Citizen-Centred Universal Health Coverage | 23 Jan 2026

Source: TH 

Why in News? 

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. 

What are the 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.

Recommendations 

• Primary Vehicle for UHC: Recommends that the health system must be publicly financed and publicly provided.  
  • The private sector should be "shaped" to play a complementary role, specifically filling gaps in tertiary care where public infrastructure is lacking, but under strict state regulation to prevent profit-maximization at the cost of patient welfare. 
• Shift to Global Budgets and Decentralization: Move from rigid line-item budgets to "Global Budgets" for districts. This would grant local authorities financial autonomy to allocate funds based on specific health outcomes and local needs rather than central dictates. 
  • Empower Panchayati Raj Institutions (PRIs) and Urban Local Bodies (ULBs) to manage local health centers. The report cites the Kerala model, where local governments have control over health functioning, leading to better accountability. 
• Empower Frontline Workers: Accredited Social Health Activists (ASHAs) should be treated as core health staff, not just "volunteers." 
  • Expand the cadre of Community Health Officers (CHOs) to handle basic outpatient care, reducing the load on specialist doctors. 
• Technology as an Enabler ("Capital-Efficient" Tech):  Instead of a centralized database that risks privacy, the report recommends a Federated Data Structure (aligned with the Digital Personal Data Protection (DPDP) Act, 2023).  
  • Under this, patient data resides locally (at the hospital/clinic) and is shared only with the patient's explicit consent via "Consent Managers." 
  • By effectively implementing the Ayushman Bharat Digital Mission (ABDM) and deploying AI and genomics for point-of-need care, the system can deliver advanced diagnostics closer to communities, reducing the need for rural patients to travel to cities. 
• Citizen Engagement: Create formal mechanisms for public participation, such as Jan Sunwais (Public Hearings) and Rogi Kalyan Samitis that have real power to audit health centers. 
  • Establish independent, district-level grievance redressal bodies where citizens can report denial of service or corruption without fear of retribution. 

Conclusion 

By leveraging "global budgets" and digital public goods to bridge the "missing middle," India can transform healthcare from a costly privilege into an accessible right. This structural overhaul is a prerequisite for securing the healthy human capital essential for realizing Viksit Bharat @2047.