Most countries make progress towards universal health coverage, but major challenges remain, WHO–World Bank report finds

Since 2000, most countries – across all income levels and regions – have made concurrent progress in expanding health service coverage and reducing the financial hardship associated with health costs, according to a new joint report from the World Health Organization (WHO) and the World Bank Group. These two indicators are the foundation of universal health coverage (UHC) – the global commitment that everyone, everywhere can access the care they need without financial hardship by 2030.

The UHC Global Monitoring Report 2025 shows that health service coverage, measured by the Service Coverage Index (SCI), rose from 54 to 71 points between 2000 and 2023. Meanwhile, the share of people experiencing financial hardship due to large and impoverishing out-of-pocket (OOP) health payments declined from 34% to 26% between 2000 and 2022.

However, the report cautions that the poorest populations continue to bear the greatest burden of unaffordable health costs, with 1.6 billion people further pushed into poverty. Overall, an estimated 4.6 billion people worldwide still lack access to essential health services and 2.1 billion people experience financial hardship to access health care, including the 1.6 billion people living in poverty or pushed deeper into it due to health expenses.

"Universal health coverage is the ultimate expression of the right to health, but this report shows that for billions of people who cannot access or afford the health services they need, that right remains out of reach,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “In the context of severe cuts to international aid, now is the time for countries to invest in their health systems, to protect the health of their people and economies. WHO is supporting them to do that.”

Financial hardship in health is defined as household spending more than 40% of its discretionary budget on OOP health expenses. Cost of medicines is a major driver of financial hardship: in three-quarters of countries with available data, medicines account for at least 55% of people’s OOP health expenses. The burden is even greater among people living in poverty who allocate a median of 60% of their OOP health expenses on medicines diverting their scarce resources from other essential needs.

While the burden of OOP health costs falls mostly on poorer people, it also affects better-off segments of the population that allocate a large share of their budgets to health expenses, particularly in middle-income countries where this group of people is growing.

Without faster progress, full-service coverage without financial hardship will remain out of reach for many: the global SCI is projected to reach only 74 out of 100 by 2030, with nearly 1 in 4 people worldwide still facing financial hardship at the end of the Sustainable Development Goals (SDG) era.