Most mornings in low-income settlements around the world start with the same quiet struggle: deciding whether to buy medicine or food. This everyday quandary is at the heart of a new joint report from the World Health Organisation (WHO) and the World Bank Group that warns that universal health coverage (UHC)—the promise that everyone can access essential care without financial hardship—remains elusive for billions of people, particularly women and the poorest households. 

According to the UHC Global Monitoring Report 2025, countries at all economic levels have achieved sustained improvement since 2000. The Service Coverage Index (SCI), a basic statistic that assesses how many key services a country's population has access to, increased from 54 to 71 between 2000 and 2023. During the same time, the proportion of those forced into financial difficulty by medical expenses declined from 34% to 26%. 

However, these averages conceal profound inequities. An estimated 4.6 billion people continue to lack access to vital health services, and 2.1 billion face financial hardship, with 1.6 billion being pushed into or deeper poverty as a result of healthcare costs. Women, individuals from rural areas, those with less education, and people with impairments face far higher challenges. Even in high-performing regions like Europe, vulnerable populations report unmet health needs. 

"Universal health coverage is the ultimate expression of the right to health, but this report shows that billions of people cannot access or afford the health services they need," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. He went on to say that, "in the context of severe cuts in 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 encouraging them to do so." 

The research defines financial hardship as a household spending more than 40% of its remaining funds on healthcare after paying for necessities like food and housing. The most significant contributor is the high cost of medications. In three-quarters of countries, pharmaceuticals account for at least 55% of out-of-pocket expenses. For already impoverished families, 60% of their healthcare costs are spent primarily on medications, leaving little money for education, nourishment, and transportation. 

While low-income nations have made the most rapid progress in extending coverage and reducing hardship, they continue to face the most significant gaps. Since 2015, progress has stalled globally. Gains have primarily come from infectious disease initiatives; noncommunicable diseases, such as diabetes and heart disease, are increasing faster than services can grow. Maternal and child health improvements are modest, making women more vulnerable. 

Looking ahead to 2030, the research says that the worldwide SCI may only reach 74 out of 100, putting nearly one in every four people in financial distress. To prevent further inequalities, the authors propose six urgent actions: making essential services free for the poorest people, increasing public investment in health systems, lowering the high cost of medicines, accelerating access to chronic disease services, strengthening primary care, and implementing multisectoral policies that recognise that health is shaped by more than just healthcare. 

For millions of families, universal health coverage is more than just a policy phrase; it is a daily concern of dignity and survival. The next five years will determine whether the world advances closer to achieving the right to health—or leaves the most vulnerable further behind.