Most countries have expanded access to health services and eased the financial strain of medical care over the past two decades, but billions of people worldwide still cannot get the care they need, according to the World Health Organization (WHO) and the World Bank Group's new report. ALSO READ: How Rwanda’s new Rwf7tn strategy plans to improve healthcare The Universal Health Coverage Global Monitoring Report 2025, released on December 6, shows that since 2000, countries at all income levels have increased both health service coverage and financial protection. ALSO READ: Rwanda moves to make cancer treatment more affordable for population The global Service Coverage Index rose from 54 to 71 between 2000 and 2023, while the share of people facing financial hardship from health costs reduced from 34 percent to 26 percent. Despite these improvements, many people still struggle to access and pay for health services. Around 4.6 billion lack essential care, and 2.1 billion face financial hardship, including 1.6 billion who live in poverty or are pushed into it by medical costs. WHO Director-General Dr Tedros Adhanom Ghebreyesus said universal health coverage is the perfect expression of the right to health, but billions of people still cannot get or afford the care they need. He added that cuts to international aid are putting extra pressure on already strained health systems. Households that spend more than 40 percent of their income on health are considered to face financial hardship, with medicines accounting for most of the cost. They make up at least 55 percent of out-of-pocket spending in most countries, rising to 60 percent for the poorest, forcing families to cut back on essentials. Even middle-income households are feeling the pressure as medical costs take up a larger share of their income, the report states. Progress on universal health coverage has slowed since 2015; only a third of countries expanded service coverage while lowering financial hardship. All WHO regions improved coverage, but only Africa, South-East Asia, and the Western Pacific reduced financial burden. Low-income countries achieved the fastest improvements, mostly in infectious disease programmes; noncommunicable disease and maternal, newborn, and child health services improved gradually. Poverty eased with better sanitation, income, and social protections, but there are still inequalities, affecting women, rural residents, the less educated, disabled, displaced, and informal settlements hardest. The report urges governments to expand essential services, lower medicine costs, and strengthen primary care. Mutuelle de santé extends affordable health services to millions of Rwandans In Rwanda, the community-based health insurance scheme, Mutuelle de santé, covers both formal and informal sector workers and provides the main access to health care for most citizens. RSSB Chief Benefits Officer Dr Régis Hitimana said the scheme does not require formal employment or salary deductions. “Other insurance schemes need a contract or a salary where deductions are made. For us, there are no entry requirements. Rwandans can join by paying a small contribution, while households unable to pay are covered by the government. Families classified as poor are enrolled without contributing and have access to services like other insured members,” he said. Hitimana noted that member contributions make up less than 40 percent of the fund’s budget, with the rest coming from public taxes and government allocations. He added that this funding ensures services continue regardless of rising costs and increasing demand. Rwanda regularly updates the Mutuelle de santé benefits to keep up with disease trends and rising demand. Services not included in the package are paid for out of pocket. The scheme now covers expensive treatments like cancer care, heart surgery, and total hip replacements, helping families avoid high medical costs, he added. “However, nearly 12 million Rwandans are now covered by Mutuelle de santé, putting pressure on public health facilities. Shortages of specialists and limited equipment have slowed service delivery, with some surgeries booked months in advance. As a result, many patients turn to private clinics or delay treatment, making their conditions more serious and costly,” Hitimana said. He explained that the 4x4 health workforce programme seeks to tackle specialist shortages and strengthen service delivery, but there are still challenges, as patients needing bone marrow transplants must travel abroad, and advanced cancer diagnostics, including PET scans, are still unavailable in Rwanda. Hitimana said plans are in progress to introduce the technology, which will allow those whose contributions are covered by the government to access care without paying at the point of service. Tracking changes in family income is still a challenge, but social support helps ensure access to care when coverage is interrupted. “If people can afford insurance but do not enroll, it can delay care because of the fear of high medical costs. RSSB works with local authorities and civil society groups to encourage enrolment, and employers should check whether workers, including casual labourers, are insured. If someone works for you, ask them if they have health insurance because an accident can happen at any time,” Hitimana said.
