Edition 25 | September 20, 2023

Dear Friends,

We are delighted to present to you the next edition of the monthly newsletter by the Lancet Citizens' Commission on Reimagining India’s Health System. This edition brings you a guide to health reform which instructs readers on how to navigate the complex challenges of doing health system reform. It further includes an analysis on how India's growing commercial health insurance (CHI) segment can be reformed to deliver adequate financial protection and good health outcomes, an exploration of the systematic review to examine the technologies for strengthening immunization coverage in India and more. 

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This Month's Highlight

Technologies for strengthening immunization coverage in India: a systematic review

Immunization coverage varies across India in different settings, geographic areas and populations. Technologies for improving immunization access can reduce disparities in coverage. This systematic review, which follows PRISMA guidelines, aims to examine the technologies for strengthening immunization coverage in India, write Nonita Dudeja, Tila Khan , Deepak Thomas Varughese, Sebin George Abraham, Marilyn Mary Ninan, Christie Leya Prasad, Rajiv Sarkar, Gagandeep Kang.

Work from the Commission

Pathways to reimagining commercial health insurance in India

In this paper we explore how India's growing commercial health insurance (CHI) segment can be reformed to deliver adequate financial protection and good health outcomes. We lay out key issues in the demand- and supply-sides of the insurance market that need to be addressed for CHI to be more aligned toward universal health coverage (UHC). On the demand side, we identify a consumer who strays far from the rational actor paradigm and therefore one whose needs require a fundamentally different approach than the one that commercial health insurance in India has so far taken, write Hasna Ashraf, Indradeep Ghosh Nishanth Kumar Anjali Nambiar Sowmini Prasad.

Evolution of community health workers: the fourth stage

Comprehensive primary care is a key component of any good health system. Designers need to incorporate the Starfield requirements of (i) a defined population, (ii) comprehensive range, (iii) continuity of services, and (iv) easy accessibility, as well as address several related issues. They also need to keep in mind that the classical British GP model, because of the severe challenges of physician availability, is all but infeasible for most developing countries, write Nachiket Mor, Bindu Ananth, Viraj Ambalam, Aquinas Edassery, Ajay Meher, Pearl Tiwari, Vinayak Sonawane, Anagha Mahajani, Krisha Mathur, Amishi Parekh and Raghu Dharmaraju.

Views & Opinions 

India’s hidden adversary, lead poisoning

With strong government leadership, financial resources, innovation, and collaboration between private industry, the public sector, and non-governmental organisations, we can control lead contamination of daily-use products, eliminate unsafe lead recycling and smelting, clean up contaminated sites, and manage the safety of drinking water. The return on such investment is enormous: Improved health, increased productivity, higher IQs, reduced violence, and a brighter future for our children, write Indu Bhushan and Soumya Swaminathan.

The pharmacy as a primary care provider

Primary care is an essential component of any health system, but building high-quality primary care has proven to be a challenge for most developing countries. Among the multiplicity of providers in South Asia, one of the most ubiquitous channels through which not only medicines are obtained but also primary care advice is sought is the neighborhood pharmacy, write Nachiket Mor, Dyuti Sen, Sarah Zaheen, Rubayat Khan, Priya Naik, Nayonika Basu,


A Guide to Health Reform: Eight Practical Steps

A Guide to Health Reform: Eight Practical Steps instructs readers on how to navigate the complex challenges of doing health system reform. The Guide builds on the 2004 book Getting Health Reform Right: A Guide to Improving Performance and Equity (GHRR), which presents a framework for understanding and achieving successful health reform. The GHHR framework (also known as the “control knob” model) is the foundation of this Guide’s Eight Practical Steps. The step-by-step guidance is presented in easy-to-read language and general terms, so that government policy makers, analysts, advisors, advocates and other stakeholders in any country can use the Guide to plan and implement health reform. The Eight Steps are: 1) Decide to start the health reform process; 2) Create a health reform team; 3) Assess the health system’s performance and define its performance problems; 4) Diagnose the causes of performance problems; 5) Decide on a reform package; 6) Conduct political analysis and design political strategies; 7) Manage the implementation of health reform to achieve results; and 8) Evaluate impacts and create sustainability for health reform, write Michael R. Reich, Paola Abril Campos, Anuska Kalita, Anya Levy Guyer, and Winnie Yip.

Featured Partner

The Population Council Institute seeks to improve the well-being and health of current and future generations in India and to help achieve a humane, equitable and sustainable balance between people and resources. The Population Council Institute is providing research support to the cross-workstream district-level study on pathways to UHC.

Help us develop a roadmap to achieve universal health coverage in India by visiting our website: https://www.citizenshealth.in/

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We love hearing back from you! Please send your comments, suggestions, and contributions for these newsletters, including research highlights and published features to citizenhealthin@gmail.com

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