A new joint report from the World Health Organization (WHO) and the World Bank Group reveals that while significant progress has been made towards achieving universal health coverage (UHC), considerable challenges remain. The report highlights advancements in health service coverage and reductions in financial hardship linked to health costs, but it underscores that millions are still left vulnerable.
The UHC Global Monitoring Report 2025 indicates that between 2000 and 2023, the Service Coverage Index (SCI) rose from 54 to 71 points. Additionally, the proportion of individuals facing financial hardship due to large out-of-pocket (OOP) health payments decreased from 34% to 26% from 2000 to 2022. Despite these improvements, it is essential to note that around 1.6 billion people have been further pushed into poverty due to unaffordable health expenses.
The report emphasizes that approximately 4.6 billion people worldwide still lack access to essential health services. Furthermore, around 2.1 billion individuals experience financial hardship when seeking healthcare, with a significant number of these individuals already living in poverty. “Universal health coverage is the ultimate expression of the right to health, but this report shows that for billions of people who cannot access or afford the health services they need, that right remains out of reach,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.
Financial Hardship and Health Costs
Financial hardship is defined as spending more than 40% of a household’s discretionary budget on OOP health expenses. The cost of medicines is a significant contributor to this burden, accounting for at least 55% of OOP expenses in three-quarters of countries with available data. For those living in poverty, the situation is even more dire, with a median of 60% of their OOP health expenses directed toward medications, diverting funds from other essential needs.
Although the burden of health costs primarily affects poorer populations, it also impacts wealthier segments, particularly in middle-income countries where health expenses take up a substantial portion of their budgets. Without accelerated progress, the goal of achieving full service coverage without financial hardship may remain unattainable for many. The global SCI is projected to reach only 74 out of 100 by 2030, indicating that nearly one in four people worldwide will continue to face financial hardship as the Sustainable Development Goals (SDG) era concludes.
Despite the positive trajectory, the report notes a slowdown in progress since 2015, with only one-third of countries demonstrating improvements in both health coverage and reductions in financial hardship. All WHO regions have reported increased service coverage, but only half—specifically Africa, South-East Asia, and the Western Pacific—have also seen decreases in financial hardship. Low-income countries have made the most significant gains in both areas but still face substantial gaps.
Ongoing Inequalities and the Path Forward
The increase in health service coverage has been primarily driven by advancements in infectious disease programs. While there have been steady improvements in coverage for noncommunicable diseases (NCDs), progress in reproductive, maternal, newborn, and child health has been modest. Improved sanitation has also contributed to gains in service coverage. Meanwhile, inclusive economic growth, rising incomes, and stronger social protection mechanisms have played a role in reducing poverty, particularly in low-income countries, thus contributing to declines in financial hardship.
Despite these advancements, persistent gaps and inequalities are on the rise. In 2022, approximately 75% of individuals in the poorest segments of the population encountered financial hardship due to health costs, compared to fewer than 1 in 25 among the wealthiest. Vulnerable groups, including women, those living in rural areas, and individuals with less education, faced greater challenges in accessing essential health services. Notably, the gap between women in the richest and poorest quintiles has slightly narrowed over the past decade.
Even in high-performing regions like Europe, vulnerable groups including the poorest and people with disabilities continue to report higher unmet health needs. The report suggests that these findings likely underestimate the true extent of health inequalities, as the most marginalized populations—such as displaced individuals and those living in informal settlements—are often excluded from the data used to monitor progress towards UHC.
Achieving the UHC goal by 2030 is critical to realizing the human right to health. With only five years remaining in the SDG agenda, the report calls for urgent action to drive progress. It emphasizes the importance of political commitment in every country and community and outlines six core areas where action is needed to ensure that health services are accessible and affordable for all.
