The Lancet Citizens’ Commission: Reimagining Healthcare in India

PLATFORM The Lancet Citizens’ Commission: Reimagining Healthcare in India

The Lancet Citizens’ Commission on Reimagining India’s Health System is an ambitious, cross-sectoral endeavor to lay out the roadmap to achieving Universal Health Coverage (UHC) for the people of India.

/ Co-Chairs TARUN KHANNA VIKRAM PATEL KIRAN MAZUMDAR-SHAW GAGANDEEP KANG / Commissioners YAMINI AIYAR VIJAY CHANDRU MIRAI CHATTERJEE SAPNA DESAI ARMIDA FERNANDEZ ATUL GUPTA NACHIKET MOR ARNAB MUKHERJI POONAM MUTTREJA THELMA NARAYAN BHUSHAN PATWARDHAN SUJATHA RAO SRINATH REDDY SHARAD SHARMA DEVI SHETTY S.V. SUBRAMANIAN LEILA E. CALEB VARKEY SANDHYA VENKATESWARAN

The Lancet Citizens’ Commission, which launched in December of 2020, aims to develop a roadmap to achieving universal health coverage (UHC) in India in the coming decade. The pandemic has had profound impacts on India’s people, and has highlighted structural weaknesses in the health system, including a disproportionately high disease burden, widespread risk factors, and deep inequities in access to care. The Commission’s work remains underpinned by a commitment to strengthening India’s public health system in all its dimensions, including promotive, preventive, and curative care.

The Commission and COVID-19

The devastating second wave of COVID-19 in India in the summer 2021 prompted the Commission to formulate and suggest urgent measures that the government needed to take. The Comment on COVID-19 Resurgence in India was published on May 25, 2021 in The Lancet. The Commission called for India’s central and state governments to take eight urgent actions to “address one of the greatest humanitarian crises facing the country since its independence.”

Five Key Structural Areas

The Commission’s work is structured across five workstreams: financing, governance, human resources, technology, and citizens’ engagement. Each of these workstreams includes a group of Commissioners and Fellows who have generated the key questions they plan to address through diverse research activities. The backbone of the Commission is a series of Theory of Change Workshops to map pathways for achieving UHC. The Commission has conducted five Theory of Change workshops as well as a full-day workshop that cut across workstreams in March of 2022.

The workshop, held in collaboration with Catalyst Management Services at the Indian Institute of Science, brought together LCC commissioners, fellows and experts from diverse sectors of the Indian health system. The participants articulated the paradigm shifts and

The Lancet Citizens’ Commission and collaborators convene to map the way forward for UHC.

As the world enters the third year of the COVID-19 pandemic, all countries have realized the need for health systems that are universal, responsive, equitable, evidence-informed, and resilient. The active engagement of citizens is critical to realizing this goal.

—VIKRAM PATEL

high-level strategies needed to truly reimagine India’s health system and move towards UHC in the coming decades.

A Go-to Healthcare Platform

The Commission has also developed into the “go-to” platform for UHC-related discussions in India with over 100,000 website views. Since May 2020, it has also hosted 11 webinars and 55+ speakers/panelists with over 3,500 attendees. One of the primary audiences of the Commission’s work is the government, as a guiding principle for its vision of UHC is that the state must act as the steward of the health system.

Toward Universal Healthcare Coverage

At the heart of the Commission’s mission is an unprecedented attempt to gather insights into the expectations of healthcare from the people of India – and that of the diverse actors in the health system. It is undertaking two major complementary research efforts: one aims to interview 50,000 citizens of India from 125 districts across all states and territories on questions related to their expectations of health care, and the other study will conduct a district-level, mixed methods approach to interview citizens and health care actors in about 16 districts.

The Commission expects to complete its research by the end of 2022 and to publish a final report in 2023 in The Lancet, laying out its recommendations for the achievement of UHC in India.