Universal health coverage (UHC) (2022)

1 April 2021

The delivery of these services require adequate and competent health and care workers with optimal skills mix at facility, outreach and community level, and who are equitably distributed, adequately supported and enjoy decent work.UHC strategies enable\r\n everyone to access the services that address the most significant causes of disease and death and ensures that the quality of those services is good enough to improve the health of the people who receive them.

Protecting people from the financial consequences of paying for health services out of their own pockets reduces the risk that people will be pushed into poverty because unexpected illness requires them to use up their life savings, sell assets, or\r\n borrow – destroying their futures and often those of their children.

Achieving UHC is one of the targets the nations of the world set when adopting the SDGs in 2015. Countries reaffirmed this commitment at the United Nations General Assembly High Level Meeting on UHC in 2019. Countries that progress towards UHC will\r\n make progress towards the other health-related targets, and towards the other goals. Good health allows children to learn and adults to earn, helps people escape from poverty, and provides the basis for long-term economic development.

WHO contributes to achieving the Thirteenth General Programme of Work 2025 target that 1 billion more people benefit from UHC, while also contributing to the 2 other billion targets of 1 billion more people better protected from health emergencies\r\n and 1 billion more people enjoying better health and well-being. It also contributes to WHO’s mission of the right to the highest attainable standard of health, to Health for All and the SDGs.

How can countries make progress towards UHC?

Many countries are already making progress towards UHC, although everywhere the COVID-19 pandemic impacted the availability the ability of health systems to provide undisrupted health services. All countries can take actions to move more rapidly towards\r\n UHC despite the setbacks of the COVID-19 pandemic, or to maintain the gains they have already made. In countries where health services have traditionally been accessible and affordable, governments are finding it increasingly difficult to respond\r\n to the ever-growing health needs of the populations and the increasing costs of health services.

Moving towards UHC requires strengthening health systems in all countries. Robust financing structures are key. When people have to pay most of the cost for health services out of their own pockets, the poor are often unable to obtain many of the services\r\n they need, and even the rich may be exposed to financial hardship in the event of severe or long-term illness. Pooling funds from compulsory funding sources (such as government tax revenues) can spread the financial risks of illness across a population.

Improving health service coverage and health outcomes depends on the availability, accessibility, and capacity of health and care workers to deliver quality people-centred integrated care. The COVID-19 pandemic dramatically demonstrated the invaluable\r\n role of the health and care workforce and the importance of expanding investments in this area. To meet the health workforce requirements of the SDGs and UHC targets, over 18 million additional health workers are needed by 2030. Gaps in the supply\r\n of and demand for health workers are concentrated in low- and lower-middle-income countries. The growing demand for health workers is projected to add an estimated 40 million health sector jobs to the global economy by 2030. Investments are needed\r\n from both public and private sectors in health worker education, as well as in the creation and filling of funded positions in the health sector and the health economy. The COVID-19 pandemic, which has initially affected the health workforce\r\n disproportionately, has highlighted the need to protect health and care workers, to prioritize investment in their education and employment, and to leverage partnerships to provide them with decent working conditions.

UHC emphasizes not onlywhatservices are covered, but alsohowthey are funded, managed, and delivered. A fundamental shift in service delivery is needed such that services are integrated and focused on the needs\r\n of people and communities. This includes reorienting health services to ensure that care is provided in the most appropriate setting, with the right balance between out- and in-patient care and strengthening the coordination of care. Health services,\r\n including traditional and complementary medicine services, organized around the comprehensive needs and expectations of people and communities will help empower them to take a more active role in their health and health system.

Investments in quality primary health care will be the cornerstone for achieving UHC around the world.

Achieving UHC requires multiple approaches. The primary health care approach and life course approaches are critical. A primary health care approach focuses on organizing and strengthening health systems so that people can access services for their\r\n health and wellbeing based on their needs and preferences, at the earliest, and in their everyday environments. PHC entails three inter-related and synergistic components, including: comprehensive integrated health services that embrace primary care\r\n as well as public health goods and functions as central pieces; multi-sectoral policies and actions to address the upstream and wider determinants of health; and engaging and empowering individuals, families, and communities for increased social participation\r\n and enhanced self-care and self-reliance in health. Applying a life course approach optimizes people’s health by addressing their needs and maximizing opportunities across all phases of life so that they can be and do what they justifiably value\r\n at all ages, always guided by principles that promote human rights and gender equality.

As the COVID-19 pandemic showed, countries need to rapidly scale up their investments in essential public health functions—those core public health functions that require collective action and can only be funded by governments or risk large market\r\n failures. These include policy making based on evidence, communication including risk communication and community outreach to empower individuals and families to better manage their own health, information systems, data analysis, and surveillance,\r\n laboratory capacity for testing; regulation for quality products and healthy behaviours, and subsidies to public health institutes and programmes.

Can UHC be measured?

Yes. Monitoring progress towards UHC should focus on 2 things:

  • The proportion of a population that can access essential quality health services (SDG 3.8.1)
  • The proportion of the population that spends a large amount of household income on health (SDG 3.8.2).

Measuring equity is also critical to understand who is being left behind—where and why.

Together with the World Bank, WHO has developed a framework to track the progress of UHC by monitoring both categories, taking into account both the overall level and the extent to which UHC is equitable, offering service coverage and financial protection\r\n to all people within a population, such as the poor or those living in remote rural areas.

WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in countries:

Reproductive, maternal, newborn and child health:

  • family planning
  • antenatal and delivery care
  • full child immunization
  • health-seeking behaviour for pneumonia.

Infectious diseases:

  • tuberculosis treatment
  • HIV antiretroviral treatment
  • use of insecticide-treated bed nets for malaria prevention
  • adequate sanitation.

Noncommunicable diseases:

  • prevention and treatment of raised blood pressure
  • prevention and treatment of raised blood glucose
  • cervical cancer screening
  • tobacco (non-)smoking.

Service capacity and access:

  • basic hospital access
  • health worker density
  • access to essential medicines
  • health security: compliance with the International Health Regulations.

Each country is unique, and each country may focus on different areas, or develop their own ways of measuring progress towards UHC. But there is also value in a global approach that uses standardized measures that are internationally recognized so that\r\n they are comparable across borders and over time.

WHO role

UHC is firmly based on the 1948 WHO Constitution, which declares health a fundamental human right and commits to ensuring the highest attainable level of health for all.

WHO is supporting countries to develop their health systems to move towards and sustain UHC, and to monitor progress. But WHO is not alone: WHO works with many different partners in different situations and for different purposes to advance UHC around\r\n the world.

Some of WHO’s partnerships include:

  • UHC2030
  • Alliance for Health Policy and Systems Research
  • P4H Social Health Protection Network
  • UHC Partnership
  • Primary Health-Care Performance Initiative

On 25–26 October 2018, WHO in partnership with UNICEF and the Ministry of Health of Kazakhstan hosted the Global Conference on Primary Health Care, 40 years after the adoption of the historic Declaration of Alma-Ata. Ministers, health workers, academics,\r\n partners and civil society came together to recommit to primary health care as the cornerstone of UHC in the bold newDeclaration of Astana. The Declaration aims to renew political commitment to primary health care from governments, non-governmental organizations,\r\n professional organizations, academia and global health and development organizations.

All countries can do more to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services.

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