India has made significant progress in public health, cutting infant and maternal mortality rates and increasing life expectancy. However, deep structural problems continue to limit access and quality of care, according to The Lancet Commission on a Citizen-Centred Health System for India.

The findings were discussed in a recent Comment by Karthik Muralidharan, economist at the University of California, San Diego, published in The Lancet. Drawing on the Commission’s analysis—produced by a multidisciplinary group of Indian and international health experts—the article highlights persistent weaknesses in the country’s health system despite recent gains.

The Commission identifies fragmented governance, weak coordination across levels of care, and a delivery model centred on facilities rather than patients as the core challenges. These shortcomings, the report argues, disproportionately affect poorer populations and undermine trust in public health services.

A central theme of both the Commission’s study and Muralidharan’s commentary is the dual importance of equity and efficiency. With public health resources constrained, improving the productivity of health spending is framed not as a bureaucratic concern but as a moral imperative. More efficient systems, the analysis suggests, are essential for achieving universal health coverage at scale.

Rather than focusing only on higher spending or new infrastructure, the Commission calls for reforms in governance and implementation. Stronger accountability, better coordination between institutions, and patient-centred service delivery are presented as critical pathways toward universal health care in India.

As debates over health reform continue, the study’s message is clear: sustainable progress will depend not just on how much India spends on health care, but on how effectively the system is organised to serve its citizens.