Introduction
Universal Health Coverage (UHC) stands as a cornerstone of global health, embodying the principle that everyone, regardless of their background or economic status, should have access to essential health services without facing financial ruin. This encompasses a full spectrum of care, from preventative measures and health promotion to treatment, rehabilitation, and palliative care, throughout all stages of life. Achieving UHC is not merely a healthcare goal; it’s a fundamental human right and a critical driver for social, economic, and environmental progress, as recognized by the United Nations’ Sustainable Development Goals (SDGs). The ambition is clear: to ensure health for all, everywhere. However, global progress towards this vital goal has faced significant headwinds, particularly in recent years.
Stagnating Progress and Growing Financial Hardship
While the world witnessed notable advancements in expanding health service coverage up to 2015, this momentum has since faltered. The UHC service coverage index, a key metric for SDG indicator 3.8.1, showed a promising climb from 45 to 68 between 2000 and 2021. However, post-2015, the pace slowed dramatically, with a mere 3-point increase between 2015 and 2021, and no discernible progress after 2019. This stagnation signifies that in 2021, an estimated 4.5 billion people globally were not fully covered by essential health services.
Adding to this concerning trend is the continuous rise in catastrophic out-of-pocket health spending (SDG 3.8.2). This metric, reflecting the proportion of the population facing financial devastation due to health costs, has steadily increased from 9.6% in 2000 to 13.5% in 2019, surpassing 1 billion individuals. The financial burden of healthcare is pushing millions into poverty. In 2019 alone, health expenditures drove 344 million people into extreme poverty and a staggering 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 concerning pattern of service coverage stagnation coupled with escalating financial hardship is not isolated to specific regions or income levels; it’s a global phenomenon impacting countries across the economic spectrum.
Inequalities Persist and the Impact of COVID-19
Beyond the overall stagnation, deep-seated inequalities continue to undermine the pursuit of UHC. National progress often masks significant disparities within countries. For example, access to reproductive, maternal, child, and adolescent health services tends to be skewed, favoring wealthier, more educated, and urban populations, especially in lower-income nations. Financial hardship disproportionately affects vulnerable groups, with catastrophic health spending more prevalent in households with older members. Poorer households, rural communities, and families with elderly members are at greater risk of being plunged into poverty by healthcare costs.
Monitoring and addressing these health inequalities is crucial. It requires identifying and tracking disadvantaged populations to provide policymakers with the evidence needed to develop equity-focused policies and programs that advance UHC for everyone. Improved data collection is essential to shed light on gender disparities, socioeconomic disadvantages, and the specific challenges faced by indigenous populations, refugees, and migrants displaced by conflict, economic instability, and environmental crises.
The COVID-19 pandemic delivered a further blow to global UHC efforts. At the height of the pandemic in 2021, essential health services faced disruptions in a staggering 92% of countries. Even in 2022, a significant 84% of countries still reported ongoing disruptions. Routine immunization suffered, with approximately 25 million children under five missing out on vaccinations in 2021. Vaccine inequity was stark, with low-income countries lagging far behind high-income nations in COVID-19 vaccination rates. Essential emergency, critical, and surgical care interventions also experienced increased disruptions, likely leading to significant negative impacts on health outcomes.
Primary Health Care: A Path to UHC and Resilience
In the face of these challenges, the World Health Organization (WHO) emphasizes reorienting health systems towards a primary health care (PHC) approach as a foundational strategy for achieving UHC and building more resilient health systems. PHC is recognized as the most inclusive, equitable, cost-effective, and efficient pathway to enhance physical and mental health and overall social well-being. It ensures universal and integrated access to a comprehensive range of health services, bringing care closer to where people live and work.
A PHC approach enables the delivery of the full spectrum of quality services and products individuals need for health and well-being, thereby expanding coverage and strengthening financial protection. It also unlocks significant cost efficiencies, with estimates suggesting that 90% of essential UHC interventions can be effectively delivered through PHC. Furthermore, approximately 75% of the projected health gains from the SDGs could be realized through robust PHC systems. This includes the potential to save over 60 million lives and increase global average life expectancy by 3.7 years by 2030. Strengthening health systems based on PHC is not just a recommendation; it is a practical and impactful strategy for measurable health improvement and progress towards UHC.
Measuring Progress and the WHO’s Role
Measuring progress towards UHC is essential for accountability and effective action. The SDG framework provides clear metrics for tracking UHC achievement, focusing on:
- Coverage of essential health services (SDG 3.8.1): This indicator assesses the proportion of the population with access to needed essential health services.
- Catastrophic health spending (and related indicators) (SDG 3.8.2): This tracks the extent to which people face financial hardship due to out-of-pocket health expenditures.
The WHO plays a central role in supporting countries to advance towards UHC. Grounded in the WHO Constitution of 1948, which enshrines health as a fundamental human right, WHO advocates for health for all. It recommends PHC as the bedrock of UHC and provides tailored support to countries based on their health system context. In countries with fragile health systems, WHO focuses on building national institutions and ensuring essential service delivery, particularly during emergencies. In countries with more robust systems, WHO engages in policy dialogue and strategic support to enhance performance and expand health coverage. Through partnerships and collaborative efforts, WHO works with diverse stakeholders globally to drive progress towards UHC, ensuring that everyone, everywhere, can access the healthcare they need without facing financial hardship.
