Citizen-Centred Universal Health Coverage:
The Lancet report titled “A Citizen-Centred Health System for India” outlines a roadmap for achieving citizen-centred Universal Health Coverage (UHC), aligned with the vision of Viksit Bharat @2047.
- It argues that as the World Health Organization (WHO) faces financial stress and the US retreats from global health leadership, India has an opportunity to reform its healthcare delivery while emerging as a strong voice for the Global South.
Key Findings of the Lancet Report on the Health System of India:
- Public Spending Stagnation: Despite policy commitments, public health expenditure remains under 2% of GDP (falling short of the National Health Policy 2017 target of 2.5%).
- Fragmented Care: The current system operates in silos (e.g., separate programs for TB, malaria, maternal health), leading to a lack of continuity in care. Patients often have to navigate multiple providers for a single condition.
- Input-Based Governance: The health administration relies on rigid “line-item budgets” (allocating funds strictly for specific items like salaries or bricks), which stifles local innovation and responsiveness to local disease burdens.
- Out-of-Pocket Expenditure (OOPE): OOPE accounts for nearly 50% of total health spending in India, which is among the highest globally.
- Primary Care Gap: The report notes that insurance schemes are “hospital-centric,” leaving outpatient care (where most poor families spend money) largely unprotected.
- Paradigm Shift in Barriers: The report notes that the barriers to UHC in India are no longer a lack of political will, funding, or infrastructure (which have all seen expansion). Instead, the core obstacles are uneven quality, fragmentation, and poor governance.
- The “Missing Middle”: While the poor have government schemes and the rich have private insurance, the middle class often faces catastrophic health expenditure with little support.
- Human Resource Valuation: The current HR policy focuses excessively on counting “qualifications” (degrees) rather than valuing “competencies, motivations, and values,” leading to the underutilization of frontline workers like ASHAs.
