What is Universal Health Coverage

 Universal Health Coverage (UHC) is a commitment rooted in the belief that the highest attainable standard of physical and mental health is a fundamental human right, and that all people should have access to quality essential health services without suffering financial hardship.

UHC builds on countries’ basic health care packages and aims to provide comprehensive and high-quality health services throughout the life course for the entire population, and across the continuum of care, which includes health promotion, prevention, screening, management, rehabilitation, and palliative care services.

It also ensures that individuals are protected from high out-of-pocket expenses and prioritises marginalised communities. Primary Health Care (PHC) is considered to be the driving force for UHC, as it empowers communities, promotes social accountability and multisectoral action, and enables the integration of healthcare services and innovative digital solutions.

Political commitments towards health for all 

In September 2023, the second United Nations High-Level Meeting (HLM) on Universal Health Coverage (UHC) will take place, providing an important opportunity to advance the prevention and control of noncommunicable diseases (NCDs) together with other health priorities.

The occasion will also take stock of progress made since the first HLM on UHC in 2019, and identify areas to advance UHC policy to meet health targets. Specifically, Sustainable Development Goal (SDG) 3.8, which aims to “achieve UHC, including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality, and affordable essential medicines and vaccines for all.”

In 2019, world leaders signed the first Political Declaration on Universal Health Coverage, where they committed to progressively reach one billion additional people by 2023 with quality essential health services and affordable essential medicines. They also committed to stop the rise and reverse the trend of catastrophic out-of-pocket health expenditure and eliminate impoverishment due to health-related expenses by 2030.

Despite these political commitments, UHC has yet to be fully realised . About half of the global population lacks access to essential health services and 100 million people are driven into extreme poverty every year due to out-of-pocket health expenses.[2] And, according to 2019 targets, we still need to reach 710 million people by 2030.[3]

Implementing Universal Health Coverage – where are we now?

Noncommunicable diseases such as diabetes, cardiovascular disease, cancer, and chronic respiratory disease, are leading causes of death and disability worldwide and account for 71% of deaths globally. A staggering 85% of premature deaths from NCDs occur in low- and middle-income countries.

Many countries are struggling to integrate NCDs into their Universal Health Coverage (UHC) benefit packages and are not on track to reach SDG 3.4, which calls for a one-third reduction in NCD deaths through prevention and treatment, and promotion of mental health and wellbeing.[4]

While data on the inclusion of NCD prevention and care in UHC packages is limited, what does exist tells a story of significant gaps in coverage within and between countries.

Service Coverage

Access to high-quality essential services across the continuum of care which leave no one behind

Many countries struggle with providing adequate coverage and access to NCD services across the continuum of care, including screening, diagnosis, treatment, rehabilitation and palliative care. For example, half of adults living with diabetes are undiagnosed and unable to access insulin[5]; hypertension is only under medical control for 1 in 5 people[6]; chronic kidney disease often goes untreated[7], and over 90% of cancer patients in low-income countries lack access to radiotherapy[8].

Too often, health systems are fragmented and focused on single-disease care rather than an integrated, life course approach.

The 2023 State of UHC Commitment Review states that while many countries have set UHC as a goal in their national policies and plans, only a small number have developed a clear action plan to achieve it, and efforts have often been focused on vertical health programmess rather than comprehensive care for the population.[9]