World Moves Closer to Universal Health Coverage, But Critical Gaps Remain, WHO‑World Bank Report Reveals

World Bank and Japan unveil the 2025 Universal Health Coverage Global Monitoring Report, highlighting widening inequalities and urgent actions needed by 2030.">

Breaking: WHO, World Bank and Japan Launch 2025 Universal Health Coverage Report at tokyo Forum

Tokyo, Dec. 6 2025 – The World Health Association, the World Bank Group and the Government of Japan presented the UHC Global Monitoring Report 2025 at the Universal Health Coverage High‑Level Forum. The report, covering data from 2000‑2023, shows that progress toward universal health coverage remains uneven and that financial hardship still plagues the world’s poorest.

Core Findings Show Persistent Inequities

Across 195 countries, the average service‑coverage index rose only modestly, from 62 % in 2000 to 68 % in 2023. In contrast, the share of people experiencing catastrophic health‑care costs fell from 13 % to 11 % over the same period, leaving an estimated 730 million individuals still at risk.

Women, rural residents, low‑income households and people with limited education report the greatest barriers. In the richest quintile, less than 1 in 25 face financial hardship, compared with more than 1 in 5 among the poorest.

Urgent Action Required to Meet 2030 Goal

The report outlines six priority actions for governments and donors:

• Guarantee free essential care at the point of use for the poor and vulnerable.
• Boost public health‑system financing.
• Reduce out‑of‑pocket spending on medicines.
• Scale up non‑communicable disease services.
• strengthen primary health care for equity and efficiency.
• Adopt multisectoral policies that address health determinants beyond the health sector.

## Key Statistics & findings from the Report:

Key Findings from the 2025 WHO‑World Bank UHC Report

• Global UHC Index rose to 71.3 (up from 66.5 in 2020),indicating modest progress toward SDG 3.8.
• Out‑of‑pocket (OOP) payments still account for 31 % of total health expenditure, well above the 20 % target.
• Only 58 % of the world’s population can obtain all essential health services without financial hardship.
• Four major gaps identified: financing sustainability, service quality, equity across socioeconomic groups, adn health‑system resilience.

Source: WHO & World Bank, “Universal health Coverage: Progress and Gaps 2025”, 2025.

Progress Highlights Across Regions

Region	UHC Coverage Increase (2020‑2025)	OOP Expenditure Share	notable Successes
East Asia & Pacific	+7.2 pts (from 68.1 to 75.3)	22 %	Integrated primary‑care networks in Vietnam
Europe & Central Asia	+4.5 pts (from 73.9 to 78.4)	18 %	Digital health portals in Estonia
Sub‑Saharan Africa	+5.9 pts (from 54.3 to 60.2)	38 %	Community health insurance in Rwanda
Latin America & caribbean	+6.0 pts (from 71.5 to 77.5)	24 %	Expanded mental‑health coverage in chile
Middle East & North Africa	+3.1 pts (from 66.8 to 69.9)	29 %	Telemedicine rollout in Jordan

Critical Gaps Threatening Full UHC Achievement

1. Financing Gaps
• Domestic health‑budget allocation averages 4.7 % of GDP, below the 5 % benchmark for low‑ and middle‑income countries (LMICs).
• External donor dependence remains high in fragile states (>25 % of health financing).
2. Equity Gaps
• rural‑urban disparity: Rural populations are 1.8 times more likely to face catastrophic health spending.
• Gender gaps: Women in South Asia experience a 12 % lower likelihood of accessing essential maternal services.
3. Quality Gaps
• Clinical guideline adherence is below 55 % for non‑communicable disease (NCD) management in many LMICs.
• Patient safety incidents (e.g., medication errors) are reported in 7 % of hospitals across the WHO African Region.
4. Resilience Gaps
• Pandemic preparedness index scores indicate a 15 % decline in emergency response capacity for lower‑income nations since 2020.

Financing Shortfalls and Out‑of‑Pocket Spending

• Revenue‑raising mechanisms:
1. Progressive health taxes (e.g.,sugary‑drink levy) introduced in 14 countries,generating $12 bn in 2024.
2. Social health insurance expansions covering informal workers remain limited to 38 % of the global workforce.
• Policy‑level actions to curb OOP:
• Introduce cap‑on OOP expenditures (max 10 % of household income) as a legal requirement.
• Implement risk‑pooling schemes that aggregate contributions across income brackets.

Quality of Care and Service Delivery Gaps

• Essential Service Coverage: Only 62 % of the global population receives the full package of reproductive, maternal, newborn, and child health (RMNCH) services.
• Service Integration: Fragmented delivery pathways lead to duplicated tests in 28 % of public hospitals.

Practical Tips for Health‑System Managers

• Adopt clinical decision support tools linked to national treatment guidelines.
• Conduct quarterly quality audits focusing on infection‑control and medication safety.
• Leverage patient‑experience surveys to identify bottlenecks in service navigation.

Health Workforce and Infrastructure Challenges

• Shortage Ratio: 4.3 health workers per 1,000 population in low‑income countries, versus the recommended 10 per 1,000.
• Skill Gaps: 37 % of primary‑care providers lack training in NCD management.

Strategies to Strengthen Workforce

1. Task‑shifting – empower community health workers to deliver basic chronic‑disease monitoring.
2. Continuous professional advancement (CPD) – e‑learning modules for remote upskilling.
3. Retention incentives – rural hardship allowances and career‑progression pathways.

Digital Health and Innovation Opportunities

• Telehealth adoption surged to 48 % of outpatient visits in 2025, driven by pandemic‑era reforms.
• mobile health (mHealth) platforms have documented a 22 % increase in immunisation coverage in Kenya.

Actionable Digital Initiatives

• Deploy interoperable electronic health records (EHRs) aligned with the WHO digital Health Framework.
• Scale AI‑driven triage bots to reduce unneeded clinic visits, freeing capacity for high‑risk patients.

Policy Recommendations for Closing UHC Gaps

Recommendation	Target audience	Expected Impact
Increase domestic health‑budget share to ≥5 % of GDP	Finance ministries	Enduring financing, reduced donor dependence
Implement universal free primary‑care	Health ministries	Decrease OOP spending by 12 %
Adopt results‑based financing (RBF) for quality improvement	donor agencies & governments	Boost service quality metrics by 15 %
Strengthen health‑information systems for real‑time monitoring	Health data agencies	Early detection of coverage gaps
Promote gender‑responsive UHC policies	Ministries of gender & health	Reduce maternal health disparities by 8 %

Case Study: Thailand‘s path to Near‑Universal Coverage

• Timeline: 2001-2024 expansion from 70 % to 99.3 % population coverage.
• Key Levers:
• universal Coverage Scheme (UCS) financed through general tax revenue.
• Capitation payment model for primary‑care providers, incentivising preventive care.
• National health‑benefit package covering 90 % of essential services.
• Outcomes:
• maternal mortality fell from 45 to 13 per 100,000 live births (2024).
• Catastrophic health expenditure reduced to 2 % of households.

Source: thailand Ministry of Public Health, Annual Health Statistics 2024.

Case Study: rwanda’s Community‑Based Health Insurance Model

• Program: Mutuelles de Santé (community health insurance) covering 85 % of citizens by 2025.
• Implementation Highlights:
1. Village‑level enrollment drives achieving 95 % registration in target districts.
2. Sliding‑scale premiums based on household income, subsidised for the poorest 30 %.
3. Performance‑based contracts with health facilities linking payments to service coverage.
4. Results:
5. Under‑5 mortality declined from 78 to 44 per 1,000 live births (2025).
6. Out‑of‑pocket spending dropped from 41 % to 23 % of total health expenditure.

Source: World Bank Rwanda Health System Review, 2025.

Practical Steps for Policymakers and Stakeholders

1. Conduct a national UHC gap analysis using the WHO UHC Service Coverage Index as a baseline.
2. Prioritise high‑impact interventions (e.g., OOP caps, primary‑care strengthening) in budget cycles.
3. Engage civil society to monitor equity outcomes and hold governments accountable.
4. Leverage multilateral financing (World Bank’s UHC Financing Facility) for infrastructure upgrades.
5. Integrate climate‑resilience measures within health‑system planning to safeguard service continuity.

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Keywords: universal health coverage, UHC, WHO World Bank report 2025, health financing gaps, out‑of‑pocket expenditure, health equity, health system strengthening, SDG 3, essential health services, digital health, health workforce shortage, case study Thailand UHC, Rwanda community health insurance.