Tracking Universal Health Coverage (UHC): 2025 Global Monitoring Report

Download Report | Access Dataset

Overview

Global progress is too slow to achieve UHC by 2030

Although service coverage increased and financial hardship decreased, midway through the implementation period of the Sustainable Development Goals, billions of people lack access to essential health services and face financial hardship due to health expenses.

Service coverage increased, but challenged by rising burden of NCDs

Service coverage expanded significantly due to fast gains in infectious disease control, in contrast with the slower pace of development in other health domains. The surge in noncommunicable diseases (NCDs) continues to challenge health systems' capacity to provide effective, affordable, and continuous care for chronic conditions.

Financial hardship decreased, but weaknesses in financial protection persist

Although fewer people experience impoverishing health expenses, those already living in poverty remain especially vulnerable to financial hardship due to medical costs. An increasing number of people face disproportionately high out-of-pocket health costs, particularly in middle-income countries.

To accelerate progress toward UHC, governments need to prioritize health in their budgets and spend more efficiently

• Governments must reduce the heavy financial burden on people by strengthening public, prepaid financing and ensuring free access to essential care for poor people.
• Closing the gaps in service coverage requires ensuring those left behind can access the services they need most and strengthening health systems to provide integrated and high-quality service delivery, especially to control and manage NCDs more effectively.

Measuring progress towards UHC

Measurement methodology

• The global UHC service coverage index rose from 54 index points in 2000 to 71 in 2023.
• The share of the global population incurring financial hardship due to OOP (out-of-pocket payments) health spending fell from 34% in 2000 to 26% in 2022.
• The service coverage index has increased in virtually all countries (97%) since 2000.
• The share of the population incurring financial hardship due to OOP health spending has declined in more than half of countries (54%).

Importantly, global inequalities in UHC outcomes have been reduced as countries, regions and country income groups with worse baseline values have achieved larger gains.

However, since the SDG's were introduced in 2015, the pace of progress on both UHC dimensions has slowed. If current trends continue, the global UHC service coverage index will only reach 74 by 2030, with 24% of the population still facing health-related financial hardship at the end of the SDG period.

The increase in the UHC service coverage index (SCI) between 2000 and 2023 is mostly explained by improvements in infectious diseases. In contrast, the index for reproductive, maternal, newborn, and child health services, which had the highest baseline score, saw the smallest change. Despite progress on noncommunicable diseases globally and across regions, the NCDs subindex is now the lowest, despite their dominance in the global burden of disease.

The downward trend in financial hardship is driven by global poverty reduction rather than improvements in financial protection. Financial hardship due to out-of-pocket (OOP) health spending can be experienced by people of all socioeconomic backgrounds, but it remains concentrated among poor people. Between 2000 and 2022, the proportion of the global population with impoverishing OOP payments for health decreased from 29% to 20%. This decline largely reflects a concurrent decrease in poverty rates between 2000 and 2022. This means fewer people live in poverty, but poor people suffer more often from financial hardship in health. At the same time, the global incidence of disproportionately large, but non-impoverishing, health spending moderately increased, particularly in middle-income countries.

How is progress towards UHC measured?

Achieving progress requires addressing both service coverage and financial hardship in health, which are tracked by:

1. The service coverage index (SCI)

A composite index on a scale of 0 to 100 represents coverage of essential health services. It is composed of 14 tracer indicators in four broad health areas:

• Reproductive, maternal, newborn, and child health (RMNCH)
• Infectious diseases
• Noncommunicable diseases (NCDs)
• Service capacity and access

2. The financial hardship indicator

This indicator measures the proportion of the population experiencing financial hardship due to out-of-pocket (OOP) payments. Financial hardship can be experienced by:

• People who see their ability to meet basic needs reduced by out-of-pocket payments (impoverishing OOP). This includes both those who are pushed into poverty due to such payments as well as those who are further impoverished by them.
• People who are better off economically (non-poor) that face disproportionately large OOP spending.

The Global Monitoring Report presents the most recent global data on progress towards universal health coverage (UHC) and tracks progress towards the Sustainable Development Target 3.8: "Achieve universal health coverage, including financial risk protection." The report presents global and regional trends in health service coverage from 2000 to 2023, and in financial hardship because of health expenses from 2000 to 2022.