To achieve the ambitious vision of ‘Viksit Bharat 2047’, India must overhaul its healthcare architecture. A landmark report titled The Lancet Commission on a citizen-centred health system for India argues that a strong, publicly provided healthcare system is crucial. It is the essential backbone required to reach Universal Health Coverage (UHC).
Based on an extensive survey of 50,000 households across 29 states, the Commission provides a comprehensive roadmap for reform. It suggests that while India has made strides in life expectancy and maternal survival, the current system is too fragmented. It remains reactive and cannot effectively meet future challenges.
Breaking the “Silos” in Public Healthcare
India currently operates several major healthcare initiatives, including the National Health Mission (NHM), Ayushman Bharat, and the Ayushman Bharat Digital Mission (ABDM).
However, the report highlights a critical flaw: these schemes have not achieved their full potential because they were designed and implemented in silos.
Furthermore, the Commission identifies several persistent hurdles, such as:
Fragmented Delivery: Services are often disconnected, leading to gaps in care.
Uneven Quality: The standard of treatment varies significantly across regions.
Poor Governance: Oversight mechanisms require strengthening to ensure accountability.
Shifting from “Reactive” to “Citizen-Centric” Care
Historically, India’s healthcare strategy has focused heavily on physical infrastructure and faced consistent funding shortages. Consequently, the current system has become hospital-centric and reactive.
The report notes that many citizens bypass primary care facilities—which are often under-resourced—in favour of expensive private hospitals. This trend is particularly concerning as India faces a rising tide of non-communicable diseases and mental health issues. To counter this, the Commission advocates for a “paradigm shift” toward a system that is publicly financed and publicly provided.
The Six Pillars of Healthcare Reform
To transform the current landscape into a citizen-centric system, the Lancet Commission proposes six strategic reform actions:
1. Meaningful Citizen Engagement: Build the health system upon active people’s participation.
2. Public Sector Reform: Implement changes in financing, purchasing, and service delivery within the public sector.
3. Private Sector Alignment: Engage private healthcare providers to align their goals with national UHC objectives.
4. Technology Integration: Scale up diverse technologies to catalyse necessary reforms.
5. Decentralised Governance: Enable transparent and accountable governance through strengthened regulatory capacities.
6. Continuous Learning: Foster a “learning health system” that champions leadership and participatory improvement.
A Decentralised Path Forward
The Commission emphasises that there is no “one-size-fits-all” solution. Instead, it suggests that governments should choose reform options based on their local requirements and existing systems. This process should involve deep consultations with civil societies and healthcare providers to refine and evaluate the delivery models over time.
By focusing on a technology-enabled and integrated delivery system, India can move toward a future where healthcare is a right, not a luxury, ensuring the success of the Viksit Bharat 2047 mission.
Why India’s Healthcare Schemes Are Underperforming and How to Fix Them
India’s vision for Universal Health Coverage (UHC) by 2047 rests on the success of its flagship public healthcare schemes. However, a landmark report by the Lancet Commission warns that major initiatives like the National Health Mission (NHM), Ayushman Bharat, and the Ayushman Bharat Digital Mission (ABDM) have yet to reach their full potential.
While these programmes exist to serve the masses, they are currently hampered by a fragmented architecture that prioritises individual “silos” over a unified system. To achieve the ‘Right to Health’ for every citizen, the Commission argues that India must move away from disjointed implementation and embrace a comprehensive, system-wide overhaul.
The “Silo” Problem: A Barrier to Progress
The Commission’s analysis reveals that the primary reason healthcare schemes underperform is their isolated design. Instead of working as a cohesive unit, these programmes often operate in silos, leading to:
Overlapping Institutional Mandates: Multiple agencies often perform similar tasks, creating confusion and wasting resources.
Weak Governance: A lack of strong oversight prevents these schemes from being effectively monitored.
Disjointed Accountability: When lines of responsibility are unclear, it becomes difficult to address failures in service delivery.
Furthermore, the report underlines that the current healthcare architecture is overly complex. With various ministries and agencies involved, the result is often uneven care and systemic inefficiencies.
What Is Derailing Healthcare Action?
Beyond administrative issues, several external factors threaten to slow down or even derail India’s progress toward UHC. The Commission identifies fiscal constraints and implementation hurdles as major roadblocks.
However, the challenges are not just financial. Ideological divides and vested interests can also obstruct reform, preventing the bold innovation needed to modernise the system. To overcome these, the report suggests that India must “invest wisely, innovate boldly, and align reforms” around the needs of its citizens.
The Public Sector as the “Backbone”
A central takeaway from the Lancet report is that India cannot achieve Universal Health Coverage by depending solely on the private sector. Instead, the public healthcare system must remain the backbone of equitable access.
This is particularly vital for socioeconomically vulnerable citizens who rely on government facilities for affordable care. While the private sector plays a “vital complementary role” in providing diagnostics, pharmaceuticals, and outpatient services, it must be aligned with national goals rather than operating independently.
A Roadmap for Unified Governance
To fix these systemic issues, the Commission calls for a “comprehensive system approach.” This involves:
1. Organisational Reforms: Streamlining how healthcare is implemented and delivered.
2. Sustainable Financing: Ensuring long-term, reliable funding for public health.
3. Unified Governance: Coordinating efforts across both the public and private sectors to ensure they work toward the same national objective.
4. Meaningful Citizen Participation: Building a system where people’s voices are heard and included in the decision-making process.
Q&A: Understanding the Lancet Commission’s Findings
Q: What is the main goal of the Lancet Commission report? A: The primary goal is to provide a roadmap for India to achieve Universal Health Coverage (UHC) by 2047 through a citizen-centred, publicly-funded system.
Q: Why does the report criticise current schemes like Ayushman Bharat? A: While these schemes are valuable, the report argues they operate in “silos,” meaning they are not integrated effectively, which limits their overall impact on the population.
Q: How was the data for this report gathered? A: The findings are based on a massive survey of 50,000 households across 29 Indian states, ensuring a broad representation of the country’s diverse healthcare needs.
FAQ: Frequently Asked Questions
What is “Viksit Bharat 2047”? It is the government’s vision to transform India into a developed nation by the 100th anniversary of its independence in 2047.
What does “hospital-centric” healthcare mean? It refers to a system where the focus is on treating illnesses in large hospitals (reactive) rather than preventing them or managing them at the community and primary care level (proactive).
Why is the private sector mentioned in a report about public healthcare? The Commission suggests that the private sector must be engaged and aligned with UHC goals to ensure that the entire national healthcare ecosystem works toward the same objective.
What are non-communicable diseases? These are chronic conditions like diabetes, heart disease, and mental health disorders that are not passed from person to person but require long-term management.
