In the 1986 budget, V P Singh introduced Modified Value-Added Tax ( MoVAT ) to correct a well known distortion in excise taxation arising from cascading input duties. The measure was presented in technical terms rather than as a headline reform. Its significance lay in eliminating taxes on taxes, thereby strengthening a system-wide public good: efficiency and neutrality of production tax regime.
Public health spending as a share of GDP has remained largely stagnant for two decades. Compounding this is the way money is spent — fragmented across schemes, departments, and line items, with limited flexibility.
A new Lancet paper outlines India’s pathway to universal health care (UHC), spotlighting fragmented governance, weak referrals, and facility-centred delivery as key barriers. It calls for moving beyond silos, citizen-centric reorientation, better primary-tertiary coordination, and stronger implementation capacity.
The Lancet Commission’s landmark report outlines how India can build a rights-based, citizen-centred health system with stronger public care, community engagement, digital tools and financing to achieve universal health coverage by 2047.
This article has been removed on February 13, 2026 after a review process found that certain details and quotes in the story could not be authenticated.
India stands at a pivotal moment in its journey towards universal health coverage (UHC)—a crucial component of the Government’s Viksit Bharat vision to elevate it to the status of a developed country by 2047. This Lancet Commission on a citizen-centred health system for India proposes a transformative approach to India’s health system by placing the needs of citizens front and centre. Drawing on extensive new and existing research, the report’s authors emphasise
The recently released report from the Lancet Commission calls for ‘a citizen-centred and technology driven system’ for Universal Health Care (UHC) in India. Lack of UHC is a worrying problem for a country of 1.4 billion people from various socio-economic groups, large diversity in health care access and under-capacity in health-care infrastructure.
India’s Republic Day, celebrated on Jan 26 with a vast parade on the Kartavya Path in central Delhi, provided the background for The Lancet’s launch of our Commission on a Citizen-Centred Health System for India. The Commission tells a story of remarkable progress during the past 20 years: the National Rural Health Mission, ambitious National Health Policies, a new cadre of health worker (the Accredited Social Health Activist or ASHA),
The Lancet Commission on a Citizen-Centred Health System for India offers a compelling framework to reorient the country’s health architecture around universality, accountability, and trust.
The Lancet Commission on a Citizen-Centred Health System for India presents a timely and comprehensive assessment of India’s health system.
Amarjeet Sinha is a Senior Fellow at the Centre for Social and Economic Progress and a former Secretary, Department of Rural Development, Government of India. A 1983-batch IAS officer (Bihar cadre), he has over four decades of experience in rural development, education, health, and social protection. He played a key role in designing/managing flagship programmes including SSA, NRHM, NRLM, MGNREGS, PMAY-G, and PMGSY. His work focuses on public policy, governance, and poverty reduction.
Dr Vijay Kumar Saraswat is a distinguished scientist with vast experience in defence research—in both basic and applied sciences—spanning several decades.
He retired as Secretary, Defence Research and Development Organisation (DRDO), after decades of government service. He holds a PhD from Osmania University and an ME degree from the Indian Institute of Science.
Dr Saraswat has had an illustrious career and is credited with the indigenous development of missiles such as Prithvi, Dhanush, Prahaar, and Agni-5; the two-tiered Ballistic Missile Defence system; the initial operational clearance of Light Combat Aircraft Tejas; and nuclear submarine INS Arihant.As Secretary, DRDO, Dr Saraswat played a pivotal role in the: (i) establishment of command, control, communication, storage, transportation and deployment infrastructure for strategic nuclear assets to support the Nuclear Doctrine; (ii) flight evaluation of long-range subsonic cruise missile (iii) long-range radars for tracking incoming (enemy) ballistic missiles, command, control and communication network, command centres with decision support system for defending the National Capital Region against ballistic missile threats, (iv) establishment of the Cyber Security Research and Development Centre for developing offensive and defensive technologies for cybersecurity.
As the Homi Bhabha Chair Professor and Consultant to IOCL R&D, Dr Saraswat evolved a roadmap for the development of alternative energy systems such as clean coal technologies; high-efficiency concentrated solar power systems, and bioenergy- and hydrogen-based economy. He is currently the Chairman of Research Advisory Council, IOCL R&D.
As Chairman of NTPC R&D Advisory Council, he prepared a similar alternative energy technology development plan focusing on clean coal technologies and advanced ultra-supercritical thermal power plant to work on efficiencies better than 40% and highly reduced greenhouse emissions.
Dr Saraswat initiated a programme for the development of silicon photonics technology by setting up the Photonics Valley Corporation in Telangana—a Government of Telangana initiative in collaboration with Photonics Inc., USA. This programme is expected to be a gamechanger for the next generation of networks, such as 5G and supercomputers.
As Chairman of the Committee for Development of Indian Microprocessors, he led a team to evolve the configuration of the M-Processor for IOT, Smart Cities and other ICT applications. He also laid out the strategy for development with DieTy, CDAC, IIT(M), IIT(B) and SCL Chandigarh. Two devices have already been developed by IIT(B) and IIT(M).
He has evolved a concept document for setting up the Indian Railway Research Institute (Shresththa) for Indian Railways, which would propel indigenous designs and manufacturing in programmes such as high-speed rail system and dedicated freight corridor and usher in a new era of R&D in the Railways.
As Member, NITI Aayog, Dr Saraswat initiated the ‘Methanol Economy’ programme for transportation, energy generation and production of chemicals and fertilisers, etc. To this end, production agencies, academic institutions and petro-refineries have been brought together to further the cause. As part of the initiative, M-15 gasoline blend, methanol cooking stove, methanol-fuelled propulsion for inland waterways, and methanol-fuelled gensets are being introduced in the country. At the academia and industry levels, R&D in the gasification of high ash content Indian coal has been undertaken.
Dr Saraswat also chaired a committee on technical textiles and prepared a roadmap for the futuristic growth of this sector in India. The plan focused on the promotion of indigenous production of technical textiles and fibres such as carbon and aramid, for strategic and ballistic needs and laid due emphasis on reviving R&D in this sector.
He has also chaired a committee for framing a ‘Roadmap for Make in India in Body Armour’. The excerpts from the committee’s report were later used to frame BIS standards on body armour.
Dr Saraswat led an empowered technical advisory committee for the development of national supercomputing systems. Configuration and strategy for development have been evolved and the programme has been launched as a multi-organisation mission.
He is the recipient of many awards, including the Padma Shri (1998) and Padma Bhushan (2013). He has been conferred an honorary doctorate by more than 25 universities, most recently in 2018 by Jamia Hamdard.
Indu is a former Indian Administrative Service officer and the founding CEO of India’s National Health Authority, where he led the design and rollout of Ayushman Bharat–PMJAY, the world’s largest publicly funded health assurance programme. He also spearheaded the Ayushman Bharat Digital Mission, laying the foundation for India’s digital health infrastructure. Earlier, as Director General at the Asian Development Bank, he oversaw portfolios exceeding USD 25 billion. He holds a PhD in Health Economics from Johns Hopkins University.
Kiran Gopal Vaska is the Joint Secretary & Mission Director (ABDM) at the National Health Authority leading the implementation of India’s flagship schemes The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) and Ayushman Bharat Digital Mission (ABDM). A career civil servant, Mr Vaska, worked at various levels of government beginning at the grass roots level implementing government policies and schemes. Prior to joining NHA, he worked in areas of education, rural development, energy & power, public health and commerce & industries in the state of Madhya Pradesh(MP). As Mission Director of National Health Mission, MP he has implemented government initiatives and coordinated the efforts of various international organizations in order to improve healthcare service delivery in the state. Mr. Vaska holds a Bachelor’s degree in Computer Science from IIT Bombay and Masters degree in Public Administration in International Development from Harvard Kennedy School. He was also the recipient of the Joint Japan-World Bank Graduate Scholarship.
K. Srinath Reddy, a cardiologist and epidemiologist by training, is the founder past President of the Public Health Foundation of India (2006-2022), presently serving as an Honorary Distinguished Professor of PHFI. He is the Chancellor of PHFI Institute of Public Health Sciences (Deemed to be University). He was earlier Head of Cardiology at the All India Institute of Medical Sciences. Prof. Reddy was the first Bernard Lown Visiting Professor of Global Cardiovascular Health at Harvard (2009-13) and is presently an Adjunct Professor at Harvard, Emory, Sydney and Pennsylvania universities.
Dr. Shamika Ravi is currently a member of the Economic Advisory Council to the Prime Minister, and Secretary to Government of India. Previously, Dr. Ravi was Director of Research at Brookings India, Vice President Economic Policy at Observer Research Foundation and Non-Resident Senior Fellow of Governance Studies Program at Brookings Institution. Her research focuses on economics of development including areas of Finance, Healthcare, Urbanization, Gender Equality, and Welfare and Poverty.
Over the last 20 years, Dr. Ravi has taught in post-graduate programmes across India including The Indian School of Business and the BITS School of Management where she teaches Managerial Economics, Game Theory and Microfinance. She publishes extensively in international peer-reviewed academic journals and writes regular opinions pieces in newspapers (English and Hindi) for the wider audience of public policy. Her research work has been featured and frequently cited by leading global media outlets, as well as national and regional newspapers and magazines across India in different languages.
Dr. Ravi has a PhD in Economics from New York University, Masters in Economics from Delhi School of Economics and B.A(H) in Economics from Lady Shri Ram College for Women. She currently lives in Delhi with her husband and two sons.
Richard Horton is Editor-in-Chief of The Lancet. He qualified in physiology and medicine with honours from the University of Birmingham in 1986. He joined The Lancet in 1990, moving to New York as North American Editor in 1993. In 2016, he chaired the Expert Group for the High Level Commission on Health Employment and Economic Growth, convened by Presidents Hollande of France and Zuma of South Africa. From 2011 to 2015, he was co-chair of the UN’s independent Expert Review Group on Information and Accountability for Women’s and Children’s Health. In 2011, he was elected a Foreign Associate of the US Institute of Medicine and, in 2015, he received the Friendship Award from the Government of China. In 2019, he was awarded the WHO Director-General’s Health Leaders Award for outstanding leadership in global health and the Roux Prize in recognition of innovation in the application of global health evidence. In 2021, he received the Physicians for Human Rights Award in recognition of extraordinary leadership in advancing health and human rights. He now works to develop the idea of planetary health – the health of human civilizations and the ecosystems on which they depend. In 2020, he published The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop It Happening Again. A revised, updated, and expanded second edition was published in 2021. As part of the UK’s 2023 Honours, Dr Horton was awarded the Order of the British Empire (OBE) in recognition for services to Health and Medical Journalism.
Mirai Chatterjee is a leader of the Self-Employed Women’s Association (SEWA), a national union that has organised 3.2 million informal women workers in India obtain work and income security, food security and social security. She is the Director of SEWA’s Social Security team including health care, child care and insurance. She is also the Chairperson of the SEWA Cooperative Federation of 112 informal women workers’ cooperatives. She was the General Secretary of SEWA after its Founder, Ela Bhatt.
Mirai serves as Chairperson of the global informal workers and policy-makers network, WIEGO (Women in Informal Employment Globalising and Organising), and is also on the Board of the Schwab Foundation for Social Entrepreneurship, among others. She was advisor to the National Commission for Enterprises in the Unorganized Sector. In addition, she was also a Commissioner in the World Health Organization’s Commission on the Social Determinants of Health and a member of the High-Level Expert Group on Universal Health Coverage set up by the Planning Commission of India in 2010. She is a former member of the National Advisory Council (NAC), appointed by the Prime Minister of India in 2010. Currently she serves on two Lancet Commissions on Oral Health and on Re-Imagining Health Care in India. She was conferred the Global Achievement award by the School of Public Health, Johns Hopkins University. Mirai holds a bachelor in History and Science from Harvard University and a Master’s in Health Sciences from Johns Hopkins University.
Over 30 years of experience in public policy and socio-economic development, with a focus on health.Served as Joint Secretary, Additional Secretary, and Special Secretary, Ministry of Health & Family Welfare, India (2012-2019), including as Mission Director of the National Health Mission, the world’s largest public health program. Currently Director, UHC/Health Systems, WHO South-East Asia Region (2019–present). Recipient of several awards including the UN Inter-agency Task Force Award for contributions to addressing the NCD challenge in India.
Vikram Patel is the Paul Farmer Professor and Chair of the Department of Global Health and Social Medicine at Harvard Medical School. He is a co-founder of the Indian NGO Sangath, recipient of the WHO Public Health Champion of India award, and served on India’s first National Mental Health Policy committee and the WHO High-Level Commission on NCDs.
Tarun Khanna is the Jorge Paulo Lemann Professor, Harvard Business School and Director of the Lakshmi Mittal & Family South Asia Institute, Harvard University. He studies entrepreneurship as a means to social and economic development across the emerging markets, is a co-founder and board member of several technology companies and non-profits across the developing world, and an occasional member of commissions of the Government of India related to education, scientific advance and entrepreneurship.
Dr. Prashanth N Srinivas is a medical doctor and health policy and systems researcher with broad interests in social equity and planetary health. He is with the Institute of Public Health Bengaluru (IPH Bengaluru) since 2009 and is currently the Director. He initiated a long-term Adivasi health program in southern Karnataka in collaboration with NGOs and CBOs. He leads multiple center grants from DBT/Wellcome Trust India Alliance, ICMR & NIHR (UK) and serves as the Vice-Chair of the General Council of ITM Antwerp.
Dr. Pankaj Bhardwaj is Director of ICMR-National Institute for Implementation Research on Non-Communicable Diseases (NIIRNCD), Jodhpur. Previously, he was Professor of Community and Family Medicine, Head, School of Public Health at AIIMS Jodhpur, leading the MPH Program and Executive Program on Public Health Policy, Leadership, and Management. His expertise spans implementation research, geriatrics, NCDs, and tobacco control. A FAMS and FAIMER Fellow, he serves as Editor-in-Chief of the Indian Journal of Community Medicine, with roles in MoHFW, ICMR, WHO committees, and collaborations at LMU Munich, Karolinska Institute, ECDC Stockholm, Public Health Agency of Sweden, and Johns Hopkins University.
Poonam Muttreja is the Executive Director of the Population Foundation of India and for the last 40 years has been a strong advocate of women’s health, reproductive & sexual rights and rural livelihoods. She has co-conceived the popular transmedia initiative, Main Kuch Bhi Kar Sakti Hoon – I, A Woman, Can Achieve Anything. Before joining PFI, she served as the India Country Director of the John D and Catherine T MacArthur Foundation for 15 years and has also co-founded and led the Ashoka Foundation, Dastkar, and the Society for Rural, Urban and Tribal Initiative (SRUTI). An alumna of Delhi University and Harvard University’s John F Kennedy School of Government, Poonam serves on the governing council of several non-governmental organisations, and is a regular commentator in India and globally for television and the print media.
Dr. Anuska Kalita is a health systems expert with over 20 years of experience in the health sector, spanning 12 countries across Asia, Africa, Latin America, and Europe, with a special focus on India. She is currently the Director of India Health Systems at Harvard University. Prior to Harvard, Dr. Kalita has worked in a variety of roles ranging from research and implementation to grant-making and policy with organizations like the Gates Foundation, The World Bank, and the WHO. She has a Doctorate in Public Health from Harvard University.
Dr. Kalita has undertaken large scale health systems and policy research, focusing on health financing, quality of care, primary health care, and political economy of health. Dr. Kalita has been facilitating the National Flagship Course on Health System Strengthening in India for senior IAS officers since 2017, and has co-designed the WHO Academy’s course on Leadership for Primary Health Care that has trained over 200 senior policymakers from across the world.
In addition to these positions, Dr. Kalita has been involved in designing some landmark health policies, most notably India’s National Health Policy (2017), where she participated in the Ministry of Health’s Task Force on Primary Healthcare, and the national ASHA Program, where she was a part of the ASHA Mentoring Group.
Dr. Kheya Furtado is Associate Professor of Healthcare Management at the Goa Institute of Management, India, and leads its Centre for Health Systems Design and Management. An Associate of the Mittal Institute at Harvard University, she was awarded the Bajaj Visiting Research Post-Doctoral Fellowship at Harvard University, Cambridge, Spring 2023. Her expertise spans health systems financing for UHC and public health policy, having been awarded funded projects from the World Health Organization and the Gates Foundation on the Ayushman Bharat PMJAY, state insurance schemes and community health worker payments. Previously with the NITI Aayog, she has led key national health policy initiatives and programmes with the Centre and States. Her doctoral research was carried out under the INSPIRE Fellowship award of the Department of Science and Technology.
Pamela Das joined The Lancet family of journals in 2001. She is currently a Senior Executive Editor at The Lancet, where she primarily oversees the journal’s global health work. Her areas of expertise and interest include infectious diseases and tropical medicine, global health, public health, and international health policy. Her roles include commissioning, managing peer review, writing editorials, and overseeing The Lancet’s Comment and News sections. She is a co-founder and current member of The Lancet’s racial equity group, GRacE. She holds a PhD in Biochemistry and, prior to joining The Lancet, worked as a medical writer and journalist.
Professor Vijay Chandru (PhD MIT) has served on the faculty of engineering at Purdue University and now with interdisciplinary research in digital health at the Indian Institute of Science. An elected fellow of both the Indian academy of sciences and engineering, he is a distinguished alumnus of BITS Pilani and the MIT India program. An inventor of the Simputer, he is a founder of Strand Life Sciences, India’s leading precision medicine solutions company which he led as Executive Chairman from inception in 2000 till retirement in 2018. A technology pioneer of the World Economic Forum since 2006, he served with the IAC of WEF on the future of healthcare from 2014-16. In his work at the Centre for Health Equity and Transparency and OPFORD Foundation, Professor Chandru has been committed to orphan diseases outreach with scalable platforms towards the vision of “no disease orphan by 2030.
Bindu is Chair, Co-Founder, and Managing Trustee of Dvara Holdings, and Founder of Dvara Health Finance. She previously served as Board Chair of Northern Arc Capital (2009–2018) and held leadership roles at ICICI Bank’s microfinance and rural banking groups. She holds degrees in Economics from Madras University, IRMA, and Harvard Kennedy School. Bindu has published extensively, served on RBI and Government of India committees, is an Independent Director on multiple boards, and received the ET Prime Women’s Leadership Award (2020).
Ajay Tandon is Lead Economist in the World Bank’s Health, Nutrition and Population Global Practice, working in the South Asia Region. He previously worked with the research department of the Asian Development Bank in Manila, Philippines. Earlier, he was an economist at the World Health Organization in Geneva working on issues related to measuring health system performance. He has also held visiting research appointments at Oxford University and Harvard University. He received his bachelor’s degree from St. Stephen’s College (India) and a PhD in economics from Virginia Tech (USA).
Soumya Swaminathan is a pediatrician and global health leader with over four decades of experience in clinical care and research. She served as Chief Scientist at the WHO and as DG of the ICMR, Govt. of India. Currently, Chairperson of the M.S. Swaminathan Research Foundation and Principal Advisor to India’s National Tuberculosis Elimination Programme. A Fellow of leading global academies, she has authored more than 480 publications. Her current work focuses on climate change, nutrition, and the health of women and children.
Viren Shetty is the Vice Chairman of Narayana Health, a globally recognized healthcare group dedicated towards making healthcare accessible to all. In his prior role, Viren was responsible for Hospital Operations, Investor Relations, Business Planning, Technology Transformation, and Business Expansion. He is currently leading a program to transform NH into a fully Integrated Healthcare Organization encompassing Hospitals, Health Insurance, Clinics, Daycare centres, and Digital health – both in India and overseas.
Kush M Parmar, M.D., Ph.D., is a Managing Partner at 5AM Ventures and serves on the boards of Ensoma, Entrada (NASDAQ: TRDA), GlycoEra, Precede Bioscience, and Prolynx, with prior board roles across multiple biotech companies. He is on advisory boards of Harvard Medical School, Penn Medicine, Princeton University, and the Grace Science Foundation, and is a Kauffman Fellow. Dr. Parmar trained at Princeton University and Harvard Medical School and is based in Boston.
Sanjay Nagral, MS, FACS, is a Mumbai-based surgeon specialising in hepatopancreatobiliary surgery and Director of Surgical Gastroenterology at Jaslok Hospital & Research Centre. He trained at GS Medical College and KEM Hospital and completed fellowships at King’s College Hospital and the Royal Free Hospital, London. He has over 120 publications, edited surgical textbooks, and serves on ethics and editorial boards, including BMJ. He is publisher of the Indian Journal of Medical Ethics and a noted public health writer.
Sunita Nadhamuni is a Board Member & Advisor at Medtronic LABS and has built health technology systems in India, enrolling over 450 million people across 31 states. Formerly Global Head of Social Innovation at Dell, she led the implementation of the Government of India’s NCD Portal with Tata Trusts. With a decade of Silicon Valley experience, her expertise spans digital public infrastructure, primary healthcare, and government systems. She is Chairperson of Arghyam, a foundation supporting India’s Jal Jeevan Mission for domestic water security.
Nachiket Mor has a PhD in Economics from the University of Pennsylvania. His work is focused on the design of national and regional health systems. He is a Visiting Scientist at The Banyan Academy of Leadership in Mental Health, and a Visiting Professor at the Indian School of Business.
Karthik Muralidharan is the Tata Chancellor’s professor of economics at the University of California San Diego (UCSD). His research spans public finance and development economics with a focus on improving education, health, welfare, and public service delivery; and has been published in several world-leading academic journals including the American Economic Review, Quarterly Journal of Economics, Journal of Political Economy, and Econometrica. He has also actively engaged in policy advising and capacity building in India at both Central and state government levels, and in public communication of research insights through several op-eds and podcasts.
Professor Muralidharan is also the co-founder and scientific director of the Centre for Effective Governance of Indian States, a non-profit organization that works with multiple state governments across India to improve state capacity, governance, and service delivery.
Born and raised in India, he holds a bachelor’s degree in economics from Harvard, an MPhil from Cambridge (UK), and a PhD in economics from Harvard.
Dr. Santhosh Mathew leads on State Execution Capacity and Health Systems Design in India for the Gates Foundation. From 1985 to 2017, he had a career as a civil servant in the Indian Administrative Service. During this time, among other assignments, he served as Additional Chief Secretary for the Government of Bihar, Chair of the National Council for Teacher Education and Joint Secretary in the Ministry of Rural Development, Government of India. From 1994 to 2000, he was Professor of Social Management at India’s Civil Service college in Mussoorie and from 2000 to 2003, Country Director of the Leadership for Environment and Development program in India.
Santhosh holds a PhD in Development Studies from IDS, Sussex, an MSc in Social Research Methods from the University of Sussex, an MA in Economics from the Delhi School of Economics and a BA in Economics from Loyola College, Chennai.
Alok Bansal is Co-founder & Executive Vice Chairman, PB Fintech Limited that owns India’s leading Insurtech brand Policybazaar. The group has recently incubated a healthcare venture to bring payer and healthcare service provider together to enable superior product offering and service to health insurance customers. Prior to PolicyBazaar.com, Alok has worked in various cross-functional roles with Mahindra & Mahindra and GE. He holds an MBA from IIM Calcutta and has a special interest in science & technology and economic empowerment.
As Tata 1mg’s Co-founder, Gaurav drives its consumer businesses and shapes its cutting-edge product and technology strategy. With a background in Computer Science from IIT Delhi and over a decade of experience in the Silicon Valley, he’s pioneering leveraging AI and ML for healthcare. Under his leadership, Tata 1mg is recognized globally for innovation in healthcare tech, reshaping the industry landscape.