The Lancet, established in 1823 in England, is among the most long-standing and influential general medical journals globally. It operates as a weekly publication, featuring peer-reviewed original research articles, review articles, editorials, book reviews, correspondence, news features, and case reports. With editorial offices located in London, New York City, and Beijing, the Lancet continues to be a cornerstone of academic and medical literature. A recently published editorial (dated 13 April 2024) “India’s elections: why data and transparency matter” set the cat among the pigeons by reigniting the debate on the dire state of India’s health infrastructure. Expectedly, government officials rubbished the editorial and claimed that “the country has a robust system which documents births and deaths…”
The Lancet editorial provides insight into the forthcoming Lok Sabha elections, framing it as the largest democratic event in history. With 970 million Indian eligible voters, constituting over 10% of the global population, the 2024 parliamentary elections will take place from April 19 to June 4. Current opinion polls forecast a third consecutive term victory for Prime Minister Narendra Modi and his coalition, the Bhartiya Janata Party. Under Modi’s leadership, India has experienced a remarkable economic surge, albeit with significant disparities. As the economy burgeons to a worth of US$3.7 trillion, projections indicate that India is on track to surpass Japan and Germany, becoming the third-largest economy globally within the next three years. However, “amidst this economic prosperity, the landscape of healthcare in India under the Modi administration tells a contrasting tale.”
Talking about healthcare challenges under Modi’s governance, the Lancet cautions that the healthcare in India has faced considerable challenges during Modi’s tenure, as outlined in this week’s World Report, despite economic advancements, Government expenditure on healthcare has dwindled to a mere 1.2% of the gross domestic product, while out-of-pocket spending remains exorbitantly high. Flagship initiatives aimed at bolstering primary healthcare and universal health coverage have yet to effectively reach those most in need, perpetuating disparities in access and quality of care. “Amidst these acknowledged inequities, India confronts a significant hurdle often overlooked by its citizens – the issue of health data transparency.”
Emphasizing the need for transparent health data, the editorial reiterates the need for accurate and readily available data to be fundamental for informed health policy formulation and management. However, India’s data collection and dissemination efforts have encountered substantial setbacks and barriers. “The delay of the 2021 census due to the COVID-19 pandemic marks the first time in 150 years that India has gone a decade without comprehensive official data. Furthermore, critical national and state-level health surveys, reliant on census data, face postponements and cancellations, depriving policymakers of crucial insights. The dismissal of KS James, the director of the Institution for Population Sciences, amidst allegations of survey result manipulation underscores the severity of the issue. Additionally, discrepancies between India’s COVID-19 mortality figures and international estimates highlight the urgent need for transparent data publication and scrutiny.”
Addressing the data deficit in India, the Lancet points out that the publication of long-awaited reports such as the 2021 Civil Registration report and the Sample Registration System survey findings could offer clarity on India’s health landscape, including COVID-19 mortality rates. However, “the reluctance to release these findings prior to the elections raises questions about the government’s commitment to data transparency. In the absence of recent and reliable data, democratic decision-making is hindered, jeopardizing India’s path towards development and progress.”
Talking about a data-driven future, the Lancet editorial suggests that as India aspires to achieve its vision of becoming a developed nation by 2047 through initiatives like Viksit Bharat 2047, prioritizing investments in healthcare and education is paramount. A robust and transparent data infrastructure is indispensable in realizing this vision and ensuring informed policymaking. Embracing India’s rich scientific heritage, the nation must lead with data, fostering an environment where information is freely accessible and utilized for the collective welfare of its people.
The Union Health Ministry did not comment on Lancet’s editorial. However, government officials responded by emphasizing that India has a robust system in place to document births and deaths under the Registration of Births and Deaths Act, 1969. They highlighted that this system provides a unified, continuous, permanent, compulsory, independent, and universal recording of births and deaths, with over 90% of these events being registered online on state or national portals.
Instead of being indifferent and antagonistic to suggestions from reputed global authorities on health like the Lancet, the government should improve India’s healthcare system by taking the following steps. Increase investment in healthcare infrastructure by constructing new facilities and upgrading existing ones. Allocate more funding for healthcare services and medical research to improve the quality and accessibility of care. Increase the number of healthcare workers by expanding medical schools and training programs. Offer financial incentives to attract professionals to work in underserved areas, addressing the shortage of healthcare providers. Implement targeted programs to increase access to healthcare for marginalized communities, including those living in poverty, lower castes, and women. Provide education and information about healthcare to these groups. Enforce regulations, quality control measures, and transparency to ensure the delivery of high-quality care. Collaborate with other sectors such as education, housing, and sanitation to address the social determinants of health. This holistic approach can reduce health inequities and improve overall population health. Implement better management systems and strengthen regulatory bodies to ensure effective and efficient healthcare services. Establish independent oversight mechanisms to monitor and evaluate healthcare delivery. Recognize the interconnectedness of human, animal, and environmental health. Develop collective health initiatives that promote sustainable climate, healthy animals, and healthy humans, with an integrated approach to healthcare.
By implementing these strategies, India can work towards building a more robust and inclusive healthcare system that meets the needs of all its citizens while addressing current challenges and preparing for future threats.