Most countries have widened access to health care since 2000, but in 2023 about 4.6 billion people were still not fully covered by essential health services, 2.1 billion faced financial hardship from paying for care in 2022, and progress has slowed markedly since 2015.
Updated October 14, 2026. Written from the sources listed below, not independently peer-reviewed.
Out of every 100 people in the world, how many were not fully covered by essential health services in 2023?
4.6 billion
People not fully covered by essential services
About 57% of the world's population. The share not covered fell by about a fifth between 2000 and 2023.
Data year 2023. Source: World Health Organization and World Bank, 2025
2.1 billion
People facing financial hardship from health costs
26% of the world's population, down from 34% in 2000. 1.6 billion of them were poor or pushed deeper into poverty by health spending.
Data year 2022. Source: World Health Organization and World Bank, 2025
71 of 100
Global service coverage index
Up from 54 in 2000. On current trends it would reach only about 74 by 2030.
Data year 2023. Source: World Health Organization and World Bank, 2025
Unit: index (0–100)
* Projection, not a measurement. Global index values from the 2025 WHO–World Bank monitoring report, based on the revised 2025 indicator. The 2030 value is a projection if current trends continue, not an observed value. Higher is better; 100 would mean full coverage of the tracer services.
SDG target 3.8 calls for universal health coverage, including financial risk protection, by 2030. At the current pace, the global service coverage index would reach only about 74 out of 100 by 2030, below 80, and about 24% of the world's population, nearly one in four people, would still face financial hardship from health costs.
In 2022, three out of four people in the poorest segment of the population faced financial hardship from health costs, compared with fewer than one in 25 among the richest.
Source: World Health Organization, 2025Low-income countries scored 47 on the service coverage index in 2023, compared with 85 in high-income countries. In 2022, 34.7% of people in low-income countries faced financial hardship from health spending, against 9.8% in high-income countries.
Source: World Health Organization and World Bank, 2025Across countries with data, the median rate of financial hardship is 13.7% higher among rural than urban populations.
Source: World Health Organization and World Bank, 2025The density of medical doctors in WHO's European Region is 13 times that of the African Region, and the density of nurses and midwives six times higher.
Source: World Health Organization, 2026Each country is shaded by its latest available value, so you can see where the gap is widest. Hover or tap a country, search for one, or open the full table.
Loading country values…
Values in index (0–100).
WHO's service coverage index (SDG 3.8.1), where 100 would mean full coverage of the tracer services, so darker shades mark countries where fewer people can use essential health services. Latest year available per country, currently 2023 for all (years can differ). Many values are partly modelled, the index measures access rather than quality, and it comes from WHO's 2026 data release using the revised index, so it can differ from older published figures.
Source: World Health Organization (Global Health Observatory), via Our World in Data. Latest year available per country; years differ.
Values load from Our World in Data. Simplified Natural Earth borders; they imply no position on disputed territories.
Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
ModerateService coverage rose from 54 to 71 index points between 2000 and 2023 and improved in 97% of countries, while the share facing financial hardship fell from 34% to 26% by 2022. Still, 4.6 billion people lack full coverage and 2.1 billion face hardship.
How mature and validated are the available solutions?
HighThe core approaches are well established: publicly funded, pooled prepayment that lowers what people pay at the point of care, strong primary health care, and adequate numbers of trained health workers. Their main limits are political and fiscal rather than technical.
How widely are effective solutions actually used?
ModerateSince 2015 only 38% of countries improved service coverage and financial protection at the same time, and low-income countries scored just 47 out of 100 on service coverage in 2023.
Service coverage data exist for 195 countries and territories and hardship data for 168, but 17% of countries have no hardship data, values for the pandemic years are interpolated or modelled, and the revised hardship indicator cannot be compared directly with earlier reports.
The service coverage index grew by 1.5% a year in 2000–2015 but only 0.5% a year in 2015–2023, and the fall in impoverishing health spending was driven by global poverty reduction rather than by stronger financial protection. Cuts to external health aid since 2023 add new risks.
Universal health coverage means that everyone can use the quality health services they need, from prevention and treatment to rehabilitation and palliative care, without being pushed into financial hardship by the cost. By this measure the world is still far from the goal. In 2023 about 4.6 billion people, some 57% of the global population, were not fully covered by essential health services. In 2022 about 2.1 billion people lived in households that faced financial hardship because of what they paid out of pocket for health care, and 1.6 billion of them were already poor or were pushed deeper into poverty by those payments.
The burden falls hardest on the poorest. In 2022, three out of four people in the poorest segment of the population faced financial hardship from health costs, compared with fewer than one in 25 among the richest. Low-income countries scored 47 out of 100 on the service coverage index in 2023, against 85 in high-income countries. Medicines make up the largest part of what households pay themselves, and many countries do not have enough health workers: WHO projects a global shortfall of 11.1 million by 2030. Since 2023, steep cuts to international health aid have added pressure on health budgets in many low- and middle-income countries.
SDG target 3.8 is tracked by WHO and the World Bank with two indicators, both revised in 2025. The revised financial hardship figures are not directly comparable with those in earlier reports. The main measures are:
Service coverage index (SDG 3.8.1)
A score from 0 to 100 that combines tracer indicators for reproductive, maternal, newborn and child health, infectious diseases, noncommunicable diseases, and service capacity and access. Many of its indicators record whether people are in contact with a service, not whether the care they received was of sufficient quality.
Financial hardship (SDG 3.8.2)
The share of people living in households whose out-of-pocket health spending exceeds 40% of their discretionary budget, meaning what is left after basic needs such as food and housing. It replaced the earlier measure based on spending above 10% or 25% of the household budget.
Impoverishing and large spending
Hardship is split into impoverishing spending, which leaves a household without enough for basic needs or deeper in poverty, and large spending, which takes a big share of the budget without pushing people into poverty.
Data sources and gaps
Service coverage combines administrative data, surveys and modelled estimates for 195 countries and territories. Hardship estimates come from more than 1,100 household surveys in 168 countries and territories, and values for the pandemic years 2020–2021 are interpolated or modelled because many surveys were interrupted.
What works
When health care is paid for in advance through taxes or compulsory insurance and the funds are pooled, people pay less at the point of care and the cost of illness is shared. The 2025 monitoring report calls for stronger publicly funded, compulsory prepaid coverage and care that is free at the point of use for the poor, and links rising national income with stronger pooling and a falling share of out-of-pocket spending.
Limits
Many governments have limited fiscal space to expand public funding. Even in high-income countries, where pooling is strongest, financial hardship did not fall between 2015 and 2022 and stood at 9.8%.
What works
Primary health care brings prevention, treatment and referral close to where people live. WHO estimates that about 75% of the projected health gains from the SDGs could be achieved through it, and that scaling up primary health care in low- and middle-income countries could save 60 million lives and add 3.7 years to average life expectancy by 2030.
Limits
WHO estimates that reaching primary health care targets would require an additional US$200 to 328 billion a year. It only works with trained staff, reliable supplies of medicines and functioning referral to hospitals.
What works
Medicines are typically 56% of what households pay out of pocket for health, and around 60% among the poorest fifth. Covering essential medicines in public benefit packages and buying them in bulk at lower prices directly targets the largest source of out-of-pocket costs.
Limits
Coverage on paper does not help if medicines are out of stock in public facilities and patients have to buy them privately. Benefit packages must also be funded over time.
What works
With budgets under pressure, WHO advises governments to protect the services used most by the poorest, buy services strategically, procure more efficiently and use health technology assessment to decide which services and products to fund.
Limits
Health technology assessment requires data, skilled analysts and institutions that can withstand political and commercial pressure, which many low-income countries are still building.
What works
Global density of doctors, nurses and midwives, dentists and pharmacists rose by 52% between 2006 and 2025, from 44.8 to 67.9 per 10,000 people, as countries trained and employed more staff.
Limits
WHO still projects a shortfall of 11.1 million health workers by 2030. Nearly one in four doctors is over 55, and health worker density remains strongly linked to national income.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
WHO launched an initiative in July 2025 urging countries to raise the real prices of tobacco, alcohol and sugary drinks by at least 50% by 2035, aiming to raise US$1 trillion over the next ten years. Tobacco taxes are a proven tool, but whether countries will adopt these steeper increases and spend the revenue on health coverage is still open.
After external health aid fell sharply, WHO advised countries in 2025 to integrate services that were funded separately by donors, such as disease-specific programmes, into primary health care, and urged governments to make health a fiscal priority in their own budgets. How well services and financial protection hold up during this transition is not yet known.
The revised SDG 3.8.2 indicator, adopted in 2025, measures health spending against a household's budget after basic needs rather than against its total budget, which better captures hardship among poor households. Countries are only beginning to use it for policy, and it still cannot see people who go without care because they cannot pay.
Implementation gap
External aid for health was projected to fall by 30% to 40% in 2025 compared with 2023. In a WHO survey of 108 low- and middle-income countries, some reported critical services cut by up to 70%, and more than 50 reported job losses among health and care workers.
Implementation gap
WHO projects a shortfall of 11.1 million health workers by 2030, with 67 countries unable to maintain population health needs. Ageing adds pressure: nearly one in four doctors worldwide, and nearly one in three in high-income countries, is over 55.
Implementation gap
In low-income countries 34.7% of people faced financial hardship from health spending in 2022. Where public funding is thin, households pay directly for consultations and especially medicines, and the poorest are hit hardest.
Implementation gap
Most gains since 2000 came from infectious disease control, which accounted for 52% of the rise in the coverage index. Care for noncommunicable diseases reached only 61 index points in 2023, and reproductive, maternal, newborn and child health services have stagnated at 72.
Coordination gap
Health services in many low- and middle-income countries have been funded through separate, often donor-driven, disease-specific programmes. Bringing them together under national primary health care and financing systems requires coordination between ministries, donors and global health initiatives.
Knowledge gap
17% of countries have no data on financial hardship, household surveys are often years old, and values for the pandemic years were interpolated or modelled, with no attempt to model the pandemic's effect because country data were insufficient. This makes it hard to see the effect of recent shocks such as aid cuts.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
How are the reductions in external health aid since 2023 changing service coverage, out-of-pocket spending and health worker employment in the most aid-dependent countries, and how can these effects be tracked before the next survey round?
How much of the slowdown in service coverage reflects the shift from infectious to chronic diseases, how much the COVID-19 pandemic, and how much stalled public investment in health?
Financial hardship measures capture people who pay for care, but not those who forgo it because they cannot afford it. How can unmet need be measured reliably and combined with hardship indicators?
Which models of primary health care can deliver long-term treatment for conditions such as high blood pressure and diabetes at scale in low-income settings without shifting costs onto patients?
Health coverage depends on public budgets and, in many low-income countries, on international aid. Telling elected representatives that you support health spending at home and abroad is one of the few ways individuals can influence these decisions.
Look for groups that support primary health care, health worker training or access to essential medicines, and that publish independent evaluations and cost data, rather than only funding short-term projects.
Many people do not use the coverage they already have. Finding out which services and medicines your public scheme or insurance covers, and helping relatives do the same, can reduce what your household pays out of pocket.
Clinicians, pharmacists, health economists, data analysts and supply-chain specialists can support health system work through training, research partnerships or volunteering with established organisations.
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World Health Organization and World Bank, published 2025
The official global monitoring report for SDG target 3.8, published in December 2025 with service coverage data to 2023 and financial hardship data to 2022, using the indicators revised in 2025. Source of the global service coverage index (54 in 2000, 71 in 2023, about 74 projected for 2030), the 4.6 billion people (57%) not fully covered, financial hardship (34% to 26%, 2.1 billion, 1.6 billion impoverishing), income-group, rural and medicine-spending gaps, rates of change before and after 2015, data coverage and limitations.
World Health Organization (5 December 2025), published 2025
WHO's summary of the 2025 monitoring report. Source of the definition of UHC, the gap between the poorest and richest (three in four versus fewer than one in 25), the sub-index values for noncommunicable diseases (61) and reproductive, maternal, newborn and child health (72), and the 52% contribution of infectious disease control.
World Health Organization (news release, 18 September 2026), published 2026
Launch of National health workforce accounts: health workforce levels and trends 2026. Source of the projected shortfall of 11.1 million health workers by 2030, the 67 countries at risk, density growth from 44.8 to 67.9 per 10,000 (2006–2025), regional density gaps and the ageing of doctors.
World Health Organization (news release, 3 November 2025), published 2025
Source of the projected 30–40% fall in external health aid in 2025 compared with 2023, results of a survey of 108 low- and middle-income countries (service cuts of up to 70%, job losses in more than 50 countries), and WHO's advice on priority setting, strategic purchasing, health technology assessment and integration into primary health care.
World Health Organization (5 December 2025), published 2025
Source of the estimates that about 75% of projected SDG health gains could come through primary health care, that scaling it up in low- and middle-income countries could save 60 million lives and add 3.7 years of life expectancy by 2030, and that it needs an additional US$200–328 billion a year.
World Health Organization (news release, 2 July 2025), published 2025
Launch of the "3 by 35" initiative. Source of the target to raise real prices of tobacco, alcohol and sugary drinks by at least 50% by 2035, the aim of US$1 trillion over ten years, and the nearly 140 countries that raised tobacco taxes between 2012 and 2022.