Universal health coverage (UHC)

Overview

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. 

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 67 in 2019, with the fastest gains in the WHO African Region. However, 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 within-country inequalities. 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.

During COVID-19, 92% of countries reported disruptions to essential services. Some 25 million children under 5 years missed out on routine immunization. There were glaring disparities in access to COVID-19 vaccines, with an average of 24% of the population vaccinated in low-income countries compared to 72% in high-income countries. Potentially life-saving emergency, critical and operative care interventions also showed increased service disruptions, likely resulting in significant near-term impact on health outcomes.  

As a foundation for and way to move towards UHC, WHO recommends reorienting health systems to primary health care (PHC). PHC enables universal, integrated access in everyday environments to the full range of quality services and products people need for health and well-being, thereby improving coverage and financial protection. Most (90%) essential UHC interventions can be delivered through PHC and there are significant cost efficiencies in using an integrative PHC approach. Some 75% of the projected health gains from the SDGs could be achieved 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 should result in measurable health impact in countries. 

Can UHC be measured?

Yes. 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. In the SDG’s, progress on UHC is tracked using two indicators:

• coverage of essential health services (SDG 3.8.1); and
• catastrophic health spending (and related indicators) (SDG 3.8.2).

Detailed data is provided in the WHO Global Health Observatory Data Repository for UHC. 

WHO response

UHC is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all.

As a foundation for UHC, WHO recommends reorienting health systems towards primary health care (PHC). In countries with fragile health systems, WHO focuses on technical assistance to build national institutions and service delivery to fill critical gaps in emergencies. In more robust health system settings, WHO drives public health impact towards health coverage for all through policy dialogue for the systems of the future and strategic support to improve performance.

But WHO is not alone: WHO works with many different partners in different situations and for different purposes to advance UHC around the world.

Some of WHO’s partnerships include:

• UHC2030
• Alliance for Health Policy and Systems Research
• P4H Social Health Protection Network
• UHC Partnership
• Primary Health-Care Performance Initiative
• Global Action Plan for Healthy Lives and Well-being for All (SDG3 GAP)