Reimagining India’s health system for future challenges

The launch of the Lancet Commission on Reimagining India's Health System late January prompted the question:

- Indu Bhushan

Are we building a health system for yesterday's diseases or tomorrow's India? India's health challenge is not just about paying for care, but ensuring that people are guided through the system with dignity and continuity.As the founding CEO of Ayushman Bharat, I have witnessed both the promise and the limitations of health reform firsthand. When the scheme was launched in 2018, many doubted whether India could pull off the world's largest government-funded health assurance programme. Eight years on, the outcomes are hard to ignore. More than 10 crore hospital treatments have been provided, and by one estimate, households have saved nearly ₹2 lakh crore in out-ofpocket expenditure.

India's health outcomes have undoubtedly improved over the decades. Life expectancy has increased, maternal and child mortality have declined, and several infectious diseases are better controlled. Yet progress has slowed, and gains remain deeply unequal. A child born in a poor district or marginalised community still faces far worse health prospects than one born into an urban middle-class household. At the same time, noncommunicable diseases and mental health conditions are rising steadily, while the climate crisis and antimicrobial resistance pose new and serious risks.