Inequitable Distribution of Healthcare Personnel a Critical Challenge, Says Lancet Commission Co-Chair Vikram Patel
In a significant interview, Vikram Patel, Commission co-chair and professor at Harvard Medical School, has underscored the persistent inequitable distribution of healthcare personnel as a major challenge in India's pursuit of universal health coverage (UHC). Speaking from Pune, Patel emphasized that while India has made strides in political will, funding, and public awareness for UHC, deep-seated issues remain.
Shift in Barriers to Universal Health Coverage
According to the latest findings of the Lancet Commission, the conventional narrative of barriers to UHC has fundamentally shifted. Patel notes that challenges are no longer primarily driven by a lack of political will, underfunding, inadequate human resources, or lack of awareness. Instead, key obstacles now include uneven quality of care, inefficiencies in spending, fragmented delivery, inadequate design and implementation of financial protection programmes, and poor governance.
The Commission advocates for a rights-based approach to health, promoting a healthcare delivery system grounded in comprehensive primary health care. It calls for increased people's participation in the planning, delivery, and monitoring of health services. Strategies recommended include empowering structures for community participation, making health system performance data publicly available, and supporting citizens through efficient resource hubs and effective grievance redressal systems.
Call for an Integrated, Citizen-Centred System
Patel identifies the single most important call to action as the establishment of an integrated, citizen-centred health-care delivery system that is publicly financed and publicly provided. This system should serve as the primary vehicle for UHC, while shaping the private sector to leverage its strengths. He highlights that despite large-scale government initiatives like Ayushman Bharat Pradhan Mantri Jan Arogya Yojana, Ayushman Arogya Mandirs, and the e-Sanjeevani telemedicine platform, citizens often face fragmented care from myriad providers, particularly for chronic conditions such as diabetes or mental illness.
At the heart of transforming India's health system, Patel stresses a commitment to accountability and integrity by all actors. Practical steps include permeating every corner of the health system, beginning with the training of healthcare providers and ensuring high-quality primary care for every citizen. The Commission also recommends major reforms in healthcare financing and governance, empowering state, district, and local government institutions to design and implement responsive reforms and be accountable to their communities.
Concerns Over Healthcare Personnel Distribution
Addressing the adequacy of medical personnel, Patel reveals that as of 2023–24, India's MBBS doctor to population ratio was 1:1,263. With AYUSH physicians included, this ratio improves to 1:834, marking an increase of over 40% since 2010. Similarly, there has been a dramatic rise in the numbers of nurses and other healthcare providers.
However, Patel expresses concern that this massive expansion in training capacity has been marred by variations in the quality of education provided. More critically, he points to the inequitable distribution of healthcare personnel, with an over-supply in some regions and too few in others. This disparity poses a significant hurdle to achieving equitable access to healthcare across the country.
Role of Technology and Continuous Learning
The Commission recognizes the unique role of technologies in catalysing governance within the health system. Patel calls for a system that continuously learns from and shares health system data, collaborating in learning networks with other health systems across India. This approach aims to foster innovation and improve outcomes through data-driven insights and shared best practices.
In summary, while India stands at a historic inflection point in its health system development, challenges like inequitable distribution of healthcare personnel and fragmented care delivery must be addressed. Patel's insights underscore the need for an integrated, accountable, and publicly supported framework to realize the goal of universal health coverage for all citizens.
