Universal Health Coverage: Many Think They Got It, But Few Have

Universal Health Coverage: Many Think They Got It, But Few Have

According to the WHO, universal health coverage (UHC) means that “all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course”. Health coverage has three critical coverage dimensions: population (who is covered), costs (how much of the cost is covered) and services (what services are covered and at what quality).


The 2030 Agenda sets out universal health coverage as an overarching theme and emphasises the interaction between UHC and other areas of sustainable development, including the social, environmental and economic dimensions.

Countries that progress towards UHC will not only meet other health goals, but also progress towards other Sustainable Development Goals: for example, good health allows children to learn (SDG 4), people to escape from poverty (SDG 1) and adults to earn and work safely (SDG 8).


Whilst the universal right to health is enshrined in many countries’ constitutions (following the UN’s International Bill of Human Rights), its de jure status frequently does not manifest itself as de facto UHC. Achieving de facto UHC entails strengthening health systems, removing barriers of access and financing, and curbing out-of-pocket spending by implementing robust financing structures.


Achieving UHC requires health systems strengthening. UHC requires sufficient and competent health care workforce at all levels, distributed equitably across the population. In total, an estimated 18 million additional health workers are needed by 2030 to achieve the SDGs and UHC targets. Health care financing is an important dimension for UHC. In countries with high out-of-pocket expenditure on health, people struggle to access the services they need and risk catastrophic costs when illness hits. Limiting out-of-pocket spending, by pooling funding to spread financial risks of illness across a population, can improve coverage. In particular, investments in quality primary health care are fundamental for achieving UHC.

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