A paper published in The Lancet calls for a radical transformation in the architecture of India's healthcare delivery system, if the country is to achieve the government's vision of assuring health for all.

The paper, authored by Professor Vikram Patel (Public Health Foundation of India and London School of Hygiene & Tropical Medicine) and colleagues, documents India's progress on major health indicators in the past decade, but also its many deficiencies; it identifies the structural problems with the health care system, and reasserts the recommendations of previous expert groups on the need for a radical new vision for India's health care delivery system.

The most disturbing indicator of the deficiencies of the Indian health care system is the observation that health care costs are driving millions into poverty. The authors argue not only for more resources, but for an integrated national health care system, built around a strong public primary care system with a clearly defined supportive role for the private and indigenous sectors, that (i) addresses acute as well as chronic health care needs; (ii) offers choice of care that is rational, accessible, and of good quality, (iii) is cashless at the point of service delivery, and (iv) is governed by a robust regulatory framework to ensure accountability.

The paper records the considerable efforts being made in the health sector, with national and local governments investing in targeted disease control programmes and the National Health Mission focusing on maternal and child health. Despite this, a variety of structural weaknesses have led to a situation where India's health system performance is unable to cope with the enormous demands placed on it by the country's growing population. According to the paper, India continues to lag behind regional neighbours especially on health indicators like mortality rates for children aged under five years, with India recording 27% of all neonatal deaths and 21% of all child deaths in the world. Chronic nutrition deficiency manifesting as stunting continues to affect a third of children under five years. Compounding this burden is the large and rapidly rising burden of non-communicable and chronic conditions.