20.18        ndian     onom
              high DALYs rates are indicating relatively   Management (SLWM) projects in rural and urban
              greater increase in NCDs.                    areas. The results of the mission are appreciable16:
              Among the leading NCDs, the largest                   The number of persons defecating in
              disease burden or DALYs rate increase                 open in rural areas declined to 25 crore in
              was observed for diabetes, at 80 per cent,            January, 2018 (from 55 crore in October,
              and ischemic heart disease, at 34 per cent            2014)—at a much faster pace compared
              during the period 1990 to 2016. Majority              to the trend observed before 2014.
              of the States have the largest dominance              Eight States and two Union Territories
              of non-communicable diseases and                      i.e., Sikkim, Himachal Pradesh, Kerala,
              injuries over infectious and associated               Haryana, Uttarakhand, Chhattisgarh,
              diseases except Delhi, Andhra Pradesh,                Arunachal Pradesh, Gujarat, Daman and
              Uttar Pradesh and Assam where this is                 Diu and Chandigarh have been declared
              relatively less.                                      as ODF (open defecation free)—a total of
              Despite improvements in overall life                  296 districts and 307,349 villages.
              expectancy in India over the years,                   Usage of toilets17 by the individuals who
              inequalities still persist among states with          have access to toilets reported more than
              a range of 64.5 years in Uttar Pradesh to             90 per cent of individuals using toilets in
              75.2 years in Kerala in 2015.                         2016 and 2017.
              The National Health Policy, 2017 has              For promoting sustainable development
              recommended increasing State sector          (SDG-3) ensuring healthy lives and promoting
              health spending to more than 8 per           the well-being for all at all ages is essential. India’s
              cent of the State government budget by       commitment to achieve the targets under SDG-3
              2020. There is a need to understand the      with some of them also aligned with the National
              efficiency of the public spending with       Health Policy 2017, will help in strengthening
              respect to DALYs behaviour across the        health delivery systems and in achieving universal
              major States and to assess whether high      health coverage.
              spending by States on health results in
              better health outcomes.                      Expenditure on Health
          The efficiency in the use of resources along     Expenditure by the Government healthcare
     with measures for preventive and curative health      providers accounted for about 23 per cent of
     care is necessary to translate enhanced expenditure   the Current Health Expenditure (CHE) as per
     into improved health outcomes. In this context,       National Health Accounts 2014-15 that reflects
     the increase in use of antibiotics in developing      the prominence of private hospitals and clinics
     countries like India where health care spending is    among health care providers. The expenditure
     low, is a cause for concern.
                                                             16.  As per baseline survey conducted by Ministry of
     Swachh Bharat Mission                                        Drinking Water and Sanitation, as quoted by the
                                                                  Economic Survey 2017-18, Vol 2, p. 183, Ministry of
     The scheme (launched on October 2, 2014) aims                Finance, GoI, N. Delhi.
     at universal sanitation coverage and elimination        17.  According to the surveys conducted by National Sample
     of open defecation by October 2, 2019. It also               Surve Office (NSSO, 2016) and Quality Council of
                                                                  India (QCI, 2017), as quoted by the Economic Survey
     aims to promote better hygiene and cleanliness               2017-18, Vol 2, p. 183, Ministry of Finance, GoI,
     by initiating Solid Waste and Liquid Waste                   N. Delhi.