Universal Health Coverage (UHC) is a fundamental goal, aiming to ensure everyone has access to quality health services without financial hardship. While the concept is widely endorsed, the reality of implementation varies significantly across the globe. This article explores the current state of universal health care programs worldwide, examining progress, challenges, and key insights into achieving health for all.
The Global Status of Universal Health Coverage
The world is striving towards Universal Health Coverage as part of the Sustainable Development Goals (SDGs), specifically target 3.8, which aims to achieve UHC by 2030. However, recent data reveals that global progress is not on track to meet this ambitious target. While there have been improvements in health service coverage since 2000, this progress has stagnated since 2015. Alarmingly, the proportion of people facing catastrophic health spending has been increasing, indicating significant financial barriers to healthcare. This concerning trend is observed across all regions and the majority of countries, regardless of income level.
Image: A visual representation of people receiving diverse medical attention, symbolizing the broad scope of universal health coverage services.
Between 2000 and 2021, the UHC service coverage index, which measures access to essential health services, increased from 45 to 68. This signifies positive development over two decades. However, the rate of improvement has slowed considerably. Between 2015 and 2021, the index only rose by 3 points, and there has been no change since 2019. This slowdown is a major cause for concern, highlighting the need for renewed efforts to accelerate progress towards UHC.
Despite some progress, a significant portion of the global population remains without full coverage of essential health services. Between 2000 and 2021, the proportion of people not covered decreased by approximately 15%. However, minimal progress has been made after 2015. This means that in 2021, an estimated 4.5 billion people worldwide were still not fully covered by the health services they need. This vast number underscores the immense challenge that remains in ensuring healthcare access for all.
Financial Hardship and the Burden of Healthcare Costs
Beyond service coverage, financial protection is a crucial component of UHC. Unfortunately, the financial burden of healthcare is a major obstacle for billions of people. Around 2 billion people globally are facing financial hardship due to health costs. Within this group, 1 billion are experiencing catastrophic out-of-pocket health spending, meaning their healthcare expenses are so high that they threaten their financial stability. Furthermore, a staggering 344 million people are pushed into extreme poverty because of health costs. These figures highlight the devastating impact of healthcare expenses on individuals and families worldwide, underscoring the urgent need for stronger financial risk protection mechanisms within UHC programs.
Image: A global map visually representing the disparities in healthcare access and the prevalence of financial hardship related to health expenditures across different countries.
The Impact of COVID-19 and Service Disruptions
The COVID-19 pandemic has further exacerbated the challenges to achieving UHC. At the height of the pandemic in 2021, essential health services were disrupted in a staggering 92% of countries. Even in 2022, a substantial 84% of countries continued to report disruptions. These disruptions have had severe consequences, including missed vaccinations and reduced access to critical care. The pandemic has not only highlighted the fragility of health systems but also widened inequalities in access to healthcare, particularly concerning access to COVID-19 vaccines. As of June 2023, only an average of 34% of the population in low-income countries had been vaccinated compared to almost 73% in high-income countries, revealing a significant global disparity.
Primary Health Care: A Path Towards Universal Health Coverage
To overcome these challenges and accelerate progress towards UHC, the World Health Organization (WHO) recommends reorienting health systems towards a primary health care (PHC) approach. PHC is considered the most inclusive, equitable, cost-effective, and efficient way to improve people’s health and well-being. It emphasizes providing essential health services within communities, making healthcare more accessible and integrated into people’s daily lives.
A primary health care approach is capable of delivering approximately 90% of essential UHC interventions. By strengthening PHC systems, countries can achieve significant cost efficiencies and make substantial strides towards UHC goals. It is estimated that approximately 75% of the projected health gains from the SDGs, including saving 60 million lives and increasing global average life expectancy by 3.7 years by 2030, could be realized through a robust focus on primary health care. Investing in and strengthening primary health care is therefore not just a health strategy but also a crucial development strategy for achieving universal health coverage and improving global health outcomes.
Measuring Progress Towards UHC
Measuring progress is essential to track advancements and identify areas needing further attention. The SDG target for UHC utilizes two key indicators:
- Coverage of essential health services (SDG 3.8.1): This indicator measures the proportion of people receiving essential health services.
- Catastrophic health spending (and related indicators) (SDG 3.8.2): This indicator assesses the extent to which people face financial hardship due to out-of-pocket health expenses.
These indicators provide a framework for countries to monitor their progress towards UHC and to identify areas where policy and programmatic adjustments are needed. Regular monitoring and reporting are vital for ensuring accountability and driving continuous improvement in the journey towards health for all.
WHO’s Role in Advancing UHC
The World Health Organization plays a central role in supporting countries to achieve UHC. UHC is deeply rooted in the WHO Constitution of 1948, which recognizes health as a fundamental human right. WHO advocates for reorienting health systems towards primary health care as a cornerstone of UHC. The organization provides technical assistance, particularly to countries with fragile health systems, to strengthen national institutions and service delivery. In countries with more developed health systems, WHO facilitates policy dialogue and strategic support to enhance performance and expand health coverage. Through collaborations and partnerships, WHO works globally to advance the UHC agenda, striving to make health a reality for everyone, everywhere.
References:
- WHO Global Health Observatory Data Repository for UHC
- WHO UHC Global Monitoring Reports
- Q&A on UHC measurement
