Question 1

What is universal health coverage?

Accepted Answer

UHC means that all people can access the health services they need — promotive, preventive, curative, rehabilitative and palliative — of sufficient quality, without financial hardship. It does not mean every service is free, but that cost is not a barrier to essential care. UHC is the goal of SDG 3.8 and the organising principle of the WHO's 13th General Programme of Work.

Question 2

How many people lack access to health services?

Accepted Answer

WHO and the World Bank estimate at least 4.5 billion people — more than half the world's population — cannot access essential health services (WHO/World Bank Tracking UHC 2023). Access is measured by the UHC Service Coverage Index. The most significant gaps are in sub-Saharan Africa, South Asia and fragile and conflict-affected states.

Question 3

What are the two dimensions of UHC?

Accepted Answer

WHO and the World Bank measure UHC along two dimensions: (1) service coverage — the UHC Service Coverage Index (0-100), which reached 68 globally in 2021; and (2) financial protection — the proportion of people not facing catastrophic or impoverishing health expenditure. Both dimensions must improve together for genuine UHC. Progress on coverage has stalled since 2015; financial protection has worsened.

Question 4

What is catastrophic health expenditure?

Accepted Answer

Catastrophic health expenditure is out-of-pocket health spending exceeding 10% of total household consumption. When health costs are "catastrophic," households sacrifice food, education and housing to pay for care. Approximately 2 billion people face financial hardship from health costs, and at least 1 billion are pushed into extreme poverty annually by out-of-pocket spending.

Question 5

What is the UHC Service Coverage Index?

Accepted Answer

The UHC SCI is a composite indicator (0-100) developed by WHO and the World Bank combining 16 indicators across four service areas: reproductive/maternal/newborn/child health; infectious diseases; NCDs; and service capacity. The global index reached 68 in 2021, up from 45 in 2000 — significant progress, but stalling in recent years and far short of universal.

Question 6

What is the role of primary health care in UHC?

Accepted Answer

Primary health care (PHC) is the foundation of UHC: the first level of contact with the health system, bringing care as close as possible to where people live and work. The 2018 Astana Declaration reaffirmed PHC as the most effective and efficient pathway to UHC. Well-functioning primary care — accessible, comprehensive, continuous, coordinated and person-centred — prevents the need for more costly secondary and tertiary care.

Question 7

How does health financing relate to UHC?

Accepted Answer

For UHC, financing arrangements must: ensure sufficient funds; protect people from financial catastrophe; and use funds efficiently and equitably. Pooling mechanisms — social health insurance, tax-funded systems — are most effective at providing financial protection. High out-of-pocket spending, which characterises many LMIC health systems, is fundamentally incompatible with UHC.

Question 8

What happened at the 2023 UN High-Level Meeting on UHC?

Accepted Answer

The September 2023 UN High-Level Meeting on UHC resulted in a political declaration committing to: increasing primary health care spending to at least 1% of GDP by 2030; achieving 80% coverage with essential services; reducing catastrophic health expenditure by at least a quarter; and annual progress reporting. The meeting followed the 2019 HLM on UHC, whose targets remain largely unmet.

Question 9

Why has UHC progress stalled?

Accepted Answer

After gains from 2000 to 2015, UHC progress stalled. Key reasons: COVID-19 disrupted essential services globally; health financing in LMICs has not kept pace with need; health worker shortages remain severe; and political commitment outpaces actual investment. The World Bank estimates the annual financing gap to achieve UHC in LMICs at approximately $371 billion by 2030.

Question 10

What is UHC2030?

Accepted Answer

The International Health Partnership for UHC 2030 (UHC2030) is a multi-stakeholder accountability platform bringing together governments, UN agencies, civil society and the private sector. It promotes mutual accountability through country compacts — agreements between governments and development partners — and tracks progress through joint annual reviews. It also coordinates civil society engagement in UHC monitoring.

Question 11

How does UHC connect to every other health topic?

Accepted Answer

UHC is the architecture within which all other health targets become achievable. Ending TB, scaling HIV treatment, reducing maternal mortality, delivering mental health care, reaching zero-dose children — all require UHC. Every GMJ News health topic hub connects ultimately to whether people can access the care they need. This hub is therefore both a standalone topic and the integrating framework for the entire knowledge hub ecosystem.

Question 12

How does GMJ News cover UHC?

Accepted Answer

GMJ News tracks WHO/World Bank UHC tracking reports, UN High-Level Meeting outcomes, health financing studies and the accreditation and quality dimensions of UHC — directly relevant to PHIG's work as Accreditation Canada representative in Georgia and the ASF accreditation programme. The GMJ has published on health system reform, quality of care and patient safety in Georgia and the South Caucasus.

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