Universal Health Coverage (UHC) is a concept of paramount importance in global health, aiming to ensure that all people, regardless of their background or economic status, have access to the full spectrum of quality health services they require, without suffering financial hardship. This encompasses a comprehensive range of essential services, from health promotion and disease prevention to treatment, rehabilitation, and palliative care, throughout every stage of life.
The provision of these services relies on a skilled and equitably distributed healthcare workforce at all levels of the health system. These dedicated health and care workers must be adequately supported with access to quality medical products and enjoy decent working conditions to effectively deliver UHC.
Protecting individuals from the financial repercussions of out-of-pocket health expenditures is a critical aspect of UHC. It mitigates the risk of individuals and families being driven into poverty when the cost of essential health services necessitates using up savings, selling assets, or incurring debt. Such financial burdens can devastate futures and impact generations.
Achieving Universal Health Coverage is a central target within the 2030 Sustainable Development Goals (SDGs), adopted by nations worldwide in 2015. The 2019 United Nations General Assembly High Level Meeting on UHC reinforced the understanding that health is not only a fundamental human right but also a prerequisite, outcome, and indicator of sustainable development across social, economic, and environmental dimensions. The World Health Organization’s (WHO) Thirteenth General Programme of Work has set ambitious goals to advance UHC, aiming for 1 billion more people to benefit from it by 2025, alongside broader targets for health emergency protection and overall well-being.
Progress Towards Universal Health Coverage: A Global Snapshot
While the vision of UHC is clear, the reality on the ground reveals a mixed picture. Prior to the COVID-19 pandemic, progress towards UHC was already showing signs of slowing. The encouraging momentum in expanding service coverage witnessed before 2015 lost pace. The UHC service coverage index, a key metric (SDG indicator 3.8.1), saw only a marginal increase, reaching 68 by 2019 and subsequently stagnating at this level through 2021. This stagnation implies that, as of 2021, approximately 4.5 billion people globally were still not fully covered by essential health services.
Furthermore, the proportion of the population facing catastrophic out-of-pocket health spending (SDG 3.8.2) has been on a concerning upward trend. It rose steadily from 9.6% in 2000 to 13.5% in 2019, surpassing the staggering figure of 1 billion people. In 2019 alone, out-of-pocket health costs pushed an estimated 344 million people into extreme poverty and a further 1.3 billion into relative poverty. In total, around 2 billion people experienced some form of financial hardship related to healthcare costs in 2019.
This pattern of stalled progress in service coverage coupled with rising catastrophic health spending is not isolated to specific regions or income levels. It is a global trend observed across various regions, income groups, and the majority of countries, regardless of their economic status.
Inequalities: A Persistent Challenge in Universal Health Coverage
Beyond the overall global trends, inequalities remain a fundamental obstacle in the pursuit of UHC. Even in countries demonstrating national progress in health service coverage, aggregated data often masks significant disparities within their borders. For instance, access to reproductive, maternal, child, and adolescent health services tends to be more readily available to wealthier, more educated individuals residing in urban areas, particularly in lower-income countries.
Financial hardship due to healthcare costs also disproportionately affects vulnerable populations. Catastrophic out-of-pocket health spending is more prevalent among households with elderly members (aged 60 years or over). Poorer households, rural communities, and families with older members are also at a higher risk of being driven deeper into poverty by healthcare expenses.
Addressing these inequalities requires robust monitoring and data collection to identify and track disadvantaged populations. This evidence base is crucial for policymakers to develop equity-focused policies, programs, and practices aimed at the progressive realization of UHC for all. Improved data is also essential to shed light on gender inequalities, socioeconomic disadvantages, and the unique challenges faced by indigenous populations, refugees, and migrants displaced by conflict, economic instability, and environmental crises.
The Impact of COVID-19 on Universal Health Coverage
The COVID-19 pandemic has further exacerbated the challenges facing Universal Health Coverage. At the peak of the pandemic in 2021, essential health services were disrupted in a staggering 92% of countries. Even in 2022, a significant 84% of countries continued to report disruptions. In 2021, approximately 25 million children under the age of five missed out on routine immunizations, a critical component of preventative healthcare.
Furthermore, the pandemic highlighted glaring disparities in access to COVID-19 vaccines. As of June 2023, an average of only 34% of the population in low-income countries had been vaccinated, compared to nearly 73% in high-income countries. Essential emergency, critical, and operative care interventions also experienced increased service disruptions, likely leading to significant negative impacts on health outcomes in the short term.
Primary Health Care: A Foundation for Achieving UHC
Recognizing the need to strengthen health systems and accelerate progress towards UHC, the WHO recommends reorienting health systems around a primary health care (PHC) approach. PHC is considered the most inclusive, equitable, cost-effective, and efficient pathway to improve physical and mental health, as well as overall social well-being.
A PHC-centered approach facilitates universal and integrated access to health services, bringing care closer to people’s everyday environments. It enables the delivery of a comprehensive range of quality services and products that individuals need for health and well-being, thereby improving both service coverage and financial protection. Significant cost efficiencies can be achieved through PHC, with estimates suggesting that approximately 90% of essential UHC interventions can be delivered through this model. Moreover, it is estimated that around 75% of the projected health gains from the SDGs could be realized through PHC, including saving over 60 million lives and increasing average global life expectancy by 3.7 years by 2030.
Strengthening health systems based on PHC is expected to yield measurable positive health impacts in countries worldwide, paving the way for more robust and equitable Universal Health Coverage.
Measuring Progress: How is UHC Tracked?
Yes, progress towards UHC is measurable. The UHC target within the SDGs focuses on assessing countries’ ability to ensure that all individuals receive the necessary healthcare, when and where they need it, without facing financial hardship. This encompasses the complete continuum of essential services, from health promotion to prevention, protection, treatment, rehabilitation, and palliative care.
Progress on UHC is primarily monitored using two key indicators:
- Coverage of essential health services (SDG 3.8.1): This indicator assesses the proportion of people receiving essential health services.
- Catastrophic health spending (and related indicators) (SDG 3.8.2): This indicator measures the proportion of households facing financial hardship due to out-of-pocket health expenditures.
For more detailed information, refer to this questions and answers page.
Comprehensive data is available in the WHO Global Health Observatory Data Repository for UHC. Country-specific profiles can be accessed and downloaded from https://data.who.int/.
Utilizing this data, the WHO publishes global reports on UHC biennially. These reports are available here.
The WHO’s Response to Advance Universal Health Coverage
The commitment to UHC is deeply rooted in the 1948 WHO Constitution, which declares health as a fundamental human right and pledges to ensure the highest attainable level of health for all.
As a cornerstone for UHC, the WHO advocates for reorienting health systems towards primary health care (PHC). In regions with fragile health systems, the WHO prioritizes technical assistance to strengthen national institutions and service delivery, addressing critical gaps particularly during emergencies. In more developed health system contexts, the WHO drives public health impact towards universal health coverage through policy dialogue aimed at shaping future health systems and strategic support to enhance performance.
The WHO recognizes that achieving UHC is a collaborative effort. It actively engages with diverse partners across various situations and for different objectives to promote UHC globally.
Some of the WHO’s key partnerships include collaborations with governments, non-governmental organizations, and international agencies, all working together to realize the vision of Universal Health Coverage – health for all, without financial hardship.
