2. Universal Health Coverage

What is Universal Health Coverage (UHC)?

Ensuring that all individuals and communities receive the health services they need without suffering financial hardship.

What are the three key principles of UHC?

Equity in access, quality of services, and financial risk protection.

What does equity in access mean?

Everyone who needs health services should receive them, not only those who can pay.

What does quality of services mean in UHC?

Health services should be good enough to improve people's health.

What is financial risk protection?

The cost of healthcare should not cause financial hardship.

Who described UHC as "the ultimate expression of the right to health"?

Dr. Tedros Adhanom Ghebreyesus.

What are the three dimensions of the UHC Cube?

Population coverage, service coverage, and financial coverage.

What does population coverage refer to?

Who is covered—everyone without exception.

What does service coverage refer to?

What health services are covered.

What services are included in service coverage?

Promotive, preventive, curative, rehabilitative, and palliative services.

What does financial coverage refer to?

How much people pay and protection from out-of-pocket expenses.

Does UHC mean all health services are free?

No. No country can sustainably provide every service free of charge.

Is UHC only about health financing?

No. It includes all components of the health system.

Is UHC only a minimum package of services?

No. It requires progressive expansion of coverage.

Does UHC only focus on individuals?

No. It also includes population-based health services.

How many people still lack access to essential health services globally?

4.6 billion people.

How many people experience financial hardship due to health costs?

2.1 billion people.

How many people are pushed into poverty by health expenses?

1.6 billion people.

How did the Service Coverage Index change between 2000 and 2023?

It increased from 54 to 71.

What is the projected Service Coverage Index by 2030 if current trends continue?

74.

If current trends continue, how many people will still face financial hardship by 2030?

Nearly 1 in 4 people.

Since when has progress toward UHC slowed?

Since 2015.

What is the global average out-of-pocket (OOP) health expenditure?

32% of total health spending.

What is the OOP share in low-income countries?

43% of national health expenditure.

What proportion of OOP spending is on medicines in most countries?

At least 55% in three-quarters of countries.

How many people are pushed into poverty due to health costs each year?

About 100 million people.

What are the two core indicators used to measure UHC?

Service Coverage Index (SCI) and Financial Hardship Indicator.

What does the Service Coverage Index measure?

Access to 14 essential health services across four areas.

What does the Financial Hardship Indicator measure?

The proportion of people spending more than 40% of their discretionary budget on health.

What are the four health service areas in the SCI?

Reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access.

Why is UHC considered a human rights issue?

Because health is a fundamental human right.

How does UHC reduce poverty?

By preventing catastrophic health spending.

How does UHC support economic development?

Healthy people can learn, work, and earn more effectively.

How does UHC promote gender equality?

By improving women's rights and access to healthcare.

How does UHC improve pandemic preparedness?

Countries with stronger UHC performed better during COVID-19.

What key question does population coverage address?

Who is included and whether vulnerable groups are reached.

What key question does service provision address?

Which services are prioritized and whether they match the disease burden.

What key question does health financing address?

How services are funded and whether financial protection exists.

What key question does health equity address?

Whether barriers to access are addressed for everyone.

What key question does leadership and governance address?

Whether there is political commitment and accountability.

When was Zambia's National Health Insurance Scheme (NHIS) enacted?

2018.

When was Zambia's NHIS implemented?

2019.

What is the purpose of Zambia's National Health Compact?

It outlines clear priorities and costed plans for achieving UHC.

What are Zambia's main UHC focus areas?

Expanding primary healthcare, improving financial protection, and strengthening the health workforce.

What motivates private providers to participate in Zambia's NHIS?

Profit and complementarity with public providers.

Which groups have especially increased NHIS utilization?

Senior citizens and the informal sector.

What are common NHIS challenges in Zambia?

Delays in pre-authorizations, loss of member details, and service restrictions.

How many additional health workers are needed globally by 2030?

18 million.

Where is the global health workforce shortage concentrated?

In low- and lower-middle-income countries.

How many countries account for most of the projected workforce shortage?

55 countries, including 37 in Africa.

What happened to nursing density in high-income countries between 2019 and 2022?

It increased from 98 to 105 per 10,000 people.

What happened to nursing density in low-income countries between 2019 and 2022?

It decreased from 9.6 to 8.1 per 10,000 people.

What is the first priority action for achieving UHC by 2030?

Ensure essential care is free at the point of care for people living in poverty.

What is the second priority action for achieving UHC by 2030?

Expand public investments in health systems.

What is the third priority action for achieving UHC by 2030?

Reduce high out-of-pocket spending on medicines.

What is the fourth priority action for achieving UHC by 2030?

Accelerate access to essential noncommunicable disease services.

What is the fifth priority action for achieving UHC by 2030?

Strengthen primary healthcare for equity and efficiency.

What is the sixth priority action for achieving UHC by 2030?

Adopt multisectoral approaches beyond the health sector.

Which SDG target is associated with UHC?

SDG Target 3.8.

What is the main goal of UHC?

To ensure access to quality healthcare without financial hardship.

Is current global progress toward UHC sufficient to meet the 2030 targets?

No. Progress is too slow.

What two major initiatives are helping Zambia progress toward UHC?

The National Health Insurance Scheme (NHIS) and the National Health Compact.

What does the statement "UHC is a direction, not a destination" mean?

Achieving UHC is a continuous process of expanding coverage and improving health systems.