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The Global Monitoring Report on Universal Health Coverage

By Roberta Fortugno

The 2030 Agenda for Sustainable Development recognizes health as a fundamental human right and places significant importance on the principle of inclusivity, aiming to ensure that no individual or group is excluded or marginalized. Universal health coverage (UCH) is the most effective approach to guaranteeing equitable access to vital healthcare services for individuals across all socio-economic backgrounds, eliminating the burden of financial constraints. Health-related Sustainable Development Goal (SDG) targets for the year 2030 require improved coordination and support from a wide range of stakeholders, including international agencies and civil society organizations.

In preparation for the upcoming High-Level Meeting on Universal Health Coverage (UHC) at the 78th session of the United Nations General Assembly, the 2023 Universal Health Coverage (UHC) Global Monitoring Report by the World Health Organization (WHO) and the World Bank is set to be released. This report aims to provide a comprehensive assessment of the current state of UHC worldwide, shedding light on the progress made and the challenges that lie ahead. The 2023 analysis found that many nations have made little progress in improving healthcare coverage and reducing catastrophic out-of-pocket health costs over the past two decades. Most countries, 96 out of 138 for which statistics on both parts of Universal Health Coverage (UHC) are available, deviate from the anticipated trend in service coverage, financial protection, or both.

Since the beginning of the 21st century, there have been notable advancements in health service coverage. However, it is worth noting that progress in this domain has experienced a notable slowdown since the adoption of the Sustainable Development Goals in 2015. The most recent research has revealed that there was a distinct lack of progress between the years 2019 and 2021. The latest data discloses a distressing reality for a substantial portion of the global population. An estimated 4.5 billion individuals persistently encounter a concerning absence of essential healthcare treatments. In 2019, nearly two billion people had considerable issues covering their healthcare costs directly out of their own pockets.

An increasing number of households are allocating more than 10% of their budget towards catastrophic out-of-pocket healthcare expenses. The number of individuals whose out-of-pocket expenses exceeded their allocated budgets amounted to more than one billion people, constituting around 14% of the global population. Minor expenses can have severe consequences for households with low incomes. These financial obligations have caused or exacerbated the impoverishment of around 1.3 billion individuals, which includes 300 million individuals who were already living in conditions of extreme poverty. Due to the financial strain of out-of-pocket healthcare costs, families regularly find themselves in the difficult position of having to decide how to allocate their resources between medical consultations, sustenance, and education. The potential trade-offs in play could significantly influence the distinction between timely intervention for a preventable illness and subsequent complications or death. To effectively tackle this challenge, it is crucial to enact health finance laws that are progressive and provide exemptions for individuals with low incomes.

To achieve universal health coverage (UHC) by 2030, a significant amount of investment from the public sector is necessary, along with intensified efforts from governments and their partners. A necessary restructuring of health systems should go hand in hand with the primary healthcare paradigm as the foundation of these initiatives. Global health progress is threatened by intensifying macroeconomic, climatic, demographic, and political trends, so these adjustments are necessary as the world works to address and recover from the COVID-19 pandemic's effects on healthcare systems and the medical workforce.


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