The public sector is the only health system in India with a presence at every level of healthcare—from the remotest communities to the largest hospitals. With its widespread network of providers and the enormous resources at its command, it is well placed to offer not only Universal Health Coverage (UHC) but also good health for all. However, while this has happened in several countries globally such as Thailand and Sweden, in India, even after 70 years of its existence, there is no state where the public sector currently offers free, comprehensive, high-quality health care and ensures the good health of the entire population, demonstrating the need to reform public health in India.

The Lancet Commission on a Citizen Centred Health System for India, established in 2020, is a cross-sectoral endeavour to lay out the roadmap to achieving universal health coverage for the people of India.

A guiding principle of the commission was that achieving structural change towards UHC requires consultative and participatory engagement with all sectors involved in health care, especially India’s citizens.

Guided by this principle, extensive research, and multiple consultation with experts, the commission identifies six reform actions for building a citizen-centred health system in India:

  1. Enable meaningful citizen engagement by firmly building the health system upon people’s participation.
  2. Implement a citizen-centred health system through financing, purchasing, and service-delivery reforms in the public sector.
  3. Engage the private sector to align with UHC goals.
  4. Invest in and scale up diverse technologies to catalyse all the reforms needed for UHC.
  5. Enable transparent and accountable governance of the entire health system through decentralisation and strengthened regulatory capacities.
  6. Foster a learning health system by embedding reflexivity, participatory approaches, and leadership that champions continuous learning and improvement.

This article explores the second and perhaps the most important recommendation of the commission: reforming the public sector.

Getting to the Root of the Problem with Reforming Public Health in India: Why Is the Public Sector Unable to Deliver UHC?

The problems of the public sector are usually attributed to insufficient financing, weak incentives, inadequate skills, or insufficient monitoring. It is important to begin the exploration of why the public sector is unable to deliver UHC by recognising that, while additional financial resources are always welcome, inadequate funding of the public sector may no longer be as significant an issue as it once was.

Read the full article about reforming public health in India by Nachiket Mor at India Development Review.