Will universal health coverage deliver health for all by 2030?

The world’s steady human population growth is the single most important piece of evidence illustrating the success of progressive healthcare development worldwide. The underdevelopment of healthcare over the past three years, a result of the COVID-19 pandemic, led to the chaotic implementation of the much-needed response, resulting in significant mortalities. The rush for vaccine development also compromised long-standing clinical practice in terms of vaccine trials, revealing unexpected shortfalls and bottlenecks within healthcare systems and infrastructures.

These recent events raise fundamental questions about the world's universal health coverage, questions that will continue to linger in the coming decades. It is worth noting that the concept of universal health coverage predates the COVID-19 pandemic and efforts to ensure continuity, in terms of developing resilient healthcare systems across the world, remain paramount in discussions today.

A preliminary study conducted by Swiss TPH and UNC2030 based on CSEM country and VNR data, of which findings have been shared with the World Health Organization, UNAIDS and other stakeholders, is referred to in this article. The study considered data from 139 countries to conduct a review and analysis of universal health coverage commitment for the years 2021 and 2022. Questions in the survey targeted the eight pillar commitment areas of universal health coverage. These included the issue of gender equality and emergency preparedness in healthcare systems across countries. These are discussed as follows:

With the goal of leaving no one behind, the level of commitment observed stood at 9% among the reviewed countries. Where political commitment was of concern, a commitment level of 17% was observed among all countries. A majority of 85% of the reviewed countries affirmed their desire to reduce financial barriers faced by individuals accessing healthcare in their countries. Of these, 52% were operational commitments, whereas 37% were institutional commitments, with 10% being rhetorical commitments.

On the issue of regulation, a 33% commitment was observed, relatively high among all countries. Many of the reviewed countries, constituting 70%, had integrated universal health coverage as their goal in their national health policy planning; however, a limited number of these countries, constituting 11%, translated these institutional commitments into clear-cut universal health coverage implementable roadmaps. A quarter had integrated at least one or two universal health coverage pillars as goals in their national health policies. The evidence also suggests that most of these countries did not operationalise their commitments into action plans or poorly communicated those resolves. Where applicable, the focus of implementation was on disease-specific programmes, rather than having established systems that provided comprehensive healthcare.

In upholding the quality of care, data showed that commitment stood at 18%. The CSEM country consultations and VNR shadow reports also discovered discriminatory practices and limited quality of healthcare services of 10.3% and 61.2%, respectively. This notwithstanding, approximately 139 countries projected a rise in institutional efforts towards establishing comprehensive healthcare programmes.

Concerning investment, the commitment by countries was estimated at 2%, relatively low given the recent global health crisis. The reviewed countries viewed the building of resilient health systems centred around universal health coverage to establish a more inclusive and equitable society as critical. Efforts have, therefore, been increased in this regard, especially on the issue of enhancing access to healthcare services. Some of the investment efforts towards universal health coverage include the introduction of telehealth systems and the strengthening of health data management systems.

Concerning the goal of moving together, a commitment of 21% by reviewed countries was observed, suggesting that most governments were committed to engaging other stakeholders during the VNR process, whereas a few did so for the policy development and implementation process. Thus, governments showed a commitment to multi-sectorial actions in addressing external factors affecting the health sector. While the issue of accountability in the healthcare system remains critical, many countries prioritised the Monitoring & Evaluation (M&E) mechanism as key to health systems' performance with less attention to indicators, such as SDG 3.8.1 (service coverage) and SDG 3.8.2 (financial protection). Only 10% affirmed the formal implementation of an accountability mechanism.

On the goal of ensuring gender equality as per universal health coverage, the study finds that women formed the majority of the workforce in the health sector, although this was not reflected in the representation in terms of health and political leadership of most countries. In addition, the integration of universal health coverage and gender equality hinged primarily on commitments to individual access to sexual reproductive health services (SRHS) out of a wider spectrum of concerns. The study finds a broader understanding of the issue in general lacking, although 75% of commitment was to SRHS among women and girls.

The COVID-19 pandemic was noted as a health emergency that highlighted the health system’s flaws, whereas legislative responses to the pandemic were viewed as a positive achievement. Many countries highlighted the impact of the pandemic on the population’s access to healthcare services with minimal input into steps needed to improve health access among the population of those countries.

The overall findings suggested that countries were making a strong commitment to universal health coverage with a continuum in universal health coverage policy infrastructure development. Thus, the majority are institutional reforms followed by implementation reforms. The trend of reforms is observed on all fronts of the commitment areas. It was observed, however, that UHC implementation in most countries was fragmented and lacked an integrated approach.

Thus, there were no clear-cut universal health coverage strategies and where available, limited use of universal health coverage targets essential to building comprehensive and inclusive healthcare systems was observed. According to the World Bank Group (WBG 2022), universal health coverage is essentially concerned with ensuring that people of the world have access to the healthcare they need without suffering financial hardship.

WBG affirmed that the concern was also fundamental to ending extreme poverty and increasing equity and shared prosperity overall, as specified in the Sustainable Development Goals (SDGs 3.8). Although some work is being done, the rate of work done across all countries varies disproportionately given the resource availability and level of commitment translated into tangible roadmaps. Henceforth, it is imperative to assert here that universal health coverage remains the only means of ensuring healthcare for all citizens of the world, no matter the location and time. Drastic changes are required to meet the targeted timelines of the health-for-all agenda 2030.

Universal Health Coverage Day falls on 12 December every year. Universal health advocates use this day to amplify their call for universal health coverage. Find out more here.