Universal health coverage (UHC)

Key facts

• The UHC service coverage index (SDG indicator 3.8.1) increased from 45 in 2000 to 68 in 2019.
• About 2 billion people are facing catastrophic or impoverishing health spending (SDG indicator 3.8.2).
• Inequalities continue to be a fundamental challenge for UHC as aggregated data masks within-country inequalities in service coverage.
• The COVID-19 pandemic further disrupted essential services in 92% of countries at the height of the pandemic in 2021. In 2022, 84% of countries still reported disruptions.
• To build back better, WHO’s recommendation is to reorient health systems using a primary health care (PHC) approach. Most (90%) of essential UHC interventions can be delivered through a PHC approach, potentially saving 60 million lives and increasing average global life expectancy by 3.7 years by 2030.

Overview

Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. It covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

The delivery of these services requires health and care workers with an optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality assured products, and enjoying decent work.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children.

Achieving UHC is one of the targets the nations of the world set when they adopted the 2030 Sustainable Development Goals (SDGs) in 2015. At the United Nations General Assembly High Level Meeting on UHC in 2019, countries reaffirmed that health is a precondition for and an outcome and indicator of the social, economic and environmental dimensions of sustainable development. WHO’s Thirteenth General Programme of Work aims to have 1 billion more people benefit from UHC by 2025, while also contributing to the targets of 1 billion more people better protected from health emergencies and 1 billion more people enjoying better health and well-being. 

Progress towards UHC

Prior to the COVID-19 pandemic, there was worldwide progress towards UHC. The UHC service coverage index (SDG indicator 3.8.1) increased from 45 in 2000 to 68 in 2019, with the fastest gains in the WHO African Region. However, about 2 billion people are facing catastrophic or impoverishing health spending (SDG indicator 3.8.2).

Inequalities continue to be a fundamental challenge for UHC. Even where there is national progress on health service coverage, the aggregate data mask inequalities within countries. For example, coverage of reproductive, maternal, child and adolescent health services tends to be higher among those who are richer, more educated, and living in urban areas, especially in low-income countries. On financial hardship, people living in poorer households and in households with older family members (those aged 60 and older) are more likely to face financial hardship and pay out of pocket for health care.  Monitoring health inequalities is essential to identify and track disadvantaged populations in order to provide decision-makers with an evidence base to formulate more equity-oriented policies, programmes and practices towards the progressive realization of UHC. Better data also are needed on gender inequalities, socioeconomic disadvantages, and specific issues faced by indigenous peoples and refugee and migrant populations displaced by conflict and economic and environmental crises.

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