Progress on Universal Health Coverage Stalls as 4.6 Billion Remain Without Essential Services, Landmark Report Warns

A stark new report from the World Health Organization (WHO) and the World Bank reveals a global health crisis simmering beneath the surface of modest gains. While most nations have improved health service coverage and reduced catastrophic medical costs since 2000, progress has dramatically slowed. Today, an estimated 4.6 billion people—over half the world’s population—still lack access to essential health services, and 2.1 billion suffer severe financial hardship paying for care, with 1.6 billion impoverished or pushed deeper into poverty by health expenses.

The 2025 Universal Health Coverage (UHC) Global Monitoring Report, released today, underscores the perilous distance to the Sustainable Development Goal of health for all by 2030. UHC, defined as everyone receiving quality care without financial ruin, remains a distant promise for the world’s poorest and most vulnerable.

A Deceleration of Progress

The report details two decades of advancement now in jeopardy. The average Service Coverage Index (SCI) rose from 54 to 71 points (out of 100) between 2000 and 2023. Simultaneously, the share of people facing catastrophic out-of-pocket (OOP) health payments fell from 34% to 26% (2000-2022). These gains, however, have markedly decelerated since 2015, with only one-third of countries now advancing on both fronts.

“Universal health coverage is the ultimate expression of the right to health, but this report shows that for billions of people, that right remains out of reach,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General. “In the context of severe cuts to international aid, now is the time for countries to invest in their health systems. WHO is supporting them to do that.”

The Crushing Burden of Medicine Costs

Financial hardship is defined as a household spending over 40% of its discretionary income on health. A primary driver is the cost of medicines, which accounts for at least 55% of OOP health expenses in three-quarters of countries studied. For people living in poverty, this burden is crushing: they allocate a median of 60% of their health spending on medicines, diverting scarce resources from food, shelter, and education.

“While the burden falls mostly on poorer people, it also affects better-off segments in middle-income countries, where this group is growing,” the report notes, highlighting a widening middle-class vulnerability.

Inequality: The Stark and Growing Divide

The report paints a picture of deepening inequality. In 2022, three out of four people in the poorest wealth quintile faced financial hardship from health costs, compared to fewer than one in 25 among the richest.

Disparities in access are equally severe. Women, the poor, rural residents, and those with less education report far greater difficulty obtaining care. Although the rich-poor gap in service coverage for women narrowed slightly over the past decade, a 33-percentage-point chasm remains. These figures likely underestimate true inequality, as displaced populations and informal settlement dwellers are often absent from the data.

Even in high-performing regions like Europe, vulnerable groups, including the poorest and people with disabilities, report significantly higher unmet health needs.

Mixed Drivers of Past Gains and Present Gaps

Global coverage gains have been largely fueled by advances in infectious disease programs (e.g., immunization, HIV treatment). Coverage for non-communicable diseases (NCDs) like diabetes and hypertension has improved steadily, but from a low base, and reproductive, maternal, newborn, and child health progress has been modest.

Improved sanitation and inclusive economic growth have supported past progress. Low-income countries, despite achieving the fastest gains, still face the largest absolute gaps. All WHO regions improved service coverage, but only half—Africa, Southeast Asia, and the Western Pacific—managed to simultaneously reduce financial hardship.

A Five-Year Sprint: The Path Forward

With the 2030 SDG deadline looming, the report issues an urgent call for accelerated, targeted action. Projections are grim: at current rates, the global SCI will reach only 74 out of 100 by 2030, with nearly one in four people still facing financial hardship.

The report’s recommended actions include:

• Making care free for the poor: Ensuring essential health services are free at point of care for people in poverty and vulnerable situations.

• Investing in public health: Expanding public investments in health systems, focusing on primary health care as a foundation for equity and efficiency.

• Taming medicine costs: Addressing exorbitant OOP spending on medicines through policies like pooled procurement and price regulation.

• Accelerating NCD care: Rapidly scaling up access to essential prevention, diagnosis, and treatment services for NCDs.

• Adopting a whole-of-society approach: Implementing multisectoral policies that address the social, economic, and environmental determinants of health.

The message is clear: without renewed political commitment and a dramatic re-prioritization of health financing, the goal of health for all will slip beyond reach, leaving billions behind.

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