Lancet urges public-sector-led health reform for India by 2047
Lancet urges public-sector-led health reform for India by 2047
A Lancet Commission report calls for publicly provided care to lead universal health coverage in India by 2047, outlining six reforms to fix governance, decentralization, and delivery.
A Lancet Commission report, based on a survey of 50,000 households across 29 states, argues that publicly provided care should be the backbone of universal health coverage in India by 2047, the centenary of the country’s independence.
It notes that governance failures and fragmented delivery, not funding shortages, are the biggest barriers to health equity for 1.4 billion people.
The commission outlines six structural reforms: empower citizens in local governance; decentralize authority to districts; scale up technology to coordinate care; shift the public sector from a passive financier to a strategic purchaser of services; embed a 'learning health system' culture to boost accountability; and engage the private sector as a partner rather than an adversary.
India’s strength in vaccine production and pharmaceutical manufacturing contrasts with a domestic system plagued by uneven quality and inefficiencies that leave millions vulnerable.
Co-chair Vikram Patel of Harvard Medical School says only the public sector has the mandate and infrastructure — from community workers to tertiary hospitals — to reach every corner of the country.
With nearly half of households currently relying on private providers despite higher costs, the report argues for a citizen-centric, publicly led approach that uses governance and data to improve outcomes and affordability.
Proponents say the moment is ripe for reform as public trust grows and India’s economy expands, potentially allowing the country to play a stronger role for the Global South on the world stage.
