Half the global population not fully covered by essential health services: Report

The growth of Universal Health Service Coverage (UHC) has stagnated since 2015 and financial protection for those who receive health services has worsened, according to a new report.

As of 2021, over half the world’s population — 4.5 billion people — was not fully covered by essential health services, showed the report released jointly by the World Health Organization and the World Bank. 

In 2019, about two billion people experienced financial hardship due to out-of-pocket (OOP) spending on health, including 344 million people living in extreme poverty, noted the report released ahead of the high-level meeting on UHC at the 78th United Nations General Assembly. 

The long-term impacts of COVID-19 pandemic haven’t been factored in but may have contributed to the outcome, the authors said.

Of the 194 countries, 108 countries experienced worsening or no significant change in health service coverage (SDG Indicator 3.8.1) since the United Nations-mandated Sustainable Development Goals were set up in 2015. 

The UHC service coverage index (SCI) score was used to calculate this. SCI captures coverage of essential services across the entire population of a country, and is therefore a reflection of the entire health system for all individuals.

Millions of people were denied access to measures that could have saved their lives and improved their health, as the score increased from 45 in 2000 to 68 in 2019, remaining steady through 2021, the findings showed.

Read more: India’s persistently high out-of-pocket health expenditure continues to push people into poverty

While the overall health service coverage has improved since 2000, progress has slowed since 2015. Further, there was no improvement from 2019 to 2021.

The largest improvements have been made in the service coverage for infectious diseases, which has witnessed an average yearly growth of 7 per cent, it said. 

However, there has been little to no improvement in service coverage for non-communicable diseases and reproductive, maternal, newborn and child health services in the recent years, flagged WHO. 

Within countries, disadvantaged demographic sub-groups such as the poorest, least educated and those living in rural areas, are more likely to suffer hurdles in accessing healthcare services.

For example, distance to a healthcare facility was cited by the report as a barrier for 45 per cent of women aged 15-49 years living in rural areas, compared with 19 per cent living in urban areas.

UHC means that all people have access to the full range of quality health services they need without financial hardship.

Out-of-pocket expenses draining households

The number of people who incurred catastrophic OOP health spending (exceeding 10 per cent of the household budget) continuously increased globally from 588.2 million in 2000 to 1.04 billion in 2019, according to the report. 

In 2019, around 13.5 per cent of the global population spent over 10 per cent of their household budget on healthcare. This is a 77 per cent increase in the population suffering substantial OOP health costs during 2000-2019, the findings showed. 

After the Western Pacific region (376.3 million people), South-East Asia (326.2 million people) had the highest number of people recording catastrophic OOP health spending. WHO Africa region (95.1 million people) ranked third in the world on catastrophic OOP health spending.

The proportion of people globally, whose households spent more than 10 per cent of their income on OOP medical expenses, continuously increased from 9.6 per cent in 2000 to 12.6 per cent in 2015, and reached 13.5 per cent in 2019, the analysts found.

“But even small expenditures in absolute terms can be devastating for poor, low-income households,” the results illustrated. Close to 1.3 billion people were pushed into or further into poverty by such payments, including 300 million people who were already living in extreme poverty, according to estimates in the report 

As the threshold increased from 10-25 per cent of total household consumption, the number of people suffering from substantial OOP health costs increased from 116.9 million to 292 million people — an increase of 150 per cent during the same period. 

OOP health spending corresponds to health spending made by people, funded from their income, savings and loans. It included both formal and informal payments.

The world will not achieve universal health coverage by 2030 as planned, according to the WHO-World Bank report. 

Undoing poverty eradication gains

OOP health spending also works against efforts to abolish poverty worldwide, but this can be prevented if OOP health payments are reduced for people living close to the poverty line and if those who are poor are exempt from them, the authors of the report observed.

Public health funding needs to increase further and be used more efficiently and equitably, suggested the report.

WHO’s Triple Billion targets for the period 2019-2023 aims to increase the number of people benefiting from UHC by 1 billion. The initial set for 2018-2023 was subsequently extended to 2025 under the recommendation of Member States. But the world is not on track to achieve this target, the report found.

Evidence from regional studies presented in this report showed that OOP spending on outpatient medicines – central to the provision of primary care – is a major driver of financial hardship. 

This underscores the need to improve policies by ensuring that primary care services include treatments, in addition to an adequate range of diagnostics, and that user charges for these are minimised or completely removed for people with low incomes or chronic conditions, the authors of the report noted. 

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