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.