Understanding Universal Health Coverage (UHC)
Universal Health Coverage (UHC) is more than just a concept; it’s a commitment to ensuring that everyone, everywhere, can access the health services they need without facing financial ruin. This encompasses a complete spectrum of essential services – from preventing illnesses and promoting well-being to treatment, rehabilitation, and palliative care, throughout all stages of life. At its core, UHC is about equitable access to quality health care, delivered by skilled health workers who are well-equipped and supported. It’s also about safeguarding individuals from the financial burdens that can arise from seeking medical care, preventing them from being pushed into poverty due to health expenses.
The pursuit of UHC is a global priority, enshrined in the 2030 Sustainable Development Goals (SDGs). Recognized as both a prerequisite for and a marker of sustainable development, UHC was further emphasized at the 2019 United Nations General Assembly High Level Meeting. The World Health Organization (WHO) is actively working towards a global goal: to ensure one billion more people benefit from universal health coverage by 2025, contributing to broader targets of global health security and well-being.
The Current Status of UHC Progress
While there was notable advancement in expanding health service coverage up to 2015, this momentum has significantly slowed. The UHC service coverage index, a key metric (SDG indicator 3.8.1), has only marginally increased since 2015, reaching 68 in 2019 and stagnating at this point through 2021. This plateau indicates that, as of 2021, approximately 4.5 billion people worldwide are not fully covered by essential health services. Simultaneously, the proportion of individuals experiencing catastrophic out-of-pocket health spending (SDG 3.8.2) has steadily risen, reaching 13.5% in 2019, affecting over a billion people. Alarmingly, in 2019, health expenditures drove 344 million people into extreme poverty and an additional 1.3 billion into relative poverty. In total, around 2 billion people globally faced some form of financial hardship related to health costs in 2019.
This concerning trend of slowed service coverage improvement coupled with increasing financial strain from health costs is not isolated; it’s a consistent pattern across all regions globally, affecting countries across different income levels.
Persistent Inequalities in Access
A critical challenge in achieving Universal Health Care is addressing deep-seated inequalities. Even in countries showing overall progress in health service coverage, disparities within nations are often masked by aggregate data. For instance, access to reproductive, maternal, child, and adolescent health services tends to be significantly higher for wealthier, more educated individuals in urban areas, particularly in lower-income countries. Financial hardship due to health costs also disproportionately affects vulnerable populations. Catastrophic out-of-pocket spending is more prevalent in households with elderly members (60 years and older). Furthermore, poorer households, rural communities, and families with older members are at a higher risk of being driven deeper into poverty by health expenditures.
Monitoring and addressing these health inequalities is crucial. It provides essential data to identify and support disadvantaged populations, enabling policymakers to create more equitable health policies and programs aimed at the progressive realization of UHC. Improved data collection is also necessary to better understand and address gender inequalities, socioeconomic disparities, and the specific health challenges faced by indigenous populations, refugees, and migrants displaced by conflict and crises.
The Impact of COVID-19 on Universal Health Care
The COVID-19 pandemic has severely disrupted progress towards universal health care. At the height of the pandemic in 2021, a staggering 92% of countries reported disruptions to essential health services. Even in 2022, 84% of countries were still experiencing these disruptions. Routine immunizations were significantly impacted, with an estimated 25 million children under five missing vaccinations in 2021. Vaccine inequity was also glaringly apparent, with low-income countries lagging far behind high-income nations in COVID-19 vaccination rates. Disruptions extended to critical emergency, intensive, and surgical care, likely leading to significant negative impacts on health outcomes in the immediate future.
Primary Health Care: A Path Forward for UHC
The World Health Organization (WHO) advocates for a primary health care (PHC) approach as a fundamental strategy for achieving universal health coverage and building more resilient health systems. PHC is recognized as the most inclusive, equitable, cost-effective, and efficient path to improve physical and mental health, as well as overall social well-being. It facilitates universal and integrated access to a comprehensive range of health services, bringing care closer to where people live and work. By delivering the necessary quality services and products, PHC enhances both health coverage and financial protection. Crucially, a PHC approach can deliver approximately 90% of essential UHC interventions, offering significant cost efficiencies. It is estimated that strengthening PHC could achieve around 75% of the projected health gains from the SDGs, potentially saving 60 million lives and increasing global average life expectancy by 3.7 years by 2030. Investing in and strengthening health systems based on primary health care is therefore essential to achieve tangible improvements in population health and progress towards UHC.
Measuring Progress Towards Universal Health Care
Measuring progress towards UHC is indeed possible and crucial for accountability and effective policy-making. The SDG framework for UHC focuses on assessing countries’ abilities to provide necessary health care to everyone, regardless of location or financial status. This assessment encompasses the full spectrum of essential health services, from health promotion and disease prevention to treatment, rehabilitation, and palliative care. Two key indicators are used to track UHC progress:
- Coverage of essential health services (SDG 3.8.1): This measures the proportion of people receiving needed essential health services.
- Catastrophic health spending (and related indicators) (SDG 3.8.2): This tracks the number of people facing financial hardship due to out-of-pocket health expenses.
For more detailed information, refer to the WHO’s Q&A document on UHC.
Comprehensive data is available in the WHO Global Health Observatory Data Repository for UHC. Country-specific profiles can be accessed at [https://www.who.int/data/gho/data/themes/universal-health-coverage/country-profiles).
The WHO regularly publishes global reports on UHC every two years, providing in-depth analysis and progress updates. These reports can be found here.
The WHO’s Commitment to Universal Health Care
The World Health Organization (WHO) is deeply committed to universal health care, grounded in the principles of the 1948 WHO Constitution, which recognizes health as a fundamental human right. WHO advocates for reorienting health systems towards primary health care (PHC) as the foundation for achieving UHC. In countries with fragile health systems, WHO provides technical assistance to strengthen national institutions and service delivery, particularly in crisis situations. In countries with more developed health systems, WHO focuses on driving public health impact through policy dialogue and strategic support aimed at improving system performance and expanding health coverage to all.
Recognizing that achieving UHC is a collaborative effort, WHO actively partners with diverse organizations across various sectors and contexts to advance universal health care globally. These partnerships are crucial in mobilizing resources, expertise, and collective action towards the shared goal of health for all.
