Brain Association IasiMost countries make progress towards universal health coverage, but major challenges remain, WHO–World Bank report finds
Since 2000, most countries – across all income levels and regions – have made concurrent progress in expanding health service coverage and reducing the financial hardship associated with health costs, according to a new joint report from the World Health Organization (WHO) and the World Bank Group. These two indicators are the foundation of universal health coverage (UHC) – the global commitment that everyone, everywhere can access the care they need without financial hardship by 2030.
The UHC Global Monitoring Report 2025 shows that health service coverage, measured by the Service Coverage Index (SCI), rose from 54 to 71 points between 2000 and 2023. Meanwhile, the share of people experiencing financial hardship due to large and impoverishing out-of-pocket (OOP) health payments declined from 34% to 26% between 2000 and 2022.
However, the report cautions that the poorest populations continue to bear the greatest burden of unaffordable health costs, with 1.6 billion people further pushed into poverty. Overall, an estimated 4.6 billion people worldwide still lack access to essential health services and 2.1 billion people experience financial hardship to access health care, including the 1.6 billion people living in poverty or pushed deeper into it due to health expenses.
"Universal health coverage is the ultimate expression of the right to health, but this report shows that for billions of people who cannot access or afford the health services they need, that right remains out of reach,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “In the context of severe cuts to international aid, now is the time for countries to invest in their health systems, to protect the health of their people and economies. WHO is supporting them to do that.”
Financial hardship in health is defined as household spending more than 40% of its discretionary budget on OOP health expenses. Cost of medicines is a major driver of financial hardship: in three-quarters of countries with available data, medicines account for at least 55% of people’s OOP health expenses. The burden is even greater among people living in poverty who allocate a median of 60% of their OOP health expenses on medicines diverting their scarce resources from other essential needs.
While the burden of OOP health costs falls mostly on poorer people, it also affects better-off segments of the population that allocate a large share of their budgets to health expenses, particularly in middle-income countries where this group of people is growing.
Without faster progress, full-service coverage without financial hardship will remain out of reach for many: the global SCI is projected to reach only 74 out of 100 by 2030, with nearly 1 in 4 people worldwide still facing financial hardship at the end of the Sustainable Development Goals (SDG) era.
Encouraging progress in low-income countries with largest gapsDespite positive direction, the global progress rate has slowed since 2015 with only one-third of countries improving in both increasing health coverage and reducing financial hardship. All WHO regions have improved service coverage, but only half – Africa, South-East Asia, the Western Pacific – also reduced financial hardship. Low-income countries achieved the fastest gains in both areas but are still facing the largest gaps.
The global increase in health service coverage has been driven largely by advances in infectious disease programmes. Coverage for noncommunicable diseases (NCDs) has shown steady improvement, while gains in reproductive, maternal, newborn, and child health have been modest.
The report notes that improved sanitation has supported service coverage gains. At the same time, inclusive economic growth, rising incomes, and stronger social protection mechanisms have driven poverty reduction, especially in low-income countries, contributing to declines in financial hardship. However, health costs have increasingly become a source of financial hardship among the poor.
Inequalities are getting starkerDespite progress, persistent gaps and inequalities are on the rise. In 2022, 3 out of 4 people among the poorest segment of the populations faced financial hardship from health costs, compared with fewer than 1 in 25 among the richest.
Women, people living in poverty, or in rural areas, or with less education, reported greater difficulty accessing essential health services. The gap between women in the richest and poorest quintiles narrowed slightly, from about 38 to 33 percentage points over the past decade. Even in high-performing regions such as Europe, vulnerable groups – including the poorest and people with disabilities – continue to report higher unmet health needs.
These findings likely underestimate the true extent of health inequalities, as the most vulnerable groups – such as displaced populations and people living in informal settlements – are often missing in data sources used to monitor progress toward UHC.
Actions leading to 2030Achieving the UHC goal by 2030 is central to realizing the human right to health. With five years remaining on the SDG agenda, urgent action is now needed to drive progress. The report underscores the critical role of political commitment in every country and community, and calls for action in six core areas:
- ensure essential health care is free at the point of care for people living in poverty and vulnerable situations;
- expand public investments in health systems;
- address high out-of-pocket spending on medicines;
- accelerate access to essential NCD services, especially as the disease burden rises;
- strengthen primary health care to promote equity and efficiency; and
- adopt multisectoral approaches, recognizing that determinants of health and UHC drivers extend beyond the health sector.
Editor’s note
This edition of the UHC Global Monitoring Report 2025 reflects the first round of UHC tracking to incorporate revised SDG indicators for health service coverage (SDG 3.8.1) and financial hardship (SDG 3.8.2), introduced in 2025. Using the revised indicators, and reproduction of the full time series, the report has presented global and regional trends in service coverage from 2000 to 2023, based on time series data for 195 countries or territories, and global and regional trends in financial hardship from 2000 to 2022, based on primary country time series for 168 countries. More about monitoring universal health coverage.
The Report is presented at the UHC High-Level Forum, jointly hosted by the Government of Japan, the World Bank Group, and WHO, in Tokyo, Japan. The Forum will also mark the official launch of the UHC Knowledge Hub in Tokyo, established by WHO and the World Bank Group with the support of the Government of Japan. The Hub offers capacity strengthening programmes for Ministries of Health and Finance to support health financing reforms. More about the Universal Health Coverage (UHC) High-level Forum 2025.
WHO, the World Bank Group, UHC2030 and the Joint Learning Network for Universal Health Coverage will organize a technical webinar “Tracking Universal Health Coverage: 2025 Global Monitoring Report” on 8 December 2025, at 8:00–9:30am EST | 14:00–15:30 CET. You can join the webinar through this link. (Passcode: .W1MJT=@r3)
Countries to reconvene sooner to accelerate progress on WHO Pathogen Access and Benefit Sharing system negotiations
WHO Member States today ended their latest round of intensive negotiations on the world’s first Pathogen Access andBenefit Sharing (PABS) system. Countries decided to resume deliberations in January in a reflection of the shared commitment and urgency needed to help make the world safer from future pandemics.
Countries convened for the fourth meeting of the Intergovernmental Working Group (IGWG) on the WHO Pandemic Agreement in Geneva from 1–5 December 2025. They requested to extend the current fourth round of negotiations, agreeing to resume from 20–22 January 2026.
The World Health Assembly established the IGWG to undertake several tasks, including, as a priority, to draft and negotiate the PABS annex to the WHO Pandemic Agreement. Member States requested the establishment of a PABS platform to operate as a global system to share pathogens and their genetic information, along with the benefits that arise from their use, in a timely, fair and transparent way. This would pave the way for a more effective and equitable response to the next pandemic.
“As we cross the halfway mark in negotiations on the Pathogen Access and Benefit-Sharing (PABS) system, I am encouraged by the progress we’ve made towards enabling a faster and more equitable global response to future pandemics," said IGWG Bureau co-chair Mr Matthew Harpur of the United Kingdom. "Member States have demonstrated real commitment to finding common ground and bridging differences, as we work to deliver a strong PABS system by the next World Health Assembly.”
IGWG Bureau co-Chair Ambassador Tovar da Silva Nunes, of Brazil, said: “WHO Member States have shown their dedication to finishing this important task. The progress achieved on access, benefit-sharing and core governance areas provides the foundation to move the process forward. We are confident we can build a strong and balanced PABS system that will benefit all people.”
WHO Director-General Dr Tedros Adhanom Ghebreyesus added: “This is both a generational opportunity and a generational responsibility. I thank Member States and the IGWG Bureau for rising to the occasion. As we get ready to close out this year, we are in a strong position to forge consensus, finalize the draft, and prepare for adoption at next year’s World Health Assembly. Together, we are moving toward a world that is better prepared for future pandemics."
Before this fourth session, the IGWG Bureau organized informal dialogues with stakeholders, including representatives from the private sector, academia, laboratories and sequence information databases. Similar focused dialogues will continue over the following weeks, in preparation for the resumed session in January. The fifth IGWG meeting will take place on 9–14 February 2026.
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New prevention tools and investment in services essential in the fight against AIDS
On World AIDS Day, the World Health Organization (WHO) calls on governments and partners to rapidly expand access to new WHO-approved tools including lenacapavir (LEN) to drive down infections and counter disruption to essential health services caused by cuts to foreign aid.
Despite dramatic funding setbacks, the global HIV response has gained a remarkable momentum in 2025 with the introduction and WHO approval of twice-yearly injectable lenacapavir for HIV prevention. LEN, a highly effective, long-acting alternative to oral pills and other options, is a transformative intervention for people who face challenges with regular adherence and stigma in accessing health care. WHO released in July this year new guidelines recommending the use of lenacapavir as an additional pre-exposure prophylaxis (PrEP) option for HIV prevention.
Sharp and sudden reductions in international funding this year led to disruptions in HIV prevention, treatment and testing services, with essential community-led programmes, including pre-exposure prophylaxis (PrEP) and harm reduction initiatives for people who inject drugs, being scaled back or shut down entirely in some countries.
“We face significant challenges, with cuts to international funding, and prevention stalling," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “At the same time, we have significant opportunities, with exciting new tools with the potential to change the trajectory of the HIV epidemic. Expanding access to those tools for people at risk of HIV everywhere must be priority number one for all governments and partners.”
Marking World AIDS Day under the theme “Overcoming disruption, transforming the AIDS response”, WHO is urging a dual track approach – solidarity and investment in innovations to protect and empower communities most at risk.
After decades of progress, the HIV response stands at a crossroads. In 2024:
- HIV prevention efforts stagnated, with 1.3 million new infections, disproportionately impacting key and vulnerable populations;
- UNAIDS data reveal that almost half (49%) of new HIV infections occurred among key populations – including sex workers, men who have sex with men, transgender women, and people who inject drugs – and their sexual partners;
- while sex workers and transgender women face a 17-fold higher risk of acquiring HIV, men who have sex with men face an 18-fold higher risk, and people who inject drugs – a 34-fold higher risk;
- underlying drivers include stigma, discrimination, and legal, social and structural barriers these groups face to access HIV care; and
- globally, an estimated 40.8 million people were living with HIV, and 630 000 people died from HIV-related causes.
While the full scale of the impact of foreign aid cuts is still being assessed, access to PrEP is believed to have declined dramatically. The AIDS Vaccine Advocacy Coalition estimates that, as of October 2025, 2.5 million people who used PrEP in 2024 lost access to their medications in 2025 due solely to donor funding cuts. Such disruptions could have far-reaching consequences for the global HIV response, jeopardizing efforts to end AIDS by 2030.
Momentum for innovation“We are entering a new era of powerful innovations in HIV prevention and treatment,” said Dr Tereza Kasaeva, Director of WHO’s Department for HIV, TB, Hepatitis and STIs. “By pairing these advances with decisive action, supporting communities, and removing structural barriers, we can ensure that key and vulnerable populations have full access to life-saving services.”
WHO prequalified LEN for HIV prevention on 6 October 2025, followed by national regulatory approvals that will increase access in South Africa (on 27 October), Zimbabwe (27 November) and Zambia (4 November). WHO’s Collaborative Registration Procedure (CRP) supported these approvals. WHO is also working closely with partners such as CIFF, the Gates Foundation, the Global Fund to Fight AIDS, Tuberculosis and Malaria and Unitaid to enable affordable access to LEN in countries. Ensuring that long-acting HIV medicines for prevention and treatment reach priority populations must be a global priority.
Integrating HIV services into primary health careWHO emphasizes that ending the AIDS epidemic depends on a fully integrated, evidence-based and rights-driven approach under the umbrella of primary health care. WHO will continue working with partners and leaders to put those most affected at the centre of the HIV response. Despite funding setbacks, the resilience and leadership of communities offer a clear path forward. By strengthening health systems, increasing domestic investment, and protecting human rights, countries can safeguard gains and ensure no one is left behind.
