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Although there has been a shift in executing universal health coverage (UHC) in India in terms of political will, funding and public awareness, challenges remain with uneven quality of care, inefficiencies in spending, fragmented delivery, and inadequate design and implementation of financial protection programmes, according to the latest findings of the Lancet Commission.
Vikram Patel, Commission co-chair and professor at Harvard Medical School, in an interview with Anuradha Mascarenhas, says that the single most important call to action is for “an integrated, citizen-centred health-care delivery system that is publicly financed, and publicly provided, as the primary vehicle for UHC, while shaping the private sector to leverage its strengths.”
Excerpts:
What are the key takeaways of the findings?
The most significant finding is a fundamental shift in the conventional narrative of barriers to realising universal health coverage. These are no longer driven by a lack of political will, underfunding, inadequate human resources and physical infrastructure or lack of awareness about healthcare services.
Instead, uneven quality of care, inefficiencies in spending, fragmented delivery, inadequate design and implementation of financial protection programmes, and poor governance emerge as key challenges. Promoting a rights-based approach to health, the Commission calls for a healthcare delivery system grounded in comprehensive primary health care and increasing people’s participation in the planning, delivery and monitoring of health services.
We recommend several strategies to empower structures for community participation; for example, making health system performance data publicly available and supporting citizens in accessing health benefits through more efficient resource hubs and effective grievance redressal systems.
You have said that this is a positive report but the Achilles’ heel is lack of accountability.
Universal health coverage is within reach. Let me emphasise what a historic inflection point this is, when we consider how meagre our health system was at the time of Independence. There are large-scale government initiatives such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, Ayushman Arogya Mandirs, e-Sanjeevani telemedicine platform and so on. Concurrently, we have a vibrant private sector…
That said, we also note major challenges and gaps. Citizens are left to fend for themselves and obtain fragmented care from a myriad of providers, often at expensive hospitals. This is particularly problematic for chronic conditions such as diabetes or mental illness. At the heart of the transformation of our health system is a commitment to accountability and integrity by all actors. In practical terms, there is a need to permeate every corner of the health system beginning with the training of health care providers, ensuring high-quality primary care for every citizen.
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Additionally, we recommend implementing major reforms of the financing of health care and the governance of the health system. State, district, and local government institutions must be empowered to design and implement responsive reforms and to be accountable to the communities they serve. The Commission recognises the unique role of technologies in catalysing governance. Finally, the Commission calls for a system that continuously learns from and shares health system data as well as collaborates in learning networks with other health systems in the country.
Do we have adequate medical personnel?
As of 2023–24, India’s MBBS doctor to population ratio was 1:1,263. With AYUSH physicians, this ratio is 1:834, an increase of over 40% since 2010. Similarly, there has been a dramatic increase in the numbers of nurses and other health care providers. However, what is of concern is that this massive expansion in training capacity has been marred by variations in the quality of education being provided. Additionally, a critical challenge is the inequitable distribution of healthcare personnel, with an over-supply in some parts of the country and too few in other parts.
Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More
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