance based contracting systemspecifies a cost sharing arrangement with the private part-ner in a manner such that the return to the private partnerdepends on its ability to find suitable employment for thegraduates of the Institute. Bonuses are built in for long-termemployment in the organized sector. Most importantly, thisPPP structure will enable the upgradation of ITIs to hap-pen almost immediately while the expense on this prog-ramme will be deferred and spread out over many years.The model will enhance the supply of tradesmen withrequisite skills requiring a high level of capital investmentin training facilities and improve the linkage of the ITIs with industry. It also accelerates the process of upgradationof ITIs in a manner that allows the expense to be deferredand spread out over many years, while the upgradationhappens almost immediately, within a year or so.

Social Infrastructure183Improvement in the quality of drinking water significantlybenefits the health and well-being of people. The ByrrajuFoundation, a not-for-profit organization dedicated torural transformation, has embarked upon the mission of providing quality drinking water conforming to WHO’sstandards in villages of rural India. Among the villages where the Foundation is working, 63 per cent are depen-dent on irrigation canals and the remaining 37 per cent of villages use ground water sources.Under the state-run Rural Water Supply (RWS)Scheme, most of the villages, especially in the GodavariRiver delta region, have a pond, fed by the irrigation canalat regular intervals, storing the required quantity of water.The water in the pond is passed through Slow SandFilters (SSFs) followed by chlorination, occasionally. This water is pumped into an overhead tank for distributionthrough a system of pipes to the few homes that have in-dividual connections but majority of the supply is throughcommon stand-posts.The filtered water supplied to villages has coliform,turbidity, chlorides, and other physical as well as chemicalimpurities in excess of permissible levels. The Foundation’ssurvey of the villages revealed that out of 40 litres of waterper capita per day supplied by RWS, about 2 litres are usedfor drinking purpose, which is about 5 per cent of totalquantity to be supplied in villages. It is much easier to treat5 per cent of water supplied to drinking water standardsrather than the entire quantity. So, the Foundation set upsmall community-based plants producing 1000–2000 litresof potable water per hour, for every three villages. Theplants called Sujala Plants use reverse osmosis (RO) andUV Treatment to provide quality water conforming to WHO drinking water standards. They are operated by thetrained youth from the village whenever power supply isavailable. Sustainability is ensured by collection of usercharges to cover O&M costs. Quality of the product wateris monitored strictly and local Science Colleges are involvedin regular testing and quality control.

O

PERATION

AND

M

AINTENANCE

OF

S

UJALA

PLANTS

In order to ensure satisfactory performance of the Sujalaplants, the quality of input water is checked thoroughlyfor various parameters like turbidity, physical and chemi-cal impurities, bacteria, and so on, on a continuous basis.Based on the levels of impurities/bacteria, process param-eters are set for effective removal of the same. To over-come the problem of power-cuts, the plant is operated onsingle-phase, as it is available for twelve to sixteen hoursa day in a village, with flexible timings, using voltagestabilizers for maintaining quality of power. 100 per centstandby for all the critical components, like pumps,motors, UV lamps, voltage stabilizers, multi-port valves,and adequate stocks of consumables are maintained withinclose proximity to the Sujala Plant. In some villages, whichdistribute a large quantity of water, a diesel generator hasbeen installed to meet power requirements. Annual maintenance contracts are entered into,initially for five years, with the suppliers of the plantto ensure trouble free operation. For every five plants, amaintenance team is deployed within close vicinity of acluster of villages by the supplier of equipment so as toattend to regular preventive and break-down maintenance.The layout of the plants and components has beenstandardized so that the plants operating under similarconditions can effectively share inventories for properoperation. The Gram Vikas Samiti (GVS), a team of volunteers formed and institutionalized by the Founda-tion in each of the participant villages, monitors theFoundation’s initiatives at the village level. The GVS mem-ber identified for water programme oversees the O&Mof the Sujala plant.

F

INANCING

OF

S

UJALA

P

LANTS

The plants are run with the active participation andinvolvement of local bodies and villagers while the Foun-dation shares the initial costs of setting up. In orderto ensure its sustainability, the cost of O&M has to becovered by the beneficiaries through user charges for theconsumption of water.

COST

OF

SUJALA

PLANT

The capital costs and operating costs of a Sujala plant aregiven below.

7.1The Byrraju Foundation’s 4P Model of QualityDrinking Water in Villages

D.R. Prasada Raju