WHO report highlights billions without health care access; Rwanda boosts coverage

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Global Progress in Health Coverage, but Challenges Remain

Over the past two decades, most countries have made significant strides in expanding access to health services and reducing the financial burden of medical care. However, despite these improvements, billions of people around the world still face barriers to receiving the care they need, according to a recent report by the World Health Organization (WHO) and the World Bank Group.

The Universal Health Coverage Global Monitoring Report 2025, released on December 6, highlights that since 2000, countries at all income levels have increased both health service coverage and financial protection. The global Service Coverage Index rose from 54 to 71 between 2000 and 2023, while the percentage of people facing financial hardship due to health costs dropped from 34% to 26%. Despite this progress, many individuals continue to struggle with accessing and affording essential health services.

Approximately 4.6 billion people lack access to essential care, and 2.1 billion face financial hardship, including 1.6 billion who are either living in poverty or pushed into it by medical expenses. WHO Director-General Dr. Tedros Adhanom Ghebreyesus emphasized that universal health coverage is the embodiment of the right to health, yet billions still cannot afford or access the care they need. He also pointed out that cuts to international aid are increasing pressure on already overburdened health systems.

Financial Strain and Out-of-Pocket Expenses

Households that spend more than 40% of their income on health care are considered to be facing financial hardship. Medicines account for the largest portion of these costs, making up at least 55% of out-of-pocket spending in most countries, rising to 60% for the poorest. This forces families to cut back on other essentials, such as food and education.

Middle-income households are also feeling the pressure, as medical costs take up a larger share of their income. The report notes that progress on universal health coverage has slowed since 2015, with only a third of countries managing to expand service coverage while reducing financial hardship. While all WHO regions improved coverage, only Africa, South-East Asia, and the Western Pacific reduced the financial burden on their populations.

Low-income countries achieved the fastest improvements, mostly in infectious disease programs, while noncommunicable diseases and maternal, newborn, and child health services saw gradual progress. Poverty has eased in some areas due to better sanitation, income growth, and social protections, but inequalities persist, disproportionately affecting women, rural residents, the less educated, disabled individuals, displaced communities, and those living in informal settlements.

Strategies for Improvement

The report urges governments to expand essential health services, lower medicine costs, and strengthen primary care systems. One example of such an initiative is Rwanda’s Mutuelle de santé—a community-based health insurance scheme that provides affordable health services to millions of Rwandans.

Dr. Régis Hitimana, Chief Benefits Officer at RSSB, explained that the scheme does not require formal employment or salary deductions. Instead, Rwandans can join by paying a small contribution, with the government covering the cost for those who cannot afford it. Families classified as poor are enrolled without contributing and have full access to services like other insured members.

Member contributions make up less than 40% of the fund’s budget, with the rest coming from public taxes and government allocations. This funding model ensures that services remain available even as costs rise and demand increases. The scheme regularly updates its benefits to reflect changing disease trends and growing needs.

Expanding Access and Addressing Limitations

Currently, Mutuelle de santé covers expensive treatments such as cancer care, heart surgery, and total hip replacements, helping families avoid high medical costs. However, nearly 12 million Rwandans are now covered, putting pressure on public health facilities. Shortages of specialists and limited equipment have slowed service delivery, with some surgeries requiring months of waiting. As a result, many patients turn to private clinics or delay treatment, leading to more severe conditions and higher costs.

To address specialist shortages, Rwanda has launched the 4x4 health workforce program, aiming to improve service delivery. However, challenges remain, as patients needing bone marrow transplants must travel abroad, and advanced cancer diagnostics, including PET scans, are still unavailable locally. Plans are underway to introduce this technology, allowing those whose contributions are covered by the government to access care without paying at the point of service.

Tracking changes in family income remains a challenge, but social support helps ensure continued access to care when coverage is interrupted. Hitimana emphasized the importance of enrollment, noting that if people can afford insurance but do not enroll, it can delay care due to fear of high medical costs. RSSB works with local authorities and civil society groups to encourage participation, and employers are urged to check whether workers, including casual laborers, are insured. If someone works for you, it is important to ask them if they have health insurance, as accidents can happen at any time.