Wooden toy people underneath an umbrella, the symbol of universal health coverage.

Stepping Up for Universal Health Coverage

Universal Health Coverage Day 2025 aims to celebrate progress toward achieving universal coverage of health services and call on governments to accelerate action.

According to the new Tracking Universal Health Coverage Report, in 2023, an estimated 2.1 billion people experienced financial hardship due to health costs, while 4.6 billion people—more than half the world's population—lacked access to essential health services. If current trends continue, the world will not be able to reach global targets set out by Sustainable Development Goal (SDG) 3.8, achieving universal health coverage (UHC) by 2030. 

UHC is defined by the World Health Organization (WHO) as when all people are able to access the full range of health services they need, where and when they need it, without financial hardship. December 12 is Universal Health Coverage Day, a day to celebrate progress toward achieving UHC and call on governments to accelerate action. UHC Day 2025 rallies around the theme “Unaffordable Health Costs? We’re Sick of It!” to highlight how unaffordable health costs undermine the right to health and have real human impacts.

Health costs are deeply intertwined with access to health care and UHC because health expenses can push people into poverty and poverty can prevent people from accessing health care. For people living in or near poverty, even small out-of-pocket health expenses can have large impacts, forcing people to make trade-offs between health and other basic needs such as food, housing, or education. Reducing poverty and implementing financial protection mechanisms such as prepayment or social insurance for health care costs are therefore key aspects of achieving UHC.

Progress toward UHC is measured using two indicators: the UHC service coverage index (SCI) and a measure of financial hardship. This year’s Tracking Universal Health Coverage Report announced revisions to how these indicators are measured.

The SCI is a composite measure that summarizes four dimensions of service coverage: reproductive, maternal, newborn, and child health; infectious diseases; noncommunicable diseases; and service capacity and access. The revised SCI replaces three out of 14 proxy indicators with newly available coverage measures, aligns two indicators with other SDG indicators, and introduced new weighting to better reflect the population affected by each indicator.

Analysis using the updated SCI shows that the global SCI score increased from 54 out of 100 points in 2000 to 71 out of 100 points in 2023. However, progress—mainly driven by improvements in the infectious disease dimension—is stalling. By the end of the SDG era in 2030, the global SCI score is expected to improve only marginally with a projected 74 out of 100 points. 

Financial hardship has traditionally been measured through catastrophic out-of-pocket health spending (out-of-pocket health spending exceeding 10 percent and 25 percent of total household budget). The revised indicator measures financial hardship as the proportion of the population with positive out-of-pocket household health expenditures exceeding 40 percent of household discretionary budget. This revised indicator captures both impoverishing and large but not impoverishing out-of-pocket spending, counting any out-of-pocket spending by those living under the societal poverty line as financial hardship and being stricter about counting financial hardship for the wealthiest.

The 2025 Tracking UHC Report finds a downward trend in financial hardship due to out-of-pocket health spending. In the period from 2000 to 2023, the proportion of people facing financial hardship due to large or impoverishing health spending declined from 36 percent to 26 percent. However, the report notes that this improvement is mainly driven by global poverty reduction rather than improving financial protection for the poor. The percentage of people already in poverty who were further pushed into poverty by out-of-pocket health spending has been increasing. Without accelerated action, by 2030, nearly one in four people worldwide will still face financial hardship due to health spending.

With slow and faltering progress on UHC, governments need to reaffirm political commitment and step up to ensure all people are able to access the health care they need. In a world where global health financing is rapidly changing, decisive action and investment on UHC is more important than ever. To learn more about UHC, explore our resource pack on Health Systems and Universal Health Coverage or the selected resources below. 

Selected Resources

The Global Health Education and Learning Incubator at Harvard University supports interdisciplinary education about world health through the production, curation, and dissemination of educational public goods. Our digital repository is a searchable library of reputable resources that support learning and teaching about interdisciplinary global health challenges. The repository includes both general resources, such as reports, articles, country profiles, and data, and teaching resources, such as teaching cases and lesson-based teaching packs. 

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