Lancet Commission Report on Citizen-Centred Health System for India

Context: The Lancet Commission report (Jan 2026) gives a roadmap for India to achieve Universal Health Coverage (UHC) by 2047.

Key Problems Identified

1. Fragmented system: Health services run in silos (disease-wise) with poor linkage between primary, secondary, and tertiary care.
2. High out-of-pocket expenditure (OOPE): Even with Ayushman Bharat, people spend heavily on outpatient care, medicines, and diagnostics.
3. Poor quality of care: “Know–do gap” — doctors often do not follow standard treatment guidelines.
4. Changing disease burden: Rising NCDs along with infectious diseases.

Major Recommendations

1. Empower citizens:

oStrengthen local bodies (VHSNCs), grievance redressal, and access to health data.

1. Reform public health system:

oCreate Integrated Delivery Systems (IDS) linking primary care with secondary hospitals for a defined population.

1. Align private sector with UHC:

oMove from fee-for-service to capitation/global budgets.

oExpand insurance to cover outpatient care and medicines.

1. Other measures:

oScale up Ayushman Bharat Digital Mission.

oUse real-time data for transparency and surveillance.

oPromote evidence-based policymaking.

5. Global Water Bankruptcy – UN University Report

Context: The UN University Institute for Water, Environment and Health (UNU-INWEH) released a report on 21 January 2026, warning that the planet has entered the era of Global Water Bankruptcy.

What is Water Bankruptcy?

• A long-term, post-crisis condition where water use exceeds renewable supply and safe depletion limits.
• Results in irreversible or near-irreversible damage to water systems.

Unlike short-term shortages, recovery is not realistically possible.

Key Findings: Large parts of Earth’s water and natural capital are damaged beyond full recovery: Rivers, Lakes, Aquifers, Wetlands, Soils, Glaciers

Difference: Key Concepts

1Water Stress:

oHigh demand vs limited supply

oReversible impacts

1. Water Crisis:

oSudden shock (drought, flood, conflict)

oSystems can recover with emergency measures

1. Water Bankruptcy:

oChronic overuse + ecological damage

oIrreversible degradation

Factors Leading to Water Bankruptcy

1. Slow-onset depletion

oContinuous overuse of surface and groundwater

oEarly warning signs ignored until tipping points crossed

1. Infrastructure-driven overshoot

oLarge dams and inter-basin transfers allow expansion beyond sustainable limits

1. Ecological liquidation

oDestruction of wetlands, floodplains, forests, and soils

oShort-term gains at the cost of long-term water storage and filtration

1. Climate-amplified overshoot

oClimate change reduces reliable supply and increases variability in already stressed systems