The goal of Universal Health Coverage (UHC) is to ensure everyone receives the health services they need without facing financial hardship. Viewing health as an investment rather than an expense can unlock human capital and economic dividends for countries.
Find out what our partners and UHC champions have to say about why Universal Health Coverage is so important, and what can be done to achieve this.
"Investing in human capital by expanding health care services is key for sustainable development"
"Strong primary healthcare is at the core of well-functioning health systems."
"Universal Health Coverage enables long and healthy lives for entire populations."
"Universal Health Coverage is a commitment to equity, gender equality, social inclusion, good nutrition, and mental health across the life cycle."
"Access to healthcare, delivered by a skilled health worker, is essential to meet the challenges we face today."
"Equitable access to vaccines and Universal Health Coverage are indivisible. Let us harness the transformative power of immunization and UHC to protect every community, with nobody left behind. "
"Rwanda has committed to promoting UHC by calling for evidence-based policy reforms that will guide a long-term model for health service delivery and financing in the country. "
"Accelerating progress towards Universal Health Coverage by tackling health inequalities is the only way to end the world's deadliest infectious diseases."
"Achieving Universal Health Coverage is every child’s right."
"It is important to increase the scale of health financing in low- and middle-income countries."
Universal health coverage (UHC) is about ensuring that everyone, especially the most vulnerable, has access to the quality health care they need without suffering financial hardship. It is key to achieving the World Bank’s mission to end extreme poverty and boost prosperity on a livable planet, and it is the driving force behind all of the WBG’s health and nutrition investments.
UHC allows countries to make the most of their strongest asset: human capital. Supporting health represents a foundational investment in human capital and in economic growth—with good health, children can attend school and eventually reach their full potential, while adults are able to lead productive healthy lives.
Global movement towards UHC
Universal health coverage is an important part of the Sustainable Development Goals (SDGs). SDG 3.8 aims to “achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” In addition, the SDG 1 call to “end poverty in all its forms everywhere” could be in peril without UHC given that out-of-pocket health spending pushes people into, or further into, poverty.
The UHC movement has gained global momentum. In September 2023, the United Nations adopted a high-level political declaration to reaffirm and renew commitment to UHC in a post-COVID world. However, turning commitment into reality will require new ways of working to overcome challenges.
Intertwined challenges
Half of the world’s population -or 4.5 billion people- is not covered by essential health services, and 2 billion people face severe financial hardship |
Since 2015, health service coverage has stagnated and financial hardship due to out-of-pocket health spending has worsened, undermining efforts to eradicate poverty globally.
Global commitments for women, children and adolescents are falling behind. According to latest estimates 4.9 million children died before their fifth birthday in 2022. While this is historically the lowest rate of child mortality, children continue to face unequal chances of survival based on where they are born and where they live. Globally, the maternal mortality rate dropped by 34% between 2000 and 2020, but progress has stagnated: between 2016 and 2020, maternal deaths either increased or stagnated in most regions.
Demographics and disease profile are changing and put pressure on health systems. Globally, fertility has fallen significantly from an average of 5 births per woman in 1950 to 2.3 per woman in 2021.
Populations are also aging worldwide: people aged 65 and older now outnumber children under 5. By 2050, 1.5 billion people will be 65 and older. Non-communicable diseases (NCDs) are on the rise, accounting for 41 million deaths each year (74% of all deaths globally), with more than three quarters of NCD deaths occurring in low and middle-income countries.
Climate change is also a critical contributor to the burden of NCDs through factors such as air pollution, heat stress, and extreme weather events.
At the same time, the lack of countries’ health service capacity hinders progress on mental illnesses. More than three quarters of people with a severe mental disorder are not receiving treatment in low and middle income.
These shifts require health systems to adapt to be greater responsive to changing needs of the population, but such changes also have implications for the financing of health systems.
Health is an investment, not an expense
Affordable accessible health care can unlock human capital and economic dividends for countries. But latest World Bank estimates show that, 41 countries – many of them low income and middle-income countries- will face stagnation or contraction of government spending over the next five years. Governments in low-income countries spend less than 2% of GDP on health, and governments in lower middle-income countries spend less than 3%. In addition to the shrinking of the overall size of government budgets, the share going to health is also decreasing.
Last Updated: Apr 04, 2024
Without urgent action, developing countries faced with aging populations, changing disease profiles and health emergencies will find themselves increasingly challenged to close the gap between the demand for health spending and available public resources, and will prolong the reliance on out-of-pocket spending by patients and their families.
In the face of these intertwined challenges the World Bank supports countries to:
The World Bank aims to support countries in delivering quality, affordable health services to 1.5 billion people by 2030. This is part of a larger effort to provide a basic standard of care through every stage of a person's life -- infancy, childhood, adolescence, and adulthood.
The World Bank is also going beyond health to improve health outcomes and support communities by improving education, broadening social services, and creating jobs. The Human Capital Project aims to support countries in taking an integrated, whole-of-government approach to improving human development outcomes.
Partnerships for greater impact
Scaling up action towards UHC requires a concerted effort to mobilize more resources to meet the challenges, while adapting health systems to provide high-quality services that are resilient to shocks from intertwined crises.
The World Bank is leveraging two partnerships hosted by the Bank -- the Global Financing Facility for Women, Children and Adolescents and the Pandemic Fund -- to crowd in more financing to end preventable deaths of women, children, and adolescents and to ensure the world is better prepared for the next pandemic.
The World Bank will also collaborate closely with key partners in global health such as The Global Fund, Gavi, the Vaccine Alliance and the World Health Organization, to streamline funding for global health, avoid duplication and provide better targeted responses to meet the challenges faced by billions of people in need.
Last Updated: Jun 10, 2024
IDA, the World Bank’s fund for the poorest countries, is one of the most important tools to finance healthcare in lower income countries. IDA’s support ranges from building stronger health systems and service delivery capacity, to working with governments to prepare for pandemics and other health emergencies. Over the last decade, IDA has provided US$13.5 billion to fund essential health interventions for 770 million people, and immunizations for 330 million children. The share of IDA funding for health and nutrition has increased by 60% over the last decade, reflecting rising demand from countries.
Achieving strong country outcomes
Through IDA, the World Bank is for instance supporting Saint Lucia in improving its public healthcare system. The Health System Strengthening project aims to ensure that at least 100,000 people on the island of 178,000 inhabitants are registered to the National Health Scheme by the end of the project, and that at least 60 percent of diabetic and hypertensive patients over 18 years old are treated according to national protocols in public primary health care facilities. In addition, primary health care centers will be equipped to serve as the first point of detection for selected infectious diseases.
In Yemen, IDA has helped save lives through the Emergency Health and Nutrition Project, which has reached more than 14.6 million people across the country, and through the Emergency Cash Transfer Program, which aims to ensure vulnerable Yemenis have money to buy food and basic necessities. Under the latter Program, cash transfers have so far been provided to about 9 million people across Yemen’s 333 districts.
The multi-stakeholder Global Financing Facility (GFF), founded in 2015 by the WBG and partners to support maternal, child and adolescent healthcare is already having an impact. Early country results show that GFF support leads to better targeting of the poorest and most vulnerable groups, increased access to services and more domestic financing for malnutrition, maternal mortality and adolescent girls’ health.
Other initiatives to support women and reproductive, maternal and child healthcare also show promising results on the ground. The Sahel Women’s Empowerment and Demographic Dividend (SWEDD) project has helped train over 6,600 midwives, create 3,420 safe spaces to give a second chance to 102,600 vulnerable out-of-school girls, and reach more than 4 million people through awareness raising campaigns on issues such as reproductive, maternal and child health and violence against women. In addition, 100,000 girls from poor backgrounds in Niger received school kits, scholarships, housing and academic support.
Mental health disorders, often neglected in the past, are receiving more attention around the world. In the Khyber Pakhtunkhwa province of Pakistan, for example, over 100 small business entrepreneurs received five weeks of Cognitive Behavioral Therapy training. The intervention helped significantly reduce the intensity and prevalence of depression and anxiety symptoms among participants and contributed to higher levels of well-being, compared with a group of entrepreneurs that did not receive training.
In Afghanistan, more than 2.2 million people received mental health services in 2018 across the country, compared to around half a million people in 2009. In Yemen, the World Bank’s emergency health programs offered mental health services and trauma care throughout the country. And in the Horn of Africa, the World Bank supported counseling for Somali women and children impacted by gender-based and sexual violence as part of a primary care package for those living in refugee camps in Kenya and Ethiopia.
With support from the World Bank Group’s $6 billion COVID-19 Global Health Emergency Response Program, several countries such as Bosnia and Herzegovina, Cambodia, Ecuador, India, Lesotho, Liberia, Morocco, Marshall Islands, Mongolia, Nigeria, Sri Lanka and Turkey have launched psychological support programs to address the negative impact of the COVID-19 pandemic on mental well-being. Investing in mental health services contributes to an inclusive, resilient recovery.
Partnering to accelerate country progress
One of the most important challenges to achieving UHC globally is the availability and sustainability of financing. That is why the WBG, along with partners, also convenes the Annual Health Financing Forum at its Spring Meetings in Washington, DC. The Forum brings together countries and partners to explore the frontiers of resource mobilization for health and provides a platform to advance knowledge and its application in UHC financing. By bringing the finance and health sectors together, and by bridging policy with evidence, the Forum creates one of the only global spaces where key actors can help catalyze progress in countries towards sustainable financing of UHC.
In addition, the WBG is also a partner in the Joint Learning Network for UHC, a network of policymakers and practitioners from low- and middle-income countries who learn from one another, jointly problem solve, and collectively produce and use new knowledge, tools, and innovative approaches to accelerate country progress toward UHC.
WBG research has for example highlighted the case of Bangladesh as a country that has rapidly improved its health outcomes at low cost. It shows how the country benefited from a combination of factors, including public funding for highly cost-effective interventions, alignment of government and development partner financing, extensive use of female community health workers and innovative civil society organizations, and contributions from a large and unusually competitive private sector.
Last Updated: May 19, 2021
