|13. What Is the Cost of Maternal Health Care and How Can it Be Financed?|
The disability-adjusted life year (DALY) was originally developed in order to calculate the global burden of disease (GBD) initiated by the World Bank and WHO in an attempt to provide information on (a) levels of ill-health from premature mortality and (b) from non-fatal health outcomes, and the contribution of different diseases, injuries and risk factors (Murray & Lopez 1998, Murray & Lopez 2000). This term has been increasingly appearing in health policy discussions since the publication of the 1993 World Development Report (World Bank 1993).
Methods of measuring the total disease burden at the global level and for setting priorities among health interventions using the principles of cost-effectiveness require a generic measure of health status which can be used to aggregate across different disease conditions with differing health outcomes.
The DALY is one such measure. The DALY is a composite measure of health status combining the time lost due to premature mortality (Years of life lost: YLL) and the time lived with a disability (years lived with disability: YLD). The process of calculation is complex, however, broadly defined, there are four main steps:
1. Calculation of the number of years of life lost due to maternal causes;
2. Calculate of the loss in quality of life for those living with the conditions;
3. Application of age weighting: reflecting the social value of people at different ages;
4. Application of a discount rate to reflect the rate of time preference (benefits sooner rather than later.