20.16 ndian onom
linking the age of prohibition with the age under level services are provided through coordination
the Right of Children to Free and Compulsory between ASHA, Anganwadi Workers (AWWs)
Education Act 2009. The amendment also and the Auxiliary Nurse Midwife (ANM) at the
includes the provisions for stricter punishment HSC.
for employers.
burden of dIseAses
HeAltH scenArIo
The report14 India: Health of the Nation’s
The draft approach paper to the 12th Plan proposed States-2017 provides the first comprehensive set
the idea of universal healthcare in 2012, for the of findings for the distribution of diseases and
first time. The funding situation did not seem risk factors across all States from 1990 to 2016.
conducive enough this is why the government
The concept of Disability Adjusted Life Years
did not think to launch it—falling growth rate in
(DALYs)15 provides a framework for analysing
wake of the western recession and many domestic
the disease burden and risk factors. DALYs is the
factors. However, providing accessible, affordable
and equitable quality health care, especially to sum of years of potential life lost due to premature
the marginalised and vulnerable sections of the mortality and the years of productive life lost due
population is one of the key objectives of the to disability. One DALY represents the loss of
Government. There are innumerable challenges the equivalent of one year of full health. Major
to the delivery of efficient health services in India, findings of the report are as given below:
given the paucity of resources and the plethora There has been significant improvement
of requirements in the health sector. Population in the health status of the individual as life
health is also significantly influenced by social expectancy at birth (LEB) has increased
and environmental determinants such as age at by approximately 10 years during the
marriage, nutrition, pollution, access to potable period 1990 to 2015. The significance of
water and hygienic sanitation facilities. DALYs as a critical health policy indicator
The Indian health sector has a mix of both
14. The India: Health of the Nation’s States-2017 report
public and private providers of health services. The
is a collective effort of Indian Council of Medical
private sector and the quality of care provided is Research (ICMR), PHFI and IHME, University of
variable, ranging from informal providers (quacks) Washington (as per the Economic Survey 2017-18,
to individually run nursing homes to large Vol. 2, pp. 176-183).
15. DALYs express the premature death and disability
polyclinics and multiplex hospitals. The regulation attributable to a particular cause, and are made up of two
for cost and quality of care is largely absent in components: years of life lost (YLLs) and years of life
most f the states. In the case of public sector, the lived with disability (YLDs). YLLs measure all the time
people lose when they die prematurely, before attaining
health services are delivered through a network
their ideal life expectancy. Ideal life expectancy is based
of health facilities including ASHA (a volunteer on the highest life expectancy observed in the world
health worker) at the community level, Health for that person’s age group. YLDs measure years of
Sub-Center (HSC), Primary Health Centres life lived with any short- or long-term condition that
prevents a person from living in full health. They are
(PHCs), Community Health Centres (CHCs), calculated by multiplying an amount of time (expressed
District Hospitals, Government Medical College in years y a disa ility weight a num er that quantifies
Hospitals and the state and central government the severity of a disability). Adding together YLLs and
YLDs yields DALYs, a measure that portrays in one
assisted Employees’ State Insurance (ESI) hospitals metric the total health loss a person experiences during
and dispensaries. Outreach and community their life.