Lancet introduces Commission for universal health coverage

The Lancet on Friday launched the Lancet Citizens’ Commission on Reimagining India’s Health System, which will work on developing a strategy for implementing universal health coverage (UHC) in India. The work of the commission will begin on Friday with an aim to publish a final report of its findings and recommendations in the next two years.

The Lancet, a global health journal, and the Lakshmi Mittal And Family South Asia Institute, Harvard University, together formulated the commission which will be led by four distinguished health and business leaders—Gagandeep Kang, a professor at the Wellcome Trust Research Laboratory of Christian Medical College, Vellore, and one of India’s leading scientists; Tarun Khanna, Jorge Paulo Lemann Professor, Harvard Business School; Lakshmi Mittal And Family South Asia Institute, Harvard University and Director, Lakshmi Mittal and Family South Asia Institute; Kiran Mazumdar Shaw, CMD, Biocon Ltd and Vikram Patel, Professor in the Department of Global Health and Population at Harvard Medical School and founder of Sangath. They have brought together 13 experts from academia, the scientific community, civil society, and private healthcare to serve with them on the Commission.

The mission of the Lancet Citizens’ Commission is to lay out the path to achieving UHC in India in the coming decade. The commission will take a participatory approach with engagement of all sectors engaged in healthcare and citizens. “We expect that the commission will formulate a roadmap for realising a resilient health system that offers comprehensive, accountable, accessible, inclusive, and affordable quality health care to all citizens in India. Although we recognise the important role that social determinants have in influencing health, the focus of the Commission will be on the architecture of India’s health system…”a commentary in Lancet India said on Thursday.

The commentary also said that despite progress in health indicators such as maternal and infant mortality, disease burden in India is disproportionately high and that less than two-thirds of children were fully immunised in 2017–18, malnutrition and other risk factors for disease and injury are widespread. The commission observed that the Covid 19 pandemic has exposed the weaknesses of India’s health system ranging from inadequate medical supplies and shortage of health care workers in public hospitals to profiteering by private hospitals. “Out-of-pocket payments for health care in India continue to be among the leading causes of poverty for many households… An estimated 400 million people could fall deeper into poverty. In the coming year, as India’s gross domestic product contracts by a projected 10·3%. The pandemic could worsen health disparities since much of the public health system has been redeployed in the Covid-19 response,” the commentary said.

Data from India’s National Health Mission showed there was a 64% decrease in child immunisation, a 50% drop in BCG vaccinations, and a 39% fall in oral polio immunisation in April, 2020, compared with January, 2020.

The commission organised a webinar on Monday where Dr Vinod Paul, member Niti Ayog said Ayushman Bharat and Digital Health Mission have laid the path towards UHC. “A few significant big tickets steps have been taken in the past few years. On the human resource front, I assure you that we will achieve a doctor patient ratio of 1 per 1000 which is the WHO norm by 2024. Our public spending has to increase we made a commitment to go to 2.5% of GDP by 2025 which we will follow through. Our 15TH Finance Commission has also put weight behind it. Two-thirds of spending on health comes from state governments. State spending should be disaggregated,” said Paul, adding: “We have a chronic problem of human resources. Our specialist scarcity is huge. The Commission should think about that granularity. We have 20 to 25% of what we should have. We need five times the number of paediatricians we have today. We cannot do without specialists. The Commission also needs to work on infrastructure. We have just about one bed per 1000 population. Under the national health policy, we aspire to be 2 beds per 1000 population.”

WHO Chief Scientist Soumya Swaminathan said “the index that’s now used was developed years ago which looks at 14 indicators focused on process indicators. We wanted to measure UHC by looking at health outcomes and impact. So instead of focusing on distribution of ORS in primary health centres as a management of childhood diarrhoea, let’s look at mortality incidence ratio for diarrhoea. India could innovate in the measurement system to move ahead. We have proposed a new UHC measuring index.”

Gagandeep Kang said that all stakeholders will be consulted. “Engagement must start with listening to issues, perspectives, goals and preferences of all stakeholders which includes the designers, providers and recipients of healthcare services. In the next year or so we will make sure we use every opportunity to listen and engage so our framing of a reliable, efficient and accountable healthcare system can be realised in ten years.”