A new report from the World Health Organization (WHO) and the World Bank Group reveals significant progress towards achieving universal health coverage (UHC) across various income levels and regions since the year 2000. The findings, presented in the UHC Global Monitoring Report 2025, indicate that while health service coverage has expanded, challenges persist, particularly for the poorest populations.
The report shows that the Service Coverage Index (SCI), which measures health service availability, increased from 54 points in 2000 to 71 points in 2023. Concurrently, the proportion of individuals facing financial hardship due to out-of-pocket (OOP) health expenses decreased from 34% in 2000 to 26% in 2022. Despite these advancements, an alarming 4.6 billion people still lack access to essential health services, with 2.1 billion experiencing financial difficulties in obtaining care. Among them, 1.6 billion individuals have been further pushed into poverty due to health costs.
Dr. Tedros Adhanom Ghebreyesus, WHO Director-General, emphasized the importance of UHC in ensuring the right to health for all. He stated, “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.” He urged countries to invest in health systems, especially in light of significant cuts to international aid.
Financial hardship in health is defined as households spending more than 40% of their discretionary budget on OOP health expenses. One of the primary contributors to this financial strain is the cost of medications; in many countries, medicines account for at least 55% of OOP health expenditures. This burden is particularly severe for those living in poverty, who allocate a median of 60% of their OOP health spending on medicines, diverting resources from other essential needs.
The report highlights that while improvements have been made, persistent gaps and inequalities are growing. In 2022, approximately three out of four individuals in the poorest segments of the population faced financial hardship due to health costs, compared to fewer than one in twenty among the wealthiest. Women, people living in poverty, those in rural areas, and individuals with lower education levels reported greater challenges in accessing necessary health services.
Despite positive trends, the global rate of progress has slowed since 2015. Only one-third of countries have improved in both expanding health coverage and reducing financial hardship. All WHO regions have made strides in service coverage, but only half, including Africa, South-East Asia, and the Western Pacific, have also seen reductions in financial hardship.
The advancements in health service coverage have been largely driven by progress in infectious disease programs. Coverage for noncommunicable diseases has improved steadily, while gains in reproductive, maternal, newborn, and child health have been more modest. Enhanced sanitation has also contributed to the overall increase in service coverage.
Despite the positive trajectory, the report warns that without accelerated efforts, comprehensive health coverage without financial hardship will remain unattainable for many. Projections suggest that the global SCI may reach only 74 out of 100 by 2030, with nearly one in four people facing financial difficulties by the end of the Sustainable Development Goals (SDG) era.
The report calls for urgent political commitment and action in six core areas to achieve the UHC goal by 2030. It stresses the need for countries to address the persistent inequalities in health access and financial burdens, particularly for vulnerable populations such as displaced individuals and those living in informal settlements.
As the world approaches the target date, the findings serve as a crucial reminder of the work that lies ahead to ensure that health care is accessible and affordable for all.
