About
Universal Health Coverage (UHC) means good quality health services must be available to all, when and where they are needed, without the need to incur financial hardship. UHC is fundamental to improving health outcomes, particularly for largely preventable diseases, and can also contribute to social inclusion, equality, ending poverty, economic growth, and human dignity.
Over the last two decades, there has been vast progress towards achieving UHC. Low- and middle-income countries have made the most improvements since 2000, but there is more to be done to promote equal access to healthcare services. The world is ageing rapidly: by 2050, it is estimated the number of older adults globally will more than double, rising to 2.1 billion, and 80% of them will reside in LMICs.
Ensuring that everyone, regardless of age can experience the benefits of UHC is therefore crucial. Achieving UHC for all at all ages will not only create healthier populations, but more prosperous ones too. And it is the only way that we can make further progress to achieving the 2030 Sustainable Development Goal target.
Through this project, we are:
- Working with HelpAge International to engage older people in LMICs and have their voices heard at a global level
- Using our Healthy Ageing and Prevention Index to produce an analysis report on LMICs
- Creating 6 short country profiles – South Africa, Rwanda, Mongolia, Senegal, Vietnam and Zambia – where significant progress has been made in UHC
This project has been supported by Amgen.
Over the past two decades, universal health coverage (UHC) in low- and middle-income countries (LMICs) has increased by 60%, reducing healthcare inequalities with high-income countries by 25%. Yet high-income countries still outperform LMICs by 22 percentage points, and the world remains off track to achieve UHC by 2030.
LMICs are ageing rapidly, faster than high-income countries. By 2050, the number of older adults will more than double to 2.1 billion, with 80% living in LMICs. Progress on UHC is impossible without resilient health systems that meet the needs of ageing populations.
Older adults are too often excluded from policy, but governments must identify the UHC challenges posed by demographic change and embed solutions to address them.
Through this programme of work, we have created two reports:
- A report on UHC in LMICs that uses our Healthy Ageing and Prevention Index, focus groups, expert roundtables, and case studies from six LMICs to highlight the value of UHC and identify scalable solutions for ageing populations
- A second report, in partnership with HelpAge International, which explores the findings from focus group discussions with older adults in Mongolia, Zambia and Rwanda in greater depth
Both reports can be read here.
Progress towards universal healthcare coverage in lower- and middle- income countries has stalled and is at risk of reversal
- People who live in countries that invest more in universal access to healthcare live on average 16 more years in good health compared to those that don’t
- Countries with universal access to healthcare report half as many deaths per 100,000 compared to those without.
- Investment in healthy ageing could save 150 million lives globally and generate $3.2 trillion in economic returns, with a return of $16 for every $1 spent.
New research by the International Longevity Centre (ILC), supported by Amgen, finds that over the last two decades, access to universal healthcare in low-and-middle-income countries (LMICs) increased by 60%. This has led to a 25% reduction in healthcare inequalities between LMICs and high-income countries. But high-income countries still outperform LMICs by 22 percentage points.
And LMICs are ageing faster than their high-income counterparts. Of the world’s one billion people aged 60 or over, 70% live in LMICs. By 2050 it is projected that there will be 2.1 billion people over 60 and 80% will reside in LMICs. For this reason, LMIC governments must take steps to account for the challenges that come with demographic change if they want to further improve access to healthcare.
The ILC report Achieving Universal Health Coverage in LMICs published today recommends:
- strengthening national healthcare so that accessing care doesn’t become a financial burden
- investing in primary health services, where 90% of healthcare including vital preventative services can be delivered
- ensure that all age groups, including older adults’ healthcare outcomes are measured.
Without such a focus, the globally agreed goal of achieving universal access to healthcare by 2030 is at risk of failure.
Universal access to healthcare guarantees all people access to the quality health services they need across the life course without financial hardship. But without accounting for the impact of demographic change on healthcare accessibility and health outcomes, the world could face an economic loss of $3.2 trillion by 2050.
ILC’s Healthy Ageing and Prevention Index, which ranks 153 countries on six metrics of healthy ageing, highlights the link between ageing and Universal access to healthcare. ILC analysis of the index shows that:
- People who live in countries that invest more in universal access to healthcare live on average 16 more years in good health compared to those that don’t
- Effective infectious disease management correlates with fewer deaths.
- Investments in non-communicable disease (NCD) management lead to lower mortality rates.
- Greater focus on maternal and child health improves fertility rates and life outcomes.
Alarmingly, global progress in achieving universal access to healthcare has stalled since 2015, and the number of people paying out of their own pocket for healthcare has risen.
Anna van Renen, ILC’s Research and Policy Officer and co-lead of the project, said:
“Low- and middle-income countries should be proud of the significant progress they’ve made towards UHC.
But these countries are ageing rapidly. Leaders in Low-and-middle-income countries need to rethink how they can deliver health services that meets the needs of everyone.
Governments must make healthcare more affordable, strengthen the delivery of preventative services through primary care, and improve health data collection.
However, if funds and support can’t be rapidly mobilised to fill the gap left by the US funding freeze or ultimate withdrawal, years of progress are likely to be reversed, placing the health of millions at stake.”
In collaboration with HelpAge International, ILC spoke to 125 older adults in Mongolia, Rwanda and Zambia to better understand their healthcare experiences. The findings highlight significant barriers:
- Long distances and inaccessible routes hinder physical access to healthcare facilities.
“Sometimes, we have to travel 180 km to the provincial centre to get our illness checked.” 67-year-old man from Bayandun, Mongolia
- High costs of healthcare, transport, and medicine force difficult trade-offs between care and financial security.
“Some medications that aren’t covered with health insurance. If the patient can’t afford to pay, they forgo the medication, even if important for them.” 57-year-old woman from Kigali, Rwanda
- Resource shortages, insufficient geriatric services, and unclear information exacerbate healthcare inequities.
“[Health workers] write a prescription when there are no drugs. They recommend an X-ray when the equipment is broken down.” 75-year-old woman from Lusaka, Zambia
- Ageism and lack of autonomy in healthcare decisions limit the rights of older adults.
“I had a leg problem that required a metal implant. The doctor asked me why they should bother putting in the implant since I was no longer of any use.” 52-year-old man from Musanze, Rwanda
Ends
Notes:
This project is supported by Amgen.
Our impact
We have built a greater understanding:
Using our Healthy Ageing and Prevention Index alongside figures from the World Health Organization’s (WHO) Universal Health Coverage (UHC) Service Coverage Index we have created bespoke new data on the progress of universal health coverage in low- and middle-income countries (LMICs) to help us understand how well countries have adapted to greater longevity.
In partnership with HelpAge International, we also conducted focus groups with older adults in Mongolia, Zambia and Rwanda to understand how they view and access health services their communities. This has allowed us to bring older adults’ voices to a global level.
We have said the right things:
Our final policy report details our bespoke data analysis, and the findings from our focus group discussions with older people in LMICs. Alongside this policy report, we have also published a report in partnership with HelpAge International, which examines the focus group discussions from Mongolia, Rwanda and Zambia in more detail. We have crafted a set of bold, urgent recommendations to be implemented by governments and international organisations to better support UHC in LMICs.
We have engaged the right people:
We hosted two region-specific roundtables, a side event alongside the UN General Assembly, and a launch webinar. These events were attended by high-level stakeholders, including:
- Representatives from the Zambian and Malawian governments
- Monique Vledder, Head of the Global Health, Nutrition and Population Department at the World Bank
- Dr Pamela Cipriano, Co-Chair of UHC 2030
- Dr K. Srinath Reddy, Former Head of Public Health India
- Dr Socorro Escalante, WHO Representative to Mongolia
We have also engaged with key stakeholders and international bodies post-publication, including the South African Government and the Africa Centre for Disease Control.
Read our report here.
Past events
Webinar report launch – Universal Health Coverage in Low- and Middle-Income Countries: A global policy agenda
Date: Tuesday 18 February 2025
Time: 11.00am – 12.00pm GMT
Location: Virtual, Zoom
Join us to launch our work on universal health coverage in low- and middle-income countries. Our engaging webinar will feature a presentation of our research, insights from expert speakers, and an interactive Q&A session.
Watch the webinar recording here.
Past events
High-level roundtable discussion: Universal Health Coverage in Low and Middle Income Countries in Africa – A Global Policy Agenda for Longevity
Date: 28 August 2024
Time: 12.00 – 13.30 BST
Location: Virtual
Join us to discuss how low-and-middle-income countries in Africa have improved in UHC over the last 20 years, and what more there is to be done.
High-level roundtable discussion: Universal Health Coverage in Low and Middle Income Countries in Asia – A Global Policy Agenda for Longevity
Date: 29 August 2024
Time: 8.00 – 9.30 UTC
Location: Virtual
Join us to discuss how low-and-middle-income countries in Asia have improved in UHC over the last 20 years, and what more there is to be done.
UNGA high-level side event: Universal Health Coverage in Low and Middle Income Countries – A Global Policy Agenda for Longevity
Date: 24 September 2024
Time: 1.00 – 3.00 EDT
Location: The Yale Club of New York City, New York, USA
Join us for a solutions workshop alongside the UNGA meeting in New York.
We want to hear from you
If you would like to get involved in this project or have any questions, please contact Anna van Renen or Arunima Himawan.