Confronting the elephants in the room: reigniting momentum for universal health coverage

Abstract

Universal health coverage (UHC) means, according to WHO's definition, that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”.1 Countries formally pledged to achieve UHC by 2030 through the UN Sustainable Development Goals (SDGs),2 and reinforced their commitments at two subsequent UN high-level meetings in 2019 and 2023.3 Yet progress towards UHC has not just stagnated, but deteriorated. Of 194 WHO member states, 108 countries have had worsening or no substantive change in health service coverage since the launch of the SDGs in 2015; only 42 countries of the 138 for which data are available have seen a reduction in catastrophic out-of-pocket health spending since 2000.4 This backsliding can be reversed and momentum reinvigorated for UHC by tackling four elephants in the room (difficult challenges that people often do not want to talk about) that are barriers to advancing UHC.