Most are likely to agree that the accompanying call for action 1 Reddy KS Patel V Jha P Paul VK Shiva Kumar AK Dandona L for The Lancet India Group for Universal HealthcareTowards achievement of universal health care in India by 2020: a call to action. Lancet. 2011; (published online Jan 12.)https://doi.org/10.1016/S0140-6736(10)61960-5 Summary Full Text Full Text PDF Scopus (229) Google Scholar towards achieving universal health care in India by 2020 (hereafter referred to as the call) is timely and overdue. However, we disagree with the call in two crucial areas. Towards achievement of universal health care in India by 2020: a call to actionTo sustain the positive economic trajectory that India has had during the past decade, and to honour the fundamental right of all citizens to adequate health care, the health of all Indian people has to be given the highest priority in public policy. We propose the creation of the Integrated National Health System in India through provision of universal health insurance, establishment of autonomous organisations to enable accountable and evidence-based good-quality health-care practices and development of appropriately trained human resources, the restructuring of health governance to make it coordinated and decentralised, and legislation of health entitlement for all Indian people. Full-Text PDF Continuing challenge of infectious diseases in IndiaIn India, the range and burden of infectious diseases are enormous. The administrative responsibilities of the health system are shared between the central (federal) and state governments. Control of diseases and outbreaks is the responsibility of the central Ministry of Health, which lacks a formal public health department for this purpose. Tuberculosis, malaria, filariasis, visceral leishmaniasis, leprosy, HIV infection, and childhood cluster of vaccine-preventable diseases are given priority for control through centrally managed vertical programmes. Full-Text PDF Reproductive health, and child health and nutrition in India: meeting the challengeIndia, with a population of more than 1 billion people, has many challenges in improving the health and nutrition of its citizens. Steady declines have been noted in fertility, maternal, infant and child mortalities, and the prevalence of severe manifestations of nutritional deficiencies, but the pace has been slow and falls short of national and Millennium Development Goal targets. The likely explanations include social inequities, disparities in health systems between and within states, and consequences of urbanisation and demographic transition. Full-Text PDF Chronic diseases and injuries in IndiaChronic diseases (eg, cardiovascular diseases, mental health disorders, diabetes, and cancer) and injuries are the leading causes of death and disability in India, and we project pronounced increases in their contribution to the burden of disease during the next 25 years. Most chronic diseases are equally prevalent in poor and rural populations and often occur together. Although a wide range of cost-effective primary and secondary prevention strategies are available, their coverage is generally low, especially in poor and rural populations. Full-Text PDF Health care and equity in IndiaIn India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. Full-Text PDF Human resources for health in IndiaIndia has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas. Bringing qualified health workers to rural, remote, and underserved areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Full-Text PDF Financing health care for all: challenges and opportunitiesIndia's health financing system is a cause of and an exacerbating factor in the challenges of health inequity, inadequate availability and reach, unequal access, and poor-quality and costly health-care services. Low per person spending on health and insufficient public expenditure result in one of the highest proportions of private out-of-pocket expenses in the world. Citizens receive low value for money in the public and the private sectors. Financial protection against medical expenditures is far from universal with only 10% of the population having medical insurance. Full-Text PDF Department of ErrorSengupta A, Prasad V. Towards a truly universal Indian health system. Lancet 2011; 377: 702–03—The print version of this Comment (Feb 26) contained the wrong DOI. The correct DOI is 10.1016/S0140-6736(10)62043-0. The online version of the Comment is correct. Full-Text PDF