Context:
Recently, a Lancet Commission report on India’s health system highlighted that while Universal Health Coverage (UHC) is now achievable, significant gaps remain in governance, quality, equity, and accountability. The report presents a rights-based, citizen-centred roadmap to ensure accessible, affordable, and high-quality healthcare for all Indians.
About Universal Health Coverage (UHC):
-
-
- Universal Health Coverage (UHC) ensures that all individuals and communities receive essential health services, preventive, promotive, curative, rehabilitative, and palliative without facing financial hardship. It emphasises equity, quality, affordability, and accessibility, ensuring that no one is denied care or pushed into poverty due to healthcare costs.
- UHC is a key target under Sustainable Development Goal (SDG) 3.8, reflecting the global commitment to “health for all.”
- India’s major UHC initiatives include the Ayushman Bharat–Pradhan Mantri Jan Arogya Yojana (PM-JAY), Health and Wellness Centres (HWCs), and digital platforms such as e-Sanjeevani.
- Universal Health Coverage (UHC) ensures that all individuals and communities receive essential health services, preventive, promotive, curative, rehabilitative, and palliative without facing financial hardship. It emphasises equity, quality, affordability, and accessibility, ensuring that no one is denied care or pushed into poverty due to healthcare costs.
-
Key Findings of the Report:
-
-
- Shift in Barriers: Earlier barriers to UHC—such as underfunding, lack of political will, and inadequate infrastructure—have largely been addressed. The report identifies current challenges as uneven quality of care, fragmented service delivery, inefficient spending, and weak governance mechanisms.
- Rights-Based, Citizen-Centred Approach: The Commission advocates a healthcare system in which access to healthcare is treated as a citizen entitlement. It emphasises community participation in planning, delivery, and monitoring, and calls for public access to health system performance data to strengthen transparency and accountability.
- Primary Health Care as the Foundation: The report stresses that UHC must be anchored in comprehensive primary healthcare. Strengthening primary care reduces dependence on expensive tertiary facilities and improves long-term management of chronic conditions such as diabetes and mental illness.
- Human Resources and Equity Gaps: Although the number of doctors, nurses, and ASHA workers has increased, unequal geographical distribution, variations in training quality, and the voluntary status of ASHAs continue to limit effective service delivery.
- Shift in Barriers: Earlier barriers to UHC—such as underfunding, lack of political will, and inadequate infrastructure—have largely been addressed. The report identifies current challenges as uneven quality of care, fragmented service delivery, inefficient spending, and weak governance mechanisms.
-
Key Recommendations:
-
-
- Strengthen Public Provision and Financing: Prioritise publicly financed and publicly provided healthcare as the backbone of UHC.
- Integrated Service Delivery: Ensure continuity of care across primary, secondary, and tertiary levels.
- Community Engagement: Empower citizens and local governance institutions to participate actively in planning and accountability.
- Data Transparency: Publicly disclose health system performance indicators.
- Human Resource Reforms: Address workforce shortages, maldistribution, and training quality.
- Empower ASHAs: Recognise and regularise ASHAs as integral healthcare providers within the formal system.
- Strengthen Public Provision and Financing: Prioritise publicly financed and publicly provided healthcare as the backbone of UHC.
-
Significance:
The report positions India as a potential model for UHC among low- and middle-income countries. It underscores that achieving UHC is not merely a technical exercise but also a political and institutional challenge requiring strong leadership, accountability, and sustained citizen participation.
About the Lancet Commission:
Established in 2020, the Commission brings together leading experts from India and abroad, including scholars from Harvard Medical School, to reimagine India’s health system. Its findings are based on a survey of over 50,000 households across 29 states, along with extensive secondary data, with the objective of advancing UHC by 2047 in line with India’s vision of “Viksit Bharat.”
Conclusion:
India’s progress in expanding healthcare coverage is significant; however, persistent gaps in quality, equity, and accountability must be addressed. A citizen-centred, rights-based, and transparent healthcare system—supported by strong governance and empowered communities—is essential to realise Universal Health Coverage by 2047.
