The World Health Organization (WHO) has raised concerns over growing health inequalities and financial barriers across Africa, noting that millions of people still cannot access essential health services.
A joint report from WHO and the World Bank Group shows that although global efforts have expanded health service coverage and reduced the financial burden of care since 2000, significant disparities remain—especially for the poorest and most vulnerable populations.
The Universal Health Coverage (UHC) Global Monitoring Report 2025 revealed that worldwide health service coverage rose from 54 to 71 points between 2000 and 2023. Meanwhile, the proportion of people facing severe financial hardship due to out-of-pocket (OOP) health expenses declined from 34% to 26% by 2022. Despite these improvements, 4.6 billion people globally still lack access to essential health services, and 2.1 billion continue to face financial difficulties, including 1.6 billion pushed further into poverty. Africa remains among the regions most affected, with poor communities bearing the heaviest burden.
WHO Director-General Dr. Tedros Ghebreyesus stressed that universal health coverage remains a distant goal for billions and urged countries to strengthen health systems amid declining international aid. Medicines are a major contributor to OOP costs, accounting for over half of health-related spending in most countries and up to 60% among the poorest populations. These expenses often force households to divert money from other essentials such as food and education.
The report also highlighted that while all WHO regions have made progress in service coverage, only half—including Africa—have significantly reduced financial hardship. Low-income African countries have achieved the fastest gains in coverage and financial protection but continue to face the largest gaps. Most improvements have come from infectious disease programmes, with gradual progress in noncommunicable diseases and modest gains in reproductive, maternal, newborn, and child health services.
Factors such as inclusive economic growth, stronger social protection, and better sanitation have helped, but high out-of-pocket costs remain a major barrier, particularly for women, rural populations, and people with lower education levels.
WHO warned that without urgent action, full health service coverage without financial strain will remain out of reach, projecting a global Service Coverage Index (SCI) of just 74 out of 100 by 2030—leaving nearly one in four people still struggling to afford care.
To achieve UHC by 2030, the report calls for free essential healthcare at the point of service for vulnerable populations, increased public investment, reduced medicine costs, expanded noncommunicable disease services, strengthened primary healthcare, and multisectoral approaches to address broader determinants of health. Political commitment, inclusive policies, and rapid implementation are critical to ensuring that Africans can access and afford the care they need.
