Tracking Universal Health Coverage: 2023 Global Monitoring Report

Abstract

Leaving no one behind is a central promise of the 2030 Agenda for Sustainable Development, which recognizes health as a fundamental human right. Achieving Universal Health Coverage (UHC) is key to delivering on this promise. UHC ensures that everyone receives good quality health services, when and where needed, without incurring financial hardship arising from payments made for those services. The 2023 Universal Health Coverage Global Monitoring Report presents an alarming picture of stagnating access to essential health services and increased financial hardship from out-of-pocket health payments affecting especially the poorest and most vulnerable people. Globally, about 4.5 billion people, more than half of the world population, lack full access to essential health services. Since 2015, health service coverage has stagnated after a dynamic increase in previous years, indicating that urgent action is required by governments to ensure people can access health services. Past progress in service coverage was largely driven by improved access to infectious disease services, but since 2015 there has been minimal to no expansion of health service coverage related to infectious and noncommunicable diseases or for reproductive, maternal, newborn, and child health services. Financial hardship due to out-of-pocket health spending continues to worsen and undermine efforts to eradicate poverty globally. The number of people incurring catastrophic out-of-pocket health spending (more than 10% of their household budget) increased to more than 1 billion people in 2019, or almost 14% of the global population. About 1.3 billion people (almost 17% of the global population) were pushed or further pushed into poverty by out-of-pocket health spending. This includes 344 million people living in extreme poverty. Out-of-pocket health payments reduce the ability of households to afford other essential goods and services and negatively affect a family’s consumption levels. Health costs also cause individuals to forgo essential care, which can lead to more severe illnesses or even death. Reaching the goal of UHC by 2030 requires substantial public sector investment and accelerated action by governments and development partners, building on solid evidence. This includes strengthening health systems based on a primary health care approach and advancing equity in both the delivery of essential health services and financial protection. Achieving UHC also requires modern, fit-for-purpose health information systems that provide timely and reliable data to inform policy design. Such shifts are essential following the pandemic’s impact on health systems and health workers and in view of deepening macroeconomic, climate, demographic, and political trends which threaten to reverse hard-won health gains around the world.