Context: The Lancet Commission on Universal Health Coverage (UHC) has called for a citizen-centric healthcare delivery system in India, arguing that people’s lived experiences and long-term care needs must guide reforms. The recommendation comes amid persistent out-of-pocket (OOP) costs, rising non-communicable diseases (NCDs), and uneven access to quality care.
Why Citizen-Centric UHC is Essential for India
India’s health system continues to impose a heavy financial burden on households. Out-of-pocket expenditure remains around 47–50% of total health spending, exposing families to medical impoverishment.
At the same time, public health expenditure is below 2% of GDP, well short of the National Health Policy target of 2.5%.
Epidemiological transition further strengthens the case for reform. Non-communicable diseases account for nearly 60% of all deaths, demanding continuous, preventive and primary-level care rather than episodic hospitalisation. Additionally, India has about 140 million elderly persons (60+), increasing demand for chronic disease management, rehabilitation and long-term care.
Key Challenges in the Existing System
- Human Resource Gaps: Many states report 20–30% vacancies in specialists and medical officers in public facilities, affecting service quality and continuity.
- Weak Financial Protection: Around 14–17% of households face catastrophic health expenditure, indicating gaps in effective risk pooling.
- Fragmented Care Delivery: Nearly 70% of outpatient care is delivered by the private sector, leading to discontinuity, duplication of tests and variable standards.
- Limited Preventive Focus: Low screening rates mean conditions like diabetes and hypertension often remain undiagnosed for years, raising complication costs.
Lancet Commission’s Key Recommendations
1. Citizen-Centric Integrated Care
The Commission advocates shifting from top-down planning to including people’s priorities and feedback in health decisions. Kerala’s People’s Plan demonstrates how local participation can strengthen accountability.
Publicly financed and provided care should form the backbone of UHC, with Ayushman Bharat Health and Wellness Centres (HWCs) acting as the primary vehicle.
Further, AYUSH practitioners should be integrated into care teams to expand preventive and promotive services.
2. Workforce and Frontline Empowerment
Instead of relying only on formal qualifications, the focus should move towards competency, ethics, and motivation in real-world service delivery.
Frontline workers must be empowered through training and decision support, as seen in Tamil Nadu’s “Makkalai Thedi Maruthuvam”, which delivers doorstep care for chronic patients.
3. Digital Technology-Led Reform
Digital platforms should integrate providers, payers and patients for seamless care pathways. The Ayushman Bharat Digital Mission (ABDM), using ABHA IDs, is central to this vision.
Emerging technologies such as AI-enabled diagnostics, genomics and portable innovations can bring advanced care closer to communities.
4. Governance and Financing Reforms
Efficient digital fund flows and simplified procedures are needed to improve utilisation.
The Commission recommends shifting from line-item budgeting to outcome-based financing, linking funding to measurable health outcomes to build trust and accountability.
Conclusion
A citizen-centric approach to Universal Health Coverage can transform India’s health system from episodic and fragmented care to continuous, preventive and people-responsive healthcare, aligning equity, efficiency and dignity.
