Global efforts to achieve Universal Health Coverage (UHC) by 2030 are falling behind, according to the latest Global Monitoring Report released on December 5, 2025. The report shows that while there have been notable improvements in health service coverage and a reduction in financial hardship due to medical expenses, billions of people still lack access to essential health services and continue to face significant financial challenges.
The expansion of service coverage has largely been driven by advances in infectious disease control. However, progress has been slower in other areas of health care. The rising prevalence of noncommunicable diseases (NCDs), such as diabetes and heart disease, is putting additional pressure on health systems worldwide. These systems are struggling to provide effective and affordable care for chronic conditions.
Financial hardship related to healthcare costs has declined globally, but major gaps remain. While fewer people are experiencing impoverishing health expenses compared to previous years, those already living in poverty remain particularly vulnerable. Additionally, more individuals—especially in middle-income countries—are facing high out-of-pocket medical costs that do not necessarily push them into poverty but still represent a substantial burden.
The report emphasizes the need for governments to prioritize health spending and improve the efficiency of their budgets. It states: "Governments must reduce the heavy financial burden on people by strengthening public, prepaid financing and ensuring free access to essential care for poor people." It also highlights the importance of addressing disparities: "Closing the gaps in service coverage requires ensuring those left behind can access the services they need most and strengthening health systems to provide integrated and high-quality service delivery, especially to control and manage NCDs more effectively."
Since 2000, the global UHC service coverage index rose from 54 points to 71 by 2023. During this period, nearly all countries saw an increase in their index scores. The share of people incurring financial hardship due to out-of-pocket payments dropped from 34% in 2000 to 26% in 2022. More than half of all countries reported declines in such hardships.
However, since the adoption of Sustainable Development Goals (SDGs) in 2015, both service coverage improvement and reduction in financial hardship have slowed down significantly. If current trends persist, projections suggest that by 2030 the global UHC service coverage index will only reach 74 out of a possible 100 points; meanwhile, about one-quarter of the world’s population will still face health-related financial hardship at that time.
The gains observed between 2000 and 2023 were mostly due to better management of infectious diseases rather than improvements across all sectors. Areas like reproductive, maternal, newborn, and child health showed less change because they started with higher baseline values. Notably, despite some progress against NCDs worldwide, these conditions now account for much of the ongoing disease burden.
A key finding is that reductions in global poverty rates contributed more significantly than changes within healthcare systems themselves when it comes to lowering instances where out-of-pocket payments cause impoverishment—from affecting roughly 29% of people globally in 2000 down to about 20% by 2022.
Progress towards UHC is measured using two main indicators: a composite Service Coverage Index (SCI), which reflects how widely essential services are available across four major areas—including reproductive/maternal/child health; infectious diseases; NCDs; and general capacity/access—and an indicator tracking what proportion of populations experience financial hardship due specifically to out-of-pocket payments.
The Global Monitoring Report provides up-to-date data on how close countries are coming toward achieving SDG Target 3.8: “Achieve universal health coverage including financial risk protection.” It covers trends from as early as 2000 through 2023 for service coverage metrics and up until 2022 regarding exposure to medical-related financial difficulty.