The Lancet Commission on a Citizen-Centred Health System for India

The Lancet Commission on a Citizen-Centred Health System for India presents evidence-based recommendations to redesign India’s healthcare framework around citizens’ needs, strengthen public health services, boost community engagement and digital integration, and achieve universal health coverage by

Table of Contents

Context

The report outlines a transformative pathway for India to achieve Universal Health Coverage (UHC) by 2047.

Key Systemic Challenges Identified

Fragmented Health Service Delivery: India’s health system remains divided into vertical, disease-specific programmes with weak coordination across primary, secondary, and tertiary levels of care.
Persistent Financial Hardship: High out-of-pocket expenditure (OOPE) continues to drive financial distress despite schemes like Ayushman Bharat, largely due to uncovered outpatient care, medicines, and diagnostics.
Variations in Quality of Care: A significant “know–do gap” exists, where healthcare providers often fail to follow established clinical protocols, resulting in low-value care and suboptimal health outcomes.
Epidemiological Transition: The health system faces the dual challenge of managing a rising burden of non-communicable diseases (NCDs) alongside persistent infectious diseases.

Key Reforms Suggested by the Lancet Commission

Empowering Citizens and Communities: Strengthening local governance and civil society platforms such as Village Health, Sanitation and Nutrition Committees, improving grievance redressal, and ensuring public access to health system performance data.
Public Sector Health System Reform: Establishing Decentralised Integrated Delivery Systems (IDS) that link modernised primary care networks with secondary hospitals, each serving a clearly defined population.
Aligning the Private Sector with UHC Goals: Transitioning from fee-for-service models to capitation and global budgets to incentivise prevention and value-based care, along with expanding voluntary insurance to cover outpatient services and medicines.
Enabling Reforms: Scaling up digital health initiatives like the Ayushman Bharat Digital Mission, strengthening transparent governance through real-time data systems, and fostering closer collaboration between researchers, policymakers, and healthcare providers for evidence-based reforms.