ACT for UHC report

Political leadership is crucial for making UHC a national health policy priority, and allocating the necessary resources for action. The evidence is positive, with UHC at the centre of national health policy and plans in most WHO Member States (90%, 168 of 187). A large majority (86%, 160 of 187) have measurable UHC targets, with around two thirds of them (68%, 128 out of 187) actively monitoring these targets through results-based monitoring and evaluation mechanisms. 

Achieving health for all requires health systems that reach everyone, particularly the most vulnerable and marginalized. Disaggregated data facilitates this by allowing for a more accurate understanding of specific population needs, revealing inequities, and enabling the targeted allocation of resources. WHO Member States have made progress in the promotion of health equity in legislative frameworks, with proxy indicators used to assess non-discriminatory access. For example, the majority of WHO Member States (94%, 123 of 131) guarantee access to essential health services to non-nationals regardless of their immigration status. However, inequalities persist in coverage for maternal, newborn and child health and for reproductive and sexual health services, with richer households and urban populations having higher service coverage than poorer households and rural populations. With only half of WHO Member States reporting disaggregated inequality data in health statistics reports, the ability to identify who is being left behind is limited. 

Legal and regulatory frameworks are the foundation for UHC, shaping how countries guarantee access to essential health services, and protect the right to health. A substantial proportion of WHO Member States (78%, 140 of 180) have explicit constitutional rights to health, but these provisions do not always translate into concrete entitlements which are realized through legislative action and judicial interpretation. Another indication of the recognition of the right to health can be seen with 106 WHO Member States providing information for national-level health benefit packages as part of their main government health financing schemes, as health benefit packages are a necessary step in defining health care coverage. However, these results only capture entitlement rules and not actual access or affordability. In addition, there are significant differentials, with coverage highest in high income countries (95%, 30 countries) and upper-middle income (87%, 28 countries) compared to 66% in lower-middle income countries (34 countries) and 58% in low-income countries (13 countries). 

Advancing digital health strategies from an equity and human rights perspective is important for removing barriers for marginalized groups. Again, a country’s income level correlates with the degree of advancement, with 46% of high-income countries (22 out of 48) implementing digital health strategies from an equity and human-rights perspective and addressing gaps in access and outcomes for different population groups. One third of low-income countries (38%, seven out of 16) are not considering equity and human rights when developing digital health strategies and programs, while 37% (13 out of 35) of lower-middle income countries consider equity and human rights implications in the development and implementation of digital health strategies but have no strategy for addressing gaps in access and outcomes for different population groups.

Health and care workers are the backbone of equitable and resilient health systems. It is therefore essential to invest in the people who care for others by ensuring adequate recruitment, distribution and retention, improving their working conditions and ensuring their safety. Overall, there are positive movements on the above, while noting that most indicators focus on institutional arrangements, such as the adoption of policies and laws – not their implementation, and on the number of health and care workers – not the quality of care being provided.

Globally, the density of medical doctors and nursing personnel increased steadily between 2013 and 2022. However, this growth masks widening disparities – particularly in nursing personnel – between high- and low-income countries, exacerbated by the COVID-19 pandemic. In 2022, nursing personnel density in high-income countries stood at 105 per 10 000 people: an increase from pre-pandemic levels (98 in 2019). In low-income countries, the average nursing personnel density value was 8.1 per 10 000 people in 2022, a decrease from 9.6 in 2019.

Health worker migration also affects health workforce availability, with an estimated 15% of health and care workers working outside their country of birth or first professional qualification. Overall, there is progress in the attention countries give to international migration of health and care workers. From 2012 to 2024, the number of Member States reporting on the WHO Global Code of Practice on the International Recruitment of Health Personnel has doubled (53 in 2012, 105 in 2024). In 2024, approximately 90% of Member States (175 of 194) have established authorities to monitor the implementation of the Code. Between 2012 and 2024, the number of Member States reporting they were taking steps to implement the Code also doubled (35 in 2012, 71 in 2024). Improvements are also evident in formal agreements on international recruitment and migration of health personnel, with 44 of 105 Member States (42%) reporting bilateral or multilateral agreements in 2024, compared to 30 of 80 Member States (38%) in 2021.

Regarding the working conditions and safety of health and care workers, 96% of WHO Member States (173 out of 181) have, or partially have laws and policies to regulate minimum wages, while 78% (80 out of 102) of them have regulatory mechanisms for promoting health worker safety.

Achieving UHC by 2030 will require substantial investment in health and greater financial protection for marginalized and vulnerable populations. Prioritization in health spending can be considered from multiple perspectives, including the share of health expenditure in gross domestic product (GDP) and health allocations as a share of government budgets, public health spending per capita, financial protection, and funding sources. 

Globally, domestic public spending on health has grown modestly since 2000, with a notable increase across all country income groups in the height of the COVID-19 pandemic. Considerable per capita differences persist, with high-income countries spending an estimated US$2,678, compared to US$8.7 in low-income countries (2022). Funding predictability and sustainability is also a concern among low-income and lower-middle income countries, with a relatively significant reliance on external aid: 31% in low-income countries and 17% in lower-middle income countries (2022).

Progress on financial protection is also evident: out-of-pocket spending as a share of current health expenditure shows a long-term declining trend between 2000 and 2022, and in 2022 continues to be lower than before the COVID-19 pandemic. However, out-of-pocket spending remains high in low-income (43% of current health expenditure in 2022) and lower-middle-income countries (39% of current health expenditure in 2022).

Real progress towards UHC happens when everyone has a seat at the table. The inclusion of civil society and communities - including young people, women and the private sector - in government decision-making ensures that policies and programmes respond to people’s needs and creates trust in public action.

Progress on inclusive and participatory governance across WHO Member States remains limited. In 2024, only 20% of WHO Member States (38 out of 192) were classified as ‘open’ on the Civic Space Rating, down from 22% in 2018 (43 out of 192). On the other hand, 26% of WHO Member States were categorized as ‘repressed’ (50 out of 192), up from 18% in 2018 (34 out of 192). Citizen engagement in budgetary processes is measured by the Open Budget Survey Public Participation score, reflecting whether there are few (0-40), limited (41-60) or adequate (61-100) citizen engagement in budgetary processes. The global average has increased from 12 to 15 (out of 100) since 2017. However, this score – based on data from 124 WHO Member States – represents few opportunities for citizen engagement in budgetary processes. 

Although these findings are not health-specific, they provide insight into the broader environment of inclusive and participatory governance through social participation.

Advancing UHC requires health systems that are gender-responsive, actively addressing gender norms and inequalities to ensure equitable access for all, including women, men and gender-diverse people. Integrating gender considerations into health policies and programmes and collecting gender-disaggregated data is critical to identify and address barriers that perpetuate discrimination and unequal access to care.

Globally, the status and progress in having laws and regulations that guarantee full and equal access to sexual and reproductive health services are relatively high, both in terms of family planning services and for maternity care. However, service coverage for contraceptives and family planning shows limited improvement, with a one percentage point increase between 2019 (74% of women of reproductive age covered, average for 184 WHO Member States) and 2023 (75% of women of reproductive age covered, average for 184 WHO Member States). 

Reporting of gender-disaggregated health workforce data remains limited. Such data is essential to design transformative and equitable policies, especially since women represent the vast majority of health and care workers but remain underrepresented in health and political leadership. 

UHC and global health security are mutually reinforcing objectives: health systems that provide essential services for all are better able to prevent, detect and respond to public health emergencies, while being better prepared to continue routine service delivery. The COVID-19 pandemic, along with emerging threats such as climate change and conflicts, has highlighted the need for health systems that can maintain essential services in crisis and calm. In response, countries are taking steps to strengthen capacities for pandemic preparedness and to integrate health considerations into climate adaptation and resilience strategies.

Close to 100% of Member States are now reporting on the International Health Regulations (IHR). The global IHR core capacity score, which reflects a country’s ability to prevent, detect and respond to public health risks and emergencies, remained relatively stable during the COVID-19 and post-COVID-19 pandemic period, at around 64% (193 out of 194 WHO Member States, 2024). The COVID-19 pandemic exposed vulnerabilities in the continuity of essential health services, with routine immunization coverage (as evidenced by diphtheria-tetanus-pertussis vaccinations and measles-containing vaccine first-dose) decreasing in 2019, but with some regions exceeding pre-pandemic levels by 2024. 

The increasing impact of climate change on health systems has prompted countries to integrate health considerations into their national climate strategies. As a result, 91% of Nationally Determined Contributions (175 out of 193 Parties) now recognize health as a priority. This signals growing recognition of climate change as a global health threat and a movement toward health-inclusive climate resilience.