Global Healthcare: Universal Health Coverage, Service Access and Financial Hardship

Universal health coverage (UHC) means all people can get the quality health services they need without financial hardship. It is Sustainable Development Goal target 3.8 and is tracked jointly by WHO and the World Bank through Global Monitoring Reports published every two years [1][3].

The 2023 Global Monitoring Report found that more than half of the world's population was still not covered by essential health services [2]. About 4.5 billion people lacked full coverage as of 2021 [3]. The report also found that 2 billion people faced financial hardship when paying out-of-pocket for the services and products they needed [2].

The UHC service coverage index (SDG 3.8.1) is a composite score from 0 to 100 built from 14 tracer indicators in four broad health areas [5].

The strongest gains came between 2000 and 2015, when the index improved by 1.5% a year; after 2015 the rate slowed to 0.5% a year [1]. Infectious disease control accounted for 52% of the increase in the index since 2000 [1]. Reproductive, maternal, newborn and child health services have stagnated at 72 index points, while care for noncommunicable diseases reached only 61 index points in 2023 [1].

Gaps between countries have narrowed. The number of countries with low or very low coverage fell from 55 in 2000 to 8 in 2023 [1].

Catastrophic out-of-pocket spending is defined as health payments above 10% of a household budget [2]. More than 1 billion people, about 14% of the global population, faced such payments by 2019 [2][3]. Approximately 1.3 billion people were pushed or further pushed into poverty by health payments, including 300 million people who were already living in extreme poverty [2].

Between 2000 and 2022, the share of people further impoverished by health payments fell from 26.6% to 18.6%, while the share pushed into poverty stayed between 1.9% and 2.8% [1]. Hardship is concentrated among the poor: in 2022, 3 out of 4 people in the poorest population segment faced financial hardship from health costs, compared with fewer than 1 in 25 among the richest [1]. Rural populations have a median hardship rate 14% higher than urban populations [1].

National averages hide large gaps. In a subset of European countries in 2019, median unmet need for health care was 32% among the poorest 20% versus 22% among the richest 30% [1]. It was 42% for people with severe disability versus 21% for people with no disability, and 27% for rural versus 23% for urban residents [1].

WHO states that the world will not achieve UHC by 2030 on the current trajectory [1]. The global service coverage index is projected at 74 out of 100 in 2030, and 24% of the population is projected to still face financial hardship [1]. In 2025 the UN Statistical Commission approved revised SDG UHC indicators, and the World Bank launched the 2025 Global Monitoring Report on 8 December 2025 [1][5].

This report uses the WHO universal health coverage fact sheet, which reflects the revised 2025 monitoring framework, together with summaries of the WHO and World Bank 2023 Global Monitoring Report published by ReliefWeb, WHO and the World Bank [1][2][3][4][5]. Service coverage is measured with SDG indicator 3.8.1, an index from 0 to 100. Financial hardship is measured with SDG indicator 3.8.2. The 4.5 billion figure refers to 2021 and the catastrophic spending figure refers to 2019, the latest years in the 2023 report. The 2030 values are WHO projections, not observed data. Figures from the 2023 and 2025 framework editions are not always directly comparable because the financial hardship indicator was revised. No FREEE.REPORT calculations were used.