Global Report Signals Slowing Progress on Health Coverage

Global progress toward universal health coverage (UHC) has advanced over the past two decades, but the pace is slowing and inequalities are widening, according to the UHC Global Monitoring Report 2025 released by the World Health Organization (WHO) and the World Bank Group. The report shows that although more people are gaining access to health services, millions continue to face financial hardship that undermines their ability to obtain care, a trend with direct implications for workforce stability and productivity.

“Countries are stepping forward with clear priorities, and we are working alongside them to deliver practical solutions at scale. When efforts align behind what works, impact grows,” says Ajay Banga, President, World Bank Group. 

The report finds that health service coverage rose from 54 to 71 points between 2000 and 2023, measured through the Service Coverage Index. During the same period, the proportion of the global population experiencing financial hardship due to large or impoverishing out-of-pocket (OOP) health payments fell from 34% to 26%.

Despite these gains, access remains uneven. An estimated 4.6 billion people still lack essential health services, and 2.1 billion experience financial hardship when seeking care. Of those, 1.6 billion people are either living in poverty or pushed deeper into it due to health-related expenses. WHO defines financial hardship as household spending that exceeds 40% of discretionary income.

Medicine expenses are a major driver of this burden. In three-quarters of countries with available data, medicines account for at least 55% of OOP health spending. For people living in poverty, the median share rises to 60%, limiting their ability to cover other basic needs. Middle-income countries are also seeing greater strain among better-off populations, as rising health costs consume a larger share of household budgets.

The report warns that, at the current rate of progress, full-service coverage without financial hardship will remain out of reach for many by 2030. The global SCI is projected to reach only 74 points by the end of the Sustainable Development Goals (SDG) period, with nearly one in four people still likely to face financial hardship.

Low-income countries have achieved the fastest gains in expanding health coverage and reducing financial hardship, but they continue to face the widest gaps. Improvements in infectious disease programs have driven most of the global increase in service coverage, while progress in reproductive, maternal, newborn, and child health has been modest. Access to noncommunicable disease (NCD) services, however, continues to expand steadily.

Economic growth, social protection, and improved sanitation have contributed to reducing financial hardship in some regions, but WHO notes that essential services remain out of reach for many vulnerable groups. Three out of four people in the poorest population segments faced financial hardship in 2022, compared with fewer than one in 25 among the richest. Women, rural residents, and people with lower education levels report greater difficulty accessing care.

The findings may underestimate the scale of inequalities, as displaced populations and people living in informal settlements are often absent from national datasets.

Tedros Adhanom, Director General, WHO, noted that progress requires stronger political commitment and investment. The report outlines six priority actions for governments: ensuring free essential health care for people living in poverty; increasing public investment in health systems; reducing high OOP spending on medicines; expanding access to NCD services; strengthening primary health care; and adopting multisectoral approaches that recognize the broader determinants of health.

For employers and labor markets, the report highlights the connection between health access and workforce outcomes. Persistent financial barriers and service gaps affect productivity, absenteeism, and long-term economic participation, issues particularly relevant for countries seeking to expand their talent base and strengthen human capital.