India Needs To Strengthen Public Sector Healthcare System To Achieve National Health Goal, Says Lancet Report

The goal to achieve universal health coverage by 2047 will be possible when there is a strong publicly provided healthcare system, a report by Lancet has said. Titled The Lancet Commission on a citizen-centred health system for India, the report is based on a survey conducted on 50,000 households in 29 states and provides a comprehensive roadmap for achieving universal health coverage (UHC) and says that a paradigm shift is required for achieving this objective. 

The report highlights that the healthcare system in India has, for many years, focused on physical infrastructure and a lack of funding. The Lancet Commission was formed in December 2020 to identify the reforms needed to achieve the vision. The commission’s report recognises the hurdles in achieving the UHC goal. It highlights the uneven quality of care, fragmented delivery, and poor governance. 

As life expectancy and maternal survival have increased, other issues, such as mental health and non-communicable diseases have also increased. According to the report, at present, the healthcare system is reactive and hospital-centric, which is why people ignore primary care facilities and opt for expensive private hospitals.

The report suggests reforms, which include a decentralised, technology-enabled, and citizen-centric integrated delivery system that is “publicly financed and publicly provided”. The report also suggests these reforms as options that the governments can choose depending on their local system and requirements, following consultations with civil societies, healthcare providers, and then evaluate and refine them further.  

To make healthcare a citizen-centric health system, it suggests six reform actions:

1. “Enable meaningful citizen engagement by firmly building the health system upon people's participation

2. Implement a citizen-centred health system through financing, purchasing, and service-delivery reforms in the public sector

3. Engage the private sector to align with UHC goals

4. Invest in and scale up diverse technologies to catalyse all the reforms needed for UHC

5. Enable transparent and accountable governance of the entire health system through decentralisation and strengthened regulatory capacities

6. Foster a learning health system by embedding reflexivity, participatory approaches, and leadership that champions continuous learning and improvement.

Public Healthcare Schemes Yet To Achieve Full Potential

The commission added that while public healthcare schemes do exist for citizens, such as for National Health Mission (NHM), Ayushman Bharat, and the Ayushman Bharat Digital Mission (ABDM), but they have often not achieved their full potential because of being “designed and implemented in silos, overlapping institutional mandates, weak governance, and disjointed lines of accountability”. 

The report added that factors, such as fiscal constraints, implementation issues, ideological divides, and vested interests can slow down or even derail the actions. The commission suggests that to achieve the citizens’ ‘Right to Health’, there is a need to “invest wisely, innovate boldly, and align reforms around”. 

It highlights that healthcare architecture is complex, with multiple ministries, agencies, and schemes involved. The report underlines that it created uneven care and inefficiencies. But to achieve the UHC goal, there is an urgent need to have a comprehensive system approach, with organisational reforms in implementation and delivery, sustainable financing, coordinated efforts, and unified governance for both public and private sectors. And more importantly, “meaningful citizen participation.”

The report stresses that India needs to strengthen its public healthcare system to achieve UHC while at the same time aligning private sector participation with the national goal. 

In simple words, UHC cannot be achieved by depending on the private sector healthcare system. 

“The public sector must remain the backbone of equitable access, particularly for socioeconomically vulnerable citizens, while the private sector—already a major provider of outpatient, hospital, diagnostic, and pharmaceutical services—plays a vital complementary role,” the report further said.