Lancet Commission Calls for Decentralised Integrated Delivery Systems Linking Primary to Secondary Care

The Lancet Commission report presents a roadmap for India to achieve Universal Health Coverage (UHC) by 2047. It flags systemic challenges in health service delivery and financing, and provides reform suggestions including decentralised integrated delivery systems linking primary care networks to secondary hospitals.

Lancet Commission Report on Universal Health Coverage (UHC) for India

Dimension	Key Details
Report focus	Provides for a roadmap for India to achieve Universal Health Coverage (UHC) by 2047
Fragmented delivery	Siloed vertical disease-specific programmes and lacks coordination between primary, secondary, and tertiary care
Financial hardship	Out-of-pocket health spending remains a major cause of financial strain despite Ayushman Bharat, mainly due to outpatient care and medicine costs.
Quality variations	Comprises a “know-do” gap where providers fail to adhere to clinical protocols, leading to low-value care and poor health outcomes
Epidemiological transition	Rising burden of non-communicable diseases (NCDs) alongside infectious diseases
Empower citizens	Strengthens local governance, improves grievance redressal, increases access to health data, and supports Village Health, Sanitation, and Nutrition Committees.
Public sector reform (IDS)	Decentralized Integrated Delivery Systems (IDS) where modernized primary care networks are linked to secondary hospitals, with each IDS serving a defined population
Align private sector with UHC goals	Moves to capitation and global budgets to promote value-based preventive care, with voluntary insurance covering outpatient care and medicines.
Technology scale-up	Scaling up technology including Ayushman Bharat Digital Mission
Transparent governance	Real-time data for surveillance
Evidence-based refinement	Connecting researchers, policymakers, and providers for evidence-based refinement