Image courtesy Lancet Citizens’ Commission.
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. A guiding principle for this Commission is that structural change towards UHC can only be attained through consultative and participatory engagement with the diverse sectors involved in health care and, most importantly, with India’s citizenry. To this end, the Commission has brought together leaders from academia, the scientific community, civil society, and private healthcare to spearhead this effort. The aim now is to go beyond the traditional boundaries of expertise to actively engage stakeholders whose voices have rarely been heard in previous reports: those who deliver healthcare and those who receive it.
The Launch of the Commission
The Commission was launched on December 11, 2020, with a commentary published in the Lancet, laying out the aims and guiding principles of the Commission. The launch event hosted a panel of three leading voices in healthcare: K. Vijay Raghavan, Principal Scientific Advisor of the Government of India; Soumya Swaminathan, Chief Scientist at the World Health Organization (WHO); and V.K. Paul, Member of NITI Aayog. The video of the launch can be seen here.
The devastating second wave of COVID-19 in India in summer 2021 slowed the momentum of the Commission and stirred it to formulate and suggest urgent measures that the government needed to take to mitigate the working crisis. The Comment on COVID-19 Resurgence in India was published on May 25, 2021. 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.” The Comment received extensive coverage from Indian media and was appreciated by the Chief Economic Advisor of the Government of India.
Image courtesy Lancet Citizens’ Commission.
Commission’s Workstreams
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 to address in relation to the workstream that is being addressed through diverse research activities. The backbone of the Commission is a series of Theory of Change Workshops to map pathways for achieving UHC, charting the final goals, outcomes, and impact of each of the workstreams and the Commission as a whole. The Commission has conducted five Theory of Change workshops with Commission members and experts in each workstream and now has a full-day workshop cutting across the work-streams planned in Bengaluru for March 10, 2022.
Image courtesy Lancet Citizens’ Commission.
Looking Ahead
A series of scoping reviews are in progress to synthesize the evidence on a range of questions generated by the workstreams, such as barriers to UHC, health care experiences, and effective best practices. At the heart of the Commission is an unprecedented attempt to gather insights into the expectations of healthcare from citizens across gender, age, geographic location and social groups – and that of the diverse actors in the health system, from ASHA to private doctors – through two major complementary research efforts. One study will conduct a district-level, mixed methods approach to interview citizens and health care actors in 15 districts, purposely selected to represent the full range of attainment of UHC based on scores on an index which has been estimated for all of India’s 700+ districts. Second, the Commission will conduct a citizens’ survey this coming summer, aiming to obtain responses from a representative sample of 50,000 citizens of India, drawn from 125 districts across all states and territories on questions related to their expectations of health care.
The Commission is also developing into the “go-to” platform for UHC-related discussions in India. Key to this public engagement is our website (www.citizenshealth.in) ,which has had over 100,000 views since its launch. We have hosted 10 webinars since May 2021 on diverse topics, which have had 55+ speakers/panelists and over 3,500 attendees. The Commission’s social media handles have over 3,000 followers, and our monthly e-newsletter has over 3,500 subscribers. Over 100 articles and op-eds have been written by Commissioners or about the Commission. The Commission has engaged with governments at various levels, keeping in regular touch with key persons in various ministries and departments. The Commission is taking close note of efforts being made by the government at both central and state levels (such as the NITI Aayog initiative on integrated medicine) and will continually consult with colleagues at all levels of government. Indeed, one of the primary audiences of the Commission 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.
The Commission expects all the research to be completed by the end of 2022 and, besides the many publications expected to arise from this research, hopes to publish the final report (in the Lancet) laying out its recommendations for the achievement of UHC in 10 years in 2023.