Universal Health Coverage Still Elusive for Billions Despite Global Progress

Bishan Papola 

New Delhi, 14, Dec-2025: A new joint report by the World Health Organization (WHO) and the World Bank Group reveals that while most countries have made measurable progress in expanding health services and reducing financial hardship since 2000, universal health coverage (UHC) remains out of reach for billions of people worldwide.

According to the UHC Global Monitoring Report 2025, health service coverage, measured through the Service Coverage Index (SCI), increased significantly from 54 in 2000 to 71 in 2023. During the same period, the proportion of people facing financial hardship due to out-of-pocket (OOP) health spending declined from 34% to 26%. These two indicators form the backbone of UHC, a global commitment to ensure that everyone can access essential health services without financial distress by 2030.

Despite this progress, the report paints a stark picture of inequality. An estimated 4.6 billion people still lack access to essential health services, while 2.1 billion people experience financial hardship when seeking care. Alarmingly, 1.6 billion people have been pushed into poverty or deeper into poverty due to health expenses, highlighting that health costs remain a major driver of economic vulnerability.

“Universal health coverage is the ultimate expression of the right to health, but for billions, that right remains out of reach,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. He warned that ongoing cuts in international aid threaten fragile gains and urged countries to invest more in resilient health systems to protect both public health and economic stability.

The report defines financial hardship as households spending more than 40% of their discretionary income on health care. Medicines are identified as the single largest contributor to this burden. In nearly three-quarters of countries with available data, medicines account for at least 55% of out-of-pocket health spending, rising to a median of 60% among people living in poverty.

While poorer populations bear the brunt of health-related financial distress, the report also notes growing pressure on middle-income households, particularly in countries where insurance coverage remains limited and private health spending is high.

Progress has slowed since 2015, with only one-third of countries managing to simultaneously expand coverage and reduce financial hardship. Low-income countries recorded the fastest gains but still face the widest gaps. Improvements have been driven largely by infectious disease programmes, while progress in noncommunicable diseases (NCDs) and maternal and child health has been comparatively modest.

Inequality remains a central concern. In 2022, three out of four people in the poorest populations faced financial hardship, compared to fewer than one in 25 among the richest. Women, rural communities, and people with lower education levels continue to report greater unmet health needs, even in high-income regions such as Europe.

With just five years left to meet the 2030 Sustainable Development Goals, the report calls for urgent action, including free essential care for the poor, higher public health spending, reduced medicine costs, stronger primary health care, and multisectoral approaches to health.