on the Impact of Grid Electricity in Powering the Expansion of STUDY ON THE IMPACT OF GRID ELECTRICITY IN POWERING THE EXPANSION OF HEALTHCARE SERVICES AND FACILITIES IN SAGAR ISLAND

Sagar Island, also known as ‘Gangasagar’ in commoners’ parlance is one of the populous islands that falls under the Sundarban Biosphere Reserve in the State of West Bengal. The Island articulates the faith and sentiments of teeming billions of this country in a transcendental and sublime manner since time immemorial. Despite the age-old religious and cultural connotations, the island’s socio-economic growth was contained to a certain extent due to non-availability of grid electricity. Islanders had to depend primarily on energy supplied in an intermittent manner through solar photovoltaic cells, diesel generator sets, kerosene-fed implements used for illumination or otherwise along with fuelwood. Situation in Sagar Island had started changing dramatically from 2012 onwards with the rolling out of 100 per cent household electrification programme under ‘Integrated Coastal Zone Management Project.’ Resonance of grid electricity is palpable cutting across all geographic, social and economic heterogeneities in Sagar Island. The execution of the entire component did have a kaleidoscopic impact through spurting of multiple socio-economic activities in Sagar Island. The present paper deliberates on the impact of grid electricity vis-à-vis the improvements that have taken place with respect to healthcare services and facilities in Sagar Island. The study shows that the initiatives, that are propelled either due to distribution of grid electricity through government-owned healthcare centres or through private healthcare enterprises, are quite impressive. Quantitative and qualitative assessments of 17 units, instrumental in providing healthcare services and facilities of varied nature in Sagar Island, have proved beyond doubt that grid electricity is not only a demand-driven project initiative whence it was conceived but in real terms is a game-changer that accelerates the pace of sustainable development.

Resonance of grid electricity is palpable cutting across all geographic, social and economic heterogeneities in Sagar Island. The execution of the entire component did have a kaleidoscopic impact through spurting of multiple socio-economic activities in Sagar Island. The present paper deliberates on the impact of grid electricity vis-à-vis the improvements that have taken place with respect to healthcare services and facilities in Sagar Island. The study shows that the initiatives, that are propelled either due to distribution of grid electricity through government-owned healthcare centres or through private healthcare enterprises, are quite impressive. Quantitative and qualitative assessments of 17 units, instrumental in providing healthcare services and facilities of varied nature in Sagar Island, have proved beyond doubt that grid electricity is not only a demand-driven project initiative whence it was conceived but in real terms is a game-changer that accelerates the pace of sustainable development.

Introduction
Sagar Island is located in the Ganges-Brahmaputra delta and lies at the mouth of the river Hooghly. Since time immemorial, the Island is drenched with the mythological mysticism of Sankhya philosophy of sage Kapil Muni that reverberates from this landmass with high amplitude, especially during 'Gangasagar Mela' -the annual religious congregation that happens each year at the time of Makar Sankranti (either 14 or 15, January) where millions from all over India do swarm in to pay their obeisance and homage to the deity Ganga and sage Kapil. Sagar block that comes under the administrative jurisdiction of South 24 Parganas district in West Bengal consists of Sagar Island and Ghoramara Island. Sagar Island also falls under Sundarban Biosphere Reserve and is totally cut-off from the mainland by Muriganga river. The total geographical area of the Sagar block is 282.11 sq. km. Apart from the religio-cultural significance of the Island, it is also considered to be one of the populous and large islands of the Indian nation State. According to 2011 Census of Government of India, the population of Sagar block was 2,12,037 and the number of households was 43,716.
The economic development of the Sagar block was constrained to a large extent not only due to absence of direct road/railway linkages with the mainland but also due to non-existence of 24 X 7 grid power. Electrification in Sagar Island' was conceived to provide grid-fed energy which would eventually bring tangible changes in the basic architecture of the scheme of socio-economic relationships that exist through the promotion and facilitation of grid power dependent livelihood options. This project component, as envisaged, not only had intended to improve the quality of life in macro, meso and micro levels of the coastal community but also to steer the process of environmental amelioration by way of phasing out the fossil fuel ravening Diesel Generator (DG) sets -which acted as a major contributory factor for the proliferation of air and noise pollution in Sagar Island. Even though the distribution of grid electricity has already brought some visible changes in the quality of life and livelihood options of the residents of Sagar Island, the present paper only delves into the impact of grid electricity as a catalyst for improving the condition of healthcare services and facilities in the Island.

An Overview of ICZM Project
The Ministry of Environment, Forests and Climate Change (MOEF&CC), Government of India, had requested the assistance of the World Bank in 2010 for financing an investment project referred to as 'India: Integrated Coastal Zone Management Project' , in order to build national level capacity for having an integrated management approach in the coastal zones of India coupled with (a) mapping, delineation and demarcation of the hazard lines and delineation of the coastal sediment cells (b) mapping, delineation, and demarcation of ecologically sensitive areas which are likely to be affected by climate change and to be classified as 'Critically Vulnerable Coastal Areas' (c) establishing a National Centre for Sustainable Coastal Zone Management to work with coastal communities and advise the MOEF&CC on policy matters. Apart from national level afore-mentioned project components, ICZMP also finances multiple pilot investments for adopting the integrated coastal zone management approach in three States, e.g., Gujarat, Odisha and West Bengal.

Grid Electricity in Sagar Island
In order to foster the spirit of inclusive growth at Sagar Island and to enhance the quality of life through augmentation of commercial activities, industrial activities, irrigation facilities, etc., WBSEDCL was assigned the task of rural electrification of Sagar Island under ICZMP. The total financial outlay of this project component was ` 34.24 crore. However, the contract signed for the work component was ` 32.27crore. The work was commenced in May 2012 and was completed in March 2015.
The scope of work financed from ICZMP is delineated below. Till date, WBSEDCL has been successful to provide over 31050 service connections (which include both domestic and commercial connections) and that too for 24 x 7. The impact of distribution of grid electricity is quite palpable with wide ranging socioeconomic ramifications and in this context, the SPMU has embarked on a brief study to analyse the impact of grid electricity vis-à-vis the augmentation of healthcare services and facilities in the Island.

Healthcare System in Sagar Island
The entire healthcare system in the Island can be dissected into two categories: public and private enterprises. Publicly owned and managed enterprises include a rural block hospital, three primary healthcare centres and 41 primary healthcare sub-centres. Private enterprises facilitating healthcare in the Island include a nursing home, allopathic medical shops, pathological labs, ECG-cum-medical imaging units, physiotherapy centres, ophthalmic-cum-dentistry polyclinics or dispensaries, homeopathic medicine shops and a number of makeshift chambers where medics (unauthorised) provide elementary healthcare services to the coastal community.

Objectives of the Study
To analyse the sources of energy that were put for use before induction of grid electricity; To study the impact of grid electricity in powering the improvement of the healthcare services and facilities in Sagar Island;

Ú
To know the quality of services provided by the service provider, e.g., WBSEDCL and the reasons for power cut.

Methodology
The study, conducted in November 2015, used a mix of quantitative and qualitative methodologies. The present work considered 17 units associated with the prevailing healthcare system spanning over 8 Gram Panchayats of Sagar Island. Quota sampling has been deployed for identification of the healthcare units in a logical and representative manner so that relevant information can be extracted for interpretation and analysis. It is to be noted that quota sampling provides the flexibility of non-probability equivalent of stratified sampling with a mix of convenient or judgment sampling to select the required number of elements from each stratum in a particular sample size. The broad strategy for selection of the afore-said 17 healthcare units revolved around the following: In addition to the above, Table 2 testifies the span of coverage of the Gram Panchayats vis-à-vis the healthcare units that were selected for the study in Sagar Island. The questionnaire that was put forward to the respondents/ interviewees of the identified healthcare units in the survey is a blend of both objective and subjective elements. Apart from the written questionnaire, impromptu short duration discussions, duly video-graphed with the respondents/interviewees, were also conducted in a bid to capture every bit of material information.

Results and Discussion
Respondents of the study belong to a varied range, as it includes physicians, pharmacists, radiographers, pathologists, proprietors of medical stores/nursing home and rural health assistants. The data collected through the key informant interviews were duly processed and the major findings are summarised below: 1.
Summarised profile of the 17 surveyed units vis-à-vis its employability and patients/consumers/customers catered per day mentioned in Table 3.

2.
Out of the 17 units, 16 are connected to the grid electricity. One primary health centre located in Muriganga I Gram Panchayat is yet to be connected to the grid electricity but the same has already applied for connection.

3.
All the 16 units connected now with the grid electricity, earlier had to depend on either of the following or a combination of the following for sustenance of their activities.
• Power supplied through DG sets for 4 hours from WBSEDCL's end • Some of the studied units also procured services of privatelyowned and managed DG sets.
• Some units were also connected with solar installations but the maintenance of the same was an issue to them.
• Illumination through kerosene lamps was also done at the premises of the surveyed units.

4.
The extent of enhancement of healthcare services and facilities due to induction of grid electricity by the surveyed units was studied from two accounts: a) application of financial resources and b) benefits that are now being permeated to the coastal community in consonance with the trickledown theory with enhanced capacity facilitation coupled with service level augmentation.  The undernoted charts testify the abovementioned arguments. Analysis of Figure 1 along with Table B Figures 2 and 3 should also be read with Table C in annexure which is a testimony of the fact that the capital expenditure was incurred as the healthcare units released the scope of enhancement of their activity in a bid to make healthcare facilities and services more accessible to the coastal community. The factor for potential revenue yield apart from the social cause by the privately-owned healthcare units should not be discounted as many of them concurred to the fact that their customer base has increased in tandem with capacity enhancement and extension of serviceability duration. Similarly, the spikes witnessed in Figure 3 corroborate the aforementioned argument.

6.
As a corollary to the above point, the surveyed units that are connected to the grid electricity have concurred, both in qualitative and quantitative terms, their service and facility level to its primary stakeholders have increased manifold. Significant points on this account have been elaborated in Table 4.

8.
The key informants have also shared their experience on frequency of power disruption. Majority of them stated that they do experience 15-30 minutes load shedding daily. Power outages sometimes do happen for 2-3 hours due to pending electrification work or for maintenance of transformer burnouts and cable faults. In addition to it, preventive major power cuts do happen for more than 10 hours in case of cyclonic storm surges.

Rural block hospital
Situation Before Connection with Grid Electricity The rural block hospital used the power supplied through DG sets of WBSEDCL and through privately-owned DG sets. A number of medical and nonmedical appliances were already put to use before the introduction of grid electricity. Major electricfed medical appliances used include X-ray, phototherapy machine ( used for reducing high bilirubin levels that cause jaundice in a newborn) and incubator.

Situation After Connection with Grid Electricity
Post-grid electricity connection-the rural block hospital has undergone a major facility upgradation. It has set up a blood bank-cum-transfusion unit and pathological laboratory. The pathological laboratory is equipped with analyser, microscope and other devices. Several pathological tests are now being done which include blood tests for thyroid, sugar, malaria, HIV and other sexually transmitted diseases and sputum, urine, etc. Drug administration with enhanced refrigeration capacity due to 24x7 grid power also gets a fillip with the introduction of the following (in qualitative and quantitative manner): Injection AVS -anti snake venom Injection Syntocinon -used for induction of labour process medications, etc. Injection Pentavalent-combination of five vaccines in one, i.e., diphtheria, tetanus, whooping cough, hepatitis-B and haemophilus influenza type b. Apart from the above BCG vaccine (used for prevention of tuberculosis, other vaccines, e.g., to prevent spread of polio and measles are also being Type of Organisation/ Firm Situation Before Connection with Grid Electricity

Situation After Connection with Grid Electricity
Out of three surveyed units, primary health centre at Gangasagar Gram Panchayat was connected with DG set backed power source and while that at Dasparasumatinagar I Gram Panchayat had to depend on solar power but that too had become dysfunctional about seven years ago. Boiler and syringe destroyer were being used through DG sets backed power supply in Gangasagar Gram Panchayat while in Dasparasumatinagar I Gram Primary healthcare centre administered from the hospital. Recently installed major electric-fed medical appliances include: Suction machine-used "to remove substances, such as mucus or serum, from a body cavity". Pulse oximeter -indirectly monitors the oxygen saturation of a patient's blood and changes in blood volume in the skin, producing a photoplethysmogram. It aids in monitoring heart rate and cardiac cycle, respiration, depth of anesthesia, hypo-and hypervolemia. Baby warmer -used to save the lives of premature and low-birth weight babies suffering from hypothermia. Electric stream steriliser & vertical steriliser-used for sterilisation of the consumables in the labour room. Both the occurrences of major and minor operations have increased in the hospital. Cesarean sections are now being done with ease. In addition to this, electric pump-fed water supply facility has also been improved.
At present two out of three primary health centres are being connected to the grid electricity. The two connected primary health centres located at Gangasagar and Dasparasumatinagar I Gram Panchayats, respectively, are now providing services with ease as have been expressed by the staff of the same. Primary health centres situated in Gangasagar are now using boiler and syringe destroyer with the aid of grid electricity.

Type of Organisation/ Firm
Situation Before Connection with Grid Electricity

Situation After Connection with Grid Electricity
Panchayat sterilisation of medical instruments were done through kerosene (consuming 4 litres of kerosene per month) fed boiling systems. Primary health centre located in Muriganga I Gram Panchayat was not connected with either DG sets or solar systems. Only in case of some emergencies some temporary DG sets backed lighting arrangements were done.
The nursing home located at Rudranagar Gram Panchayat used the power supplied through DG sets of WBSEDCL and through privately-owned DG sets. A number of medical and nonmedical appliances were put on use before induction of grid electricity. Electric-fed medical appliances used were ECG and USG machines.
Nursing home Primary health centres located in Dasparasumatinagar I have undergone a major facility augmentation through installation of both electric-fed medical and non-medical appliances. Electric-fed medical appliances operated now include microscope for investigation of blood samples, especially for detection of malaria and a steriliser for disinfection of invasive medical instruments. Primary health centre located in Muriganga I Gram Panchayat has also applied for grid electricity and soon the same will be connected with the grid.
The nursing home has concurred that due to 24x7 grid electricity, some major facility upgradations have been undertaken by the same. Electric-fed medical appliances procured and used mainly for surgical purposes include (a) diatherm for blood coagulation and blood vessel cauterisation during operation and (b) cardiac monitor for cardiovascular system measurement and treatment. Transfusion of blood and blood fractions are also now being done at the unit. Drug administration enhanced with the introduction of Termin, Scolin, Myopyrolate, Adrenaline and Propofol-used for anesthesia. Major surgical operations increased from 10 to 20, in case of minor operations from 30 to 50 cases.Capacities for aiding pathological tests have also increased as more specimens can be collected and preserved for investigation.

Type of Organisation/ Firm
Situation Before Connection with Grid Electricity

Situation After Connection with Grid Electricity
The situation has changed dramatically with the introduction of grid electricity in all the surveyed units. It came out from the study that all the surveyed medical shops/drug stores kept open their establishments even during late evening hours, which were quite unbecoming about 2-3 years back. The benefit accrued is in both ways. Patient parties get the drugs on real time basis while volume of business on drugs and allied accessories get a new stimulus for growth and development. All of the surveyed units have procured refrigeration units (fridge) and are now inventorising drugs (some are not only essential but also life-saving in nature) which require refrigeration. Some of the drugs noted below are worth mentioning: Humulin 70/30, Actrapid and Mixtard -varied forms of insulin are being used for treatment of diabetic patients. Depo Medrol -an anti-inflammatory glucocorticoid for intramuscular, intraarticular, soft tissue or intralesional injection relieves patients swelling, itching, and redness Rabipur-used to prevent or treat infection by the virus that causes rabies Tetanus toxoid -medication used for providing protection against tetanus D Cort 40 and Tricort -used in patients afflicted with various inflammatory conditions and steroid insufficiency, e.g., rheumatoidarthritis, osteoarthritis, active chronic hepatitis, tuberculosis, severe lepra reaction, Medical shops/drug stores that were surveyed had narrated in unambiguous terms that prior to grid electricity they used to preserve the bare minimal quantum of drugs in a format that may not be subscribed to be proper. Some of the interviewees recounted that due to lack of electric-fed refrigeration units, drugs were kept in ice bags or ice boxes meant for ferrying fish catch to the mainland. However, most of the drugs which are required for daily usages or in emergency situations in the island are generally being procured from the two main junction points of mainland, i.e., Kakdwip and Diamond Harbour either daily or on real time basis as the case may be. The source energy for operating the minimal electrical devices at the druggist stores are either DG sets or solar power.
Medical store/ druggist & chemist shops certain forms of bacterial meningitis, pneumocystis, etc. Depo-Provera-a progesterone injection which is used in contraception. Dulcolax Laxative Suppositoriesrelieves the ailing patients from constipation.
In the post-grid electrification phase all the surveyed units have procured number of electric-fed medical and non-medical appliances. Major medical appliances bought noted in bracketed figures and its usages have been stated below: Microscope (2) -aids in investigation of collected specimens and identification of possible presence of microorganisms using artificial light source. Incubator (2) -assists in sample storage system for culture of microorganisms in urine and blood in a controlled atmosphere Centrifuge (3)-used for assessing of hematocrit, serum analysis and plasma separation Semi auto-analyser (1)  It appears from the narratives of the respondents that one of them has recently started the enterprise. The other two establishments, which were functioning before grid electricity, generally, rely on manual testing methods on the collected samples and that too are few in nature. In addition to that, pathological labs used to send specimens to Kolkata and elsewhere for testing; even though the technicians in Sagar Island do have the requisite knowledge base to perform the same.Two out of three units were using DG set backed power supply before the advent of grid electricity.
Pathological diagnostic centre ECG-cum-medical imaging unit The respondents of the surveyed units noted that both the quality and duration of rendering services to their customers have improved. Now the grid-fed ECG and medical imaging (Xray) devices are powering the outputs with higher degree of accuracy and precision. One of the surveyed units has recently procured a Nebulizer and Tooth Scaling machine in a bid to expand its scope of activities.
The newly established physiotherapy clinic which becomes functional after induction of grid power in Sagar Island has deployed several electric-fed equipment, e.g., Ultrasound, Short Wave Diathermy and Interferential Therapy (IFT) machines for relieving patients from inflammation, muscular spasms, strains, sprains, etc.
Before grid electricity, both the surveyed units have ECG and Xray machines. In earlier occasions, power supplied through DG sets were prone to voltage fluctuations and this had led to generate not so accurate results in case of X-ray or ECG of the patients.
Prior to grid electricity the centre was not in existence.

Physiotherapy clinic
Type of Organisation/ Firm Situation Before Connection with Grid Electricity

Future Scope of the Study
The scope of the study can be enhanced by taking into consideration the volume of business of medical supplies that are being done now in comparison to two to three years back by the distributors and the same should be shown in reconciliation with the opinions from the consumers'/customers' end.

Conclusion
The development narrative sets through grid electricity is quite clear, i.e., a wellexecuted project having the potential of transforming lives not only succeeds at the implementation level but also accelerates the momentum to unplug the entrepreneurial spirit of the community. The benefit accrued in the healthcare sector due to grid electricity is a layered one having multiplier impact.
Indeed, due to grid electricity service facility augmentations of the healthcare units have taken place in Sagar Island, both in quantitative and qualitative terms, and this has benefited the residents of the island who were generally transshipped in earlier occasions to the mainland even for treatment of minor ailments.