The COVID-19 pandemic is likely to halt the progress made towards universal health coverage over the past 20 years.

People, especially disadvantaged populations, are struggling to access health care due to financial constraints. Financial hardship is likely to worsen further for those seeking health care as poverty increases and income falls.

The COVID-19 pandemic has significantly disrupted the delivery of essential health services. In 2021, WHO released a report on Universal health coverage and financial protection in health, jointly with the World Bank. The report confirmed that the world was off-track to achieve universal health coverage even before the pandemic. It shows that, although the coverage of essential health services has increased globally, in 2017, an estimated 1.4–1.9 billion people suffered catastrophic or impoverishing health spending. It also shows that 92 countries have experienced little change in financial hardship since 2000 and little improvement.

Without concerted policy action, rising poverty and shrinking incomes due to the global economic recession are likely to increase financial barriers to accessing care and to exacerbate financial hardship, particularly among already disadvantaged populations. The combination of pre-COVID challenges and difficulties arising from the pandemic bring even greater urgency to the quest for universal health coverage. 

At least 20 countries received WHO support to track financial hardship and to identify its drivers and inequities in service use. The evidence is used to provide tailored guidance to each country on policy priorities.

WHO has supported governments in having strong health financing policies; the choices that governments make in health financing policies are crucial to ensure that people can seek and afford health services, medicines and products.

In 2021, WHO pointed out the priorities to be addressed to get back on track for universal health coverage in the light of the macro-fiscal disruptions arising from the pandemic. Previous work during fiscal shocks highlighted policy actions that can limit negative consequences and, indeed, strengthen the foundations of universal health coverage.

WHO delivered tailored, evidence-based technical support to national governments through various tools and products to track health spending flows and address efficiency, public financial management and strategic purchasing. The updated Health financing progress matrix allows countries to transform WHO guidance into means to identify their specific strengths and weaknesses and to determine priorities for health financing reform. During the biennium, WHO supported many countries in reforming health financing, including several that initiated and others that finalized assessments.

Financial planning for effective deployment of COVID-19 vaccines

When life-saving COVID-19 vaccines arrived, governments developed national plans to ensure that as many people as possible were vaccinated. More than 40 countries used the WHO COVID-19 vaccine introduction and deployment costing tool. Published in the six UN languages, the tool contains relevant national data and facilitates dialogue with key stakeholders, including Ministry of Finance officials.