Universal Health Coverage Day 2024: Moving Forward Together for Health Equity

Universal Health Coverage: A Pillar of Health and Development

What is UHC? Universal Health Coverage (UHC) ensures access to quality health services without financial hardship. It spans the full spectrum of essential health services, including promotion, prevention, treatment, rehabilitation, and palliative care, catering to needs across the lifespan.
Building Strong Health Systems: Delivering UHC requires a well-distributed and adequately supported health workforce, equipped with quality-assured resources and provided with decent working conditions to ensure equitable and efficient service delivery.
Protecting Financial Well-being: UHC shields individuals from catastrophic out-of-pocket expenses, preventing them from depleting savings, selling assets, or borrowing money. This financial security safeguards their future and the well-being of their children.
Global Commitments: UHC is central to the 2030 Sustainable Development Goals (SDGs) adopted in 2015. At the 2019 UN General Assembly High-Level Meeting on UHC, nations reaffirmed that health is both an essential goal and a measure of sustainable development across social, economic, and environmental domains.
WHO’s Vision: The Thirteenth General Programme of Work (GPW 13) aims to extend UHC benefits to an additional billion people by 2025. It also seeks to better protect another billion from health emergencies and ensure improved health and well-being for yet another billion.

Progress Toward UHC: Key Highlights

Stagnating Service Coverage: Progress in UHC service coverage slowed significantly after 2015, with the index rising only 3 points to 68 by 2019 and stagnating through 2021. About 4.5 billion people lacked full access to essential health services in 2021.
Financial Hardship Rising: The percentage of people incurring catastrophic health spending grew from 9.6% in 2000 to 13.5% in 2019, impacting over 1 billion people. Out-of-pocket costs pushed 344 million into extreme poverty and 1.3 billion into relative poverty, with 2 billion people facing financial hardships overall.
Widening Inequalities: Wealth, education, and urban residency continue to determine access to health services, especially in low-income countries. Rural households, older adults, and marginalized groups face greater financial strain and health inequities.
COVID-19 Disruptions: By 2021, essential health services were disrupted in 92% of countries, with 84% still affected in 2022. Routine immunization for 25 million children under 5 years was missed in 2021, and vaccine inequities persisted, with only 34% coverage in low-income countries by mid-2023.
PHC as a Solution: WHO advocates a Primary Health Care (PHC) approach as the most cost-effective and equitable path to UHC. PHC can deliver 90% of essential UHC interventions, save 60+ million lives, and increase global life expectancy by 3.7 years by 2030, contributing significantly to SDG health targets.

Introduction: Why UHC Day Matters

Universal Health Coverage (UHC) Day, celebrated annually on December 12, serves as a global call to action for equitable and accessible healthcare for everyone, everywhere. This year’s theme, “Health for All: Leaving No One Behind,” resonates deeply as the world continues to address systemic inequities in health systems exposed by recent global crises. In Nepal, UHC Day presents an opportunity to reflect on our progress in achieving health equity while recognizing the challenges that remain. Today, let us commit to working together to ensure health as a right, not a privilege.

The History of UHC Day

UHC Day was first declared in 2012 following a unanimous resolution by the United Nations General Assembly (UNGA), recognizing December 12 as a day to advocate for health as a universal human right. Since 2014, UHC Day has been marked by global campaigns to galvanize action and measure progress toward achieving Universal Health Coverage.

Year-wise Themes:

Universal Health Coverage (UHC) Day from 2014 to 2024:

Year	Theme
2014	Health Coverage for All: Everywhere, Everyone.
2015	Act with Ambition.
2016	Health for All.
2017	Leave No One Behind: Investing in Health Systems for All.
2018	Unite for Universal Health Coverage: Now is the Time for Collective Action.
2019	Keep the Promise.
2020	Health for All: Protect Everyone.
2021	Leave No One Behind: Invest in Health Systems for All.
2022	Build the World We Want: A Healthy Future for All.
2023	Strengthen the Foundation: Health Systems for UHC.
2024	Health for All: Leaving No One Behind.

Universal Health Coverage Day was officially recognized starting in 2014. The years 2012 and 2013 were primarily focused on foundational advocacy efforts leading to UHC Day’s formal declaration. During this period:

2012: The United Nations General Assembly passed a resolution endorsing Universal Health Coverage (UHC) as a key component of sustainable development and human well-being.
2013: Advocacy continued globally, emphasizing the importance of making UHC a reality, which culminated in the establishment of UHC Day in 2014.

There were no specific annual themes for 2012 and 2013 as UHC Day was not officially celebrated then.

What is Universal Health Coverage?

Universal Health Coverage (UHC) means that all individuals and communities receive the health services they need without suffering financial hardship. It encompasses three essential components:

Access to Essential Health Services: Ensuring everyone has access to necessary health services, including preventive, curative, rehabilitative, and palliative care.
Financial Risk Protection: Preventing individuals from falling into poverty due to out-of-pocket health expenditures.
Equity in Service Delivery: Prioritizing the needs of vulnerable and underserved populations.

Aligned with Sustainable Development Goal 3.8, UHC is not only a goal but a pathway to achieving health equity and social justice globally.

Key facts

The world is off track to make significant progress towards universal health coverage (Sustainable Development Goals (SDGs) target 3.8) by 2030. Improvements to health services coverage have stagnated since 2015, and the proportion of the population that faced catastrophic levels of out-of-pocket health spending increased continuously since 2000. This global pattern is consistent across all regions and the majority of countries.
The UHC service coverage index increased from 45 to 68 between 2000 and 2021. However, recent progress in increasing coverage has slowed compared to pre-2015 gains, rising only 3 index points between 2015 and 2021 and showing no change since 2019.
The proportion of the population not covered by essential health services decreased by about 15% between 2000 and 2021, with minimal progress made after 2015. This indicates that in 2021, about 4.5 billion people were not fully covered by essential health services.
About 2 billion people are facing financial hardship including 1 billion experiencing catastrophic out-of-pocket health spending (SDG indicator 3.8.2) or 344 million people going deeper into extreme poverty due to health costs.
The COVID-19 pandemic further disrupted essential services in 92% of countries at the height of the pandemic in 2021. In 2022, 84% of countries still reported disruptions.
To build back better, WHO’s recommendation is to reorient health systems using a primary health care (PHC) approach. Most (90%) of essential UHC interventions can be delivered through a PHC approach, potentially saving 60 million lives and increasing average global life expectancy by 3.7 years by 2030.

Ref: Universal health coverage (UHC)

The Global Perspective: UHC in 2024

Globally, countries have made remarkable strides in advancing UHC. For instance, Japan and Thailand stand out for their robust health systems that emphasize equity and sustainability. However, challenges persist, with over half of the world’s population still lacking access to essential health services. The COVID-19 pandemic underscored the fragility of health systems and the need for resilient, inclusive frameworks. In 2024, the focus has shifted to rebuilding stronger systems, leveraging technology, and fostering partnerships to close existing gaps.

universal health coverage progress of the world

Source:SDG 3.8.2 Catastrophic health spending (and related indicators)

Can UHC be measured?

Yes, The UHC target of the SDGs measures the ability of countries to ensure that everyone receives the health care they need, when and where they need it, without facing financial hardship. It covers the full continuum of key services from health promotion to prevention, protection, treatment, rehabilitation and palliative care.

Progress on UHC is tracked using two indicators:

coverage of essential health services (SDG 3.8.1); and
catastrophic health spending (and related indicators) (SDG 3.8.2).

Detailed data is provided in the WHO Global Health Observatory Data Repository for UHC. Country profiles can be downloaded from https://data.who.int/.

Progress in service coverage (SDG indicator 3.8.1) and catastrophic health spending (SDG indicator 3.8.2,10% threshold), 2000–2019

Related SDG UHC Indicators

Comparing UHC models amongst nations

Countries with publicly supported healthcare systems, such as the UK and Canada, provide strong UHC models.
The National Health Service (NHS), which is financed by general taxes, offers free access to necessary medical treatments in the United Kingdom.
In a similar vein, Medicare in Canada guarantees access to healthcare at no direct cost to patients, with extensions such as the Pharmacare Act covering prescription drugs.
Nepal, on the other hand, depends on a combination of public programs. Private insurance covers specialist treatments to fill in the gaps left by public programs, which cover basic and emergency care.
Nepal still confronts issues including unequal access and high out-of-pocket costs in spite of these steps, underscoring the necessity of comprehensive health insurance.

UHC in Nepal: Progress and Challenges

Nepal’s journey toward UHC has been marked by significant achievements and persistent obstacles. Initiatives such as the National Health Insurance Program have expanded financial risk protection, while the Primary Health Care (PHC) system has brought basic services to rural and remote areas. The dedication of Female Community Health Volunteers (FCHVs) in extending maternal and child health services has been exemplary.

Yet, challenges remain:

Funding Gaps: Insufficient public health funding limits the expansion of essential services.
Workforce Shortages: There is a critical need for trained health workers, particularly in rural regions.
Geographical Barriers: Nepal’s diverse and rugged terrain hinders equitable service delivery.

The Role of Primary Health Care (PHC)

Primary Health Care is the cornerstone of UHC, providing a comprehensive approach to health promotion and disease prevention. In Nepal, PHC revitalization efforts have included:

Strengthening health posts and rural outreach clinics.
Training FCHVs to deliver essential services at the community level.
Integrating traditional and modern practices to address local health needs.

Success Stories and Innovations

Nepal’s collaboration with international partners has led to notable successes:

Community-Based Health Insurance Schemes: Piloted in select districts, these schemes have improved financial protection for vulnerable populations.
Telemedicine Initiatives: Bringing specialist consultations to remote areas through digital platforms.
Youth-Led Health Advocacy: Programs empowering young people to promote healthy behaviors and advocate for equitable health policies.

Globally, innovations such as mobile health applications and decentralized health service models offer inspiration for Nepal to adapt and scale similar solutions.

Global and Regional Data Facts

Over 930 million people worldwide spend more than 10% of their household income on healthcare.
In South Asia, over 60% of health expenditures are out-of-pocket, highlighting the urgent need for UHC.
The World Health Organization (WHO) estimates that achieving UHC could prevent 97 million people globally from falling into extreme poverty annually.
Nepal’s health insurance enrollment stands at around 15%, indicating a need for improved awareness and accessibility.

Useful Resources for Learning More

World Health Organization (WHO) UHC Portal: https://www.who.int/health-topics/universal-health-coverage
UHC2030 Partnership: https://www.uhc2030.org
Nepal Health Insurance Board: https://hib.gov.np
Health Systems Global: https://healthsystemsglobal.org
The Lancet Global Health: https://www.thelancet.com/global-health

Call to Action: How Can We Contribute?

Achieving UHC requires collective effort from individuals, organizations, and governments. Here’s how you can contribute:

Advocate for Policies: Engage with policymakers to prioritize health funding and equity.
Volunteer: Support local health initiatives, especially in underserved areas.
Raise Awareness: Use platforms to educate others about UHC and its importance.
Adopt Healthy Practices: Lead by example in promoting preventive health measures.

Conclusion: A Shared Vision for UHC

Universal Health Coverage is not merely a target; it is a testament to the collective aspiration for a healthier, more equitable world. On this UHC Day 2024, let us reaffirm our commitment to “Moving Forward Together for Health Equity.” By addressing barriers, embracing innovation, and strengthening partnerships, we can turn the vision of Health for All into a reality. Together, we can ensure no one is left behind.

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