By Dr Catharina Boehme, Officer-in-Charge, WHO South-East Asia
Universal Health Coverage (UHC) represents a transformative principle in public health and embodies a profound expression of fairness in health policy. December 12 marks the UHC Day, the anniversary of the United Nations’ historic and unanimous endorsement of UHC in 2012. It is an occasion to reaffirm our collective commitment to ensure that everyone, everywhere, can access the essential health services they need without facing financial hardship.
When people delay care or choose between medical care and basic needs because of cost, health systems fail their populations and social inequalities widen. This year’s theme, "Unaffordable health costs? We’re sick of it!" reflects widespread discontent and a fundamental moral imperative: financial protection is not optional but constitutes a core pillar of UHC, as well as a prerequisite for sustained social and economic progress. It underscores the human realities underlying these statistics, reminding policymakers that unaffordable health expenditures are impoverishing communities, exacerbating poor health and impeding progress across the full spectrum of the Sustainable Development Goals.
Countries in the WHO South-East Asia have demonstrated commitments, often accompanied with bold reforms, and recorded notable progress to advance the vision of Health for All. Between 2010 and 2023, the regional UHC service coverage index improved from 53 to 68, with country-specific scores ranging from 46 to 82. The proportion of the population spending more than 40% of their household discretionary budget on health out-of-pocket consistently decreased from 38.4% in 2010 to 34.7% in 2015, reaching 30.9% in 2022.
However, the pace of progress has not been fast enough to achieve the minimum essential global UHC targets by 2030, nor meet the regional and country aspirations. The proportion of the population incurring large but not impoverishing OOP health spending continued to rise from 6.7% in 2010 to 8.6% in 2022 in the region, and financial hardship is growing among the poorest segment of the population. Country-level analyses reveal that a significant proportion of households in South-East Asia face financial hardship due to high out-of-pocket expenditures on medicines and outpatient care, with the burden most acute among poorer, rural and multi-generational households.
When families are forced to choose between medicines and food, or when a single serious illness depletes a lifetime of household wealth, the consequences extend beyond health. This constitutes a profound crisis of development, equity and human dignity. On UHC Day, we urge governments and partners in the Region to accelerate progress in the following critical areas:
- Shift financing toward public funds by increasing tax-based and mandatory prepayment mechanisms, budget prioritization for health, accelerating options to enhance domestic fiscal capacity and reducing reliance on out-of-pocket payments.
- Invest in resilient and quality primary health care system by allocating resources to frontline services, ensuring essential medicines and diagnostics are continuously available, building a well‑trained health workforce, and strengthening mechanisms for high-quality care.
- Guarantee an affordable benefits package that includes coverage for chronic care and emergencies to prevent repeated out‑of‑pocket shocks.
- Institutionalize evidence-informed priority setting, including institutionalizing health technology assessments, to enhance health systems efficiency and value for money.
- Prioritize the poorest and vulnerable with targeted subsidies, waivers and social protection measures.
- Leverage digital technologies, AI and innovations in a manner that enhances equity, quality, and efficiency of healthcare services while safeguarding privacy.
Access to quality health services is only half the promise; protection from financial ruin completes UHC. Let us honour the UHC Day by recommitting to bold and decisive actions on financial protection. Together, we can build a future where everyone has access to the healthcare they need without financial barriers, ensuring a healthier, more equitable and prosperous tomorrow.