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.