Below are extracts from the editorial in this week's Lancet, and comments from me. Read online: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02511-5/fulltext
'Universal health coverage (UHC) rests on a simple idea: every person, everywhere, should be able to access the health services they need without fear of financial ruin...
'Yet translating this promise into reality has proven complex. Progress is measured through two indicators — service coverage (SDG 3.8.1) and financial hardship (SDG 3.8.2). The 2025 Global Monitoring Report shows that 4·6 billion people lacked essential health services in 2023, and 2·1 billion faced financial hardship in 2022.
'When UHC is interpreted narrowly, it risks becoming overly technocratic. There are many paths towards UHC... Without clearer prioritisation, there is a danger that UHC demands more than can be feasibly delivered.
'How, then, can meaningful gains be achieved despite limited resources? The Global Health 2050 Commission shows the potential of a strategic focus. Concentrating on just 15 priority conditions — eight infectious and maternal health conditions, seven non-communicable diseases and injuries — could halve the number of premature deaths by 2050. A modular approach to services allows governments to build core capacities and expand coverage over time...
'UHC alone cannot secure resilient health systems or sustained population health. The task is not to broaden UHC endlessly, but to ground it in the priorities that strengthen systems and improve population health...'
COMMENTS (NPW):
1. The WHO definition of UHC emphasises quality, a word that is missing from the editorial. 'Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.' https://www.who.int/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
2. The proposal to focus on 'just 15 priority conditions' reminds me of UNICEF's Director-General, James Grant (1980-1995) who introduced the GOBI-FFF concept (growth monitoring, oral rehydration therapy, breastfeeding, immunization, food supplementation, female education and family planning) whic contributed to dramatic falls in child mortality.
3. Although there is an argument for a prioritised approach, there is also a strong counterargument that this should not be imposed centrally. Rather, member states should be empowered with the information and support they need to define their own priorities.
4. The focus on quality is vital. HIFA has worked for several years with the WHO Global Learning Laboratory for Quality [ https://www.who.int/initiatives/who-global-learning-laboratory-for-quali... ] and our completed projects are available here [ https://www.hifa.org/projects/learning-quality-health-services ] and here [ https://www.hifa.org/projects/essential-health-services-and-covid-19 ].
5. It is unquestionable that quality universal health coverage can only be achieved if healthcare providers are empowered to deliver such care. 'Patient-centred care' is meaningless if providers are no empowered, and some of us have argued for a shift to a greater emphasis on supporting health workers. Improving the availability and use of reliable healthcare inforamtion is central to quality UHC, as we argued in the BMJ Global Health (Universal access to essential health information: accelerating progress towards universal health coverage and other SDG health targets. https://gh.bmj.com/content/5/5/e002475 ). Our call was subsequently echoed by a team of authors including the then-Deputy Director-General of WHO ('Universal health information is essential for universal health coverage.' https://fmch.bmj.com/content/11/2/e002090 )
6. In 2023/2024 we undertook a global consultation for WHO which had two main conclusions: 1. WHO should champion universal access to reliable healthcare information; 2. WHO, HIFA and partners should convene stakeholders to develop a global strategy for its realisation.
7. Our priority in 2026 is to encourage WHO to explicitly champion universal access to reliable healthcare information and prepare to convene stakeholders to develop a global strategy. This work is overseen by the HIFA-WHO Collaboration Group as we implement our agreed Collaboration Plan 2025-2027.
8. We are focusing on the first two activities in the Plan: Activity 1: Provide technical input (Report 1) for WHO`s consideration towards universal access to reliable healthcare information. ($10k) Activity 2: Provide technical input (Report 2) for WHO`s consideration to consider the feasibility and development of a global strategy for universal access to reliable healthcare information. ($20k)
9. We need modest financial support to fund these two activities and accelerate progress towards quality UHC. Will you or your organisation make a donation to help us take this forward? Any organisation that gives £100 or more will be recognised as a HIFA Partner (see here for Partner benefits: www.hifa.org/support/partners ). Please don't hesitate to contact me for further information: heil@hifa.org
Many thanks, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org