Countries driving UHC progress

At the 2025 UHC High-Level Forum held in Tokyo on 6 December, 15 countries presented National Health Compacts endorsed at the highest levels of government. These compacts align Health and Finance Ministries behind measurable targets, provide a roadmap for coordinated action, and guide support from development partners around country-led priorities. The reforms focus on three main areas: expanding the reach and quality of primary care, improving financial protection, and strengthening the health workforce. Countries include: Bangladesh, Egypt, Ethiopia, Fiji, Indonesia, Mexico, Morocco, Nigeria, Philippines, Sierra Leone, Tajikistan, Uganda, Uzbekistan, Zambia 

The Health Works Leaders Coalition is a high-level platform in response to the urgent need for stronger, more sustainable health systems worldwide. It aims to accelerate reforms in primary care, health financing, regulation, and workforce development.

Chaired by World Bank Group President Ajay Banga and WHO Director-General Dr. Tedros Adhanom Ghebreyesus, the Coalition brings together global and national leaders from governments, the private sector, philanthropies, and civil society to catalyze political will and align actions for better health outcomes and economic growth.

The Coalition’s primary objectives are to raise ambition for health investment, support country-led reform efforts through the development and financing of country compacts, and foster knowledge sharing and alignment among stakeholders. It will function as a focused, time-bound platform through 2025—driving momentum in the lead-up to the UHC High-level Forum 2025 in Japan, co-hosted by the Government of Japan, the World Bank, and WHO.

Coalition members include: World Bank Group, World Health Organization, Japan, Apollo Hospitals, Egypt, Ethiopia, GAVI The Vaccine Alliance, Indonesia, Kenya, Nigeria, Philippines, Seed Global Health, Sierra Leone, St. Lucia, The Global Fund to Fight AIDS, Tuberculosis and Malaria, The Susan Thompson Buffett Foundation, United Kingdom, WACI Health, Wellcome Trust

At the 78th World Health Assembly, member states unanimously adopted the Resolution on Strengthening Health Financing Globally, which was formally sponsored by Nigeria alongside the following 20 Member States: Bangladesh, Botswana, Cameroon, Canada, Chile, Ecuador, Ghana, Japan, Lesotho, Luxembourg, Morocco, Mozambique, Norway, Senegal, South Africa, Ukraine, United Kingdom, Tanzania, Zambia and Zimbabwe). 

This resolution focuses on urging countries to strengthen public health investment, increase domestic resource mobilization, reduce out-of-pocket spending, and expand equitable access to health services — all key components of progressing toward UHC. 

The Group of Friends of UHC under the leadership of Georgia, Japan and Thailand serves as an informal platform for UN Member States to exchange information on events and initiatives worldwide. Since 2019, the Group has been advocating systematically to keep UHC at the forefront of UN debates. It also serves as a forum where members of the Group of Friends can discuss how to reiterate the value of UHC as an overarching goal to promote good health and well-being for all, at all ages, within the context of the UN and the 2030 Agenda. Finally, it provides an opportunity for interested Member States to hear from relevant experts, partners and advocates on the various components and implications of health systems strengthening, including monitoring, accountability and the implementation measures necessary to achieve and sustain UHC.

South Africa used its G20 Presidency in 2025 to explicitly prioritize universal health coverage (UHC) as a core health theme across the G20’s health track. Emphasis was on financial protection from catastrophic health spending and sustainable domestic health financing as essential to UHC and primary health care as the backbone of stronger, resilient, and inclusive health systems Through the Health Working Group, it put UHC — especially equity, solidarity, and access — front and centre of discussions and technical deliberations. UHC was a key issue alongside strengthening primary health care, health workforce development, non-communicable disease action, and pandemic preparedness Government peeches framed UHC not just as a technical target, but as a moral and economic imperative for the G20 and global health architecture. 

The G20 Leaders’ Declaration at the 2025 summit refers to strengthening equitable, sustainable, and inclusive health systems and intensifying coordinated action to accelerate progress toward UHC. By helping secure this language in the official summit declaration, South Africa ensured that UHC was part of the G20’s shared political commitments.

The adoption of the WHO Pandemic Agreement in May 2025 marks a historic milestone in global health. At the center of this achievement is the Intergovernmental Negotiating Body (INB) Bureau, which was established to draft and negotiate a WHO convention, agreement, or other international instrument on pandemic prevention, preparedness and response. The INB Bureau was comprised of six member states (two co-chairs and four vice-chairs) from each of WHO’s six regions. These Bureau members were selected and appointed by WHO’s Member States and supported throughout by the WHO Secretariat.

The INB Bureau members who led the process from the establishment of the INB to the adoption of the Pandemic Agreement at the Seventy-eighth World Health Assembly on 20 May 2025 were Co-Chairs Ms Precious Matsoso (South Africa), Ambassador Anne-Claire Amprou (France) and Mr Roland Driece (the Netherlands). Vice-Chairs were Ambassador Tovar da Silva Nunes (Brazil), Ambassador Amr Ramadan (Egypt), Dr Viroj Tangcharoensathien (Thailand), Ms Fleur Davies (Australia), Ambassador Honsei Kozo (Japan), Mr Kazuho Taguchi (Japan) and Mr Ahmed Soliman (Egypt).

Their work resulted in the landmark agreement, which reflects WHO Member States' shared commitment to strengthening international coordination, ensuring equitable access to essential health tools, and building a more resilient global health system to better prevent and respond to future pandemics. It also builds on the commitments made in the 2023 Political Declaration of the High-Level Meeting on Universal Health Coverage (UHC), with UHC recognized as a foundational element for pandemic prevention, preparedness and response. 

The WHO Pandemic Agreement is the second international legal instrument negotiated under Article 19 of the WHO Constitution, following the WHO Framework Convention on Tobacco Control. Work is now underway through an Intergovernmental Working Group (IGWG) to negotiate the Pathogen Access and Benefit-Sharing (PABS) system, a key component of the Pandemic Agreement that will be included as an annex. Once this annex is finalized and adopted by the World Health Assembly, the complete Agreement will be opened for countries to sign and formally approve, based on their national legal procedures. The Agreement will then come into effect 30 days after 60 countries have completed their ratification.

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In 2024, member states adopted the first World Health Assembly resolution on Social Participation for Universal Health Coverage (UHC), Health and Well-being, marking a major milestone in global health governance. The Core Group on Social Participation, made up of member state representatives from Thailand, Slovenia, France, Brazil, Norway and Tunisia, has played a pivotal role in both championing the resolution’s adoption (2024) and advancing its implementation (2025). 

The Core Group is working to embed meaningful social participation in health decision-making at all levels. Their efforts reinforce the importance of inclusive health governance and underscore the need to ensure that the perspectives of all people—especially vulnerable and marginalized communities—guide progress toward UHC.

Together, they continue to drive momentum for stronger, more responsive and more equitable health systems worldwide.

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Bangladesh's National Health Compact represents the government's collective pledge to strengthen the health system so that all people, especially the most vulnerable and underserved, can access quality, affordable, and people-centered health services. It is aligned with national policies, sector strategies, and the broader national aspiration to build a healthy, resilient, and productive population capable of contributing to sustained economic growth and social stability. The Government commits to deepening reforms in primary health care, strengthening the public sector’s capacity, enabling responsible private sector participation, addressing long-standing inequities, and ensuring that no one is left behind.The proposed action plans are fully aligned with the recommendations of the Health Sector Reform Commission which recommended earlier in 2025 recommended that the government make primary healthcare its constitutional obligation and provide it free of cost to ensure universal access.

The President of the Democratic Republic of Congo (DRC) champions the importance of UHC as a fundamental right for all Congolese citizens. In June 2025, the President called on provincial leaders to devote at least 15% of their annual budgets to the health sector and announced the gradual implementation of compulsory health insurance to improve access to healthcare and reduce dependence on international aid, during the 12th Conference of Governors on the theme of Health as a factor of social cohesion and sustainable development. 

The National Health Insurance Law was adopted in 2018 under the leadership of the President of Egypt, aiming to achieve UHC by 2032 over a 15 year period. Now Egypt has begun its 2nd phase, covering an additional 4 governates, and serving 12 million people. Alongside the bill, there have been steady increases in the health budget: e.g. a 124 percent increase in the 2025/2026 budget from 2021/2022. The recently launched National Health Compact outlines high-level government support for priorities, reforms, and investment needs in health.

Ethiopia is accelerating progress toward UHC through major expansions in financial protection and digital transformation. The country’s Community-Based Health Insurance (CBHI) scheme now covers more than 53 million people, extending affordable healthcare to informal-sector and rural households that have long been excluded from the health system. CBHI is reducing out-of-pocket costs and improving access to essential services, including outpatient and maternal care.

Ethiopia is also strengthening its health workforce by deploying digital tools such as e-learning platforms, AI-enabled diagnostics, and telehealth networks to at least 40 percent of primary health centers. Partnerships with private telecom providers and digital health start-ups are expanding access to quality services while creating new skilled employment opportunities for health professionals and digital workers. The recently launched National Health Compact outlines high-level government support for priorities, reforms and investment needs in health.
 

In 2025, Fiji is strengthening access to essential health services by expanding the use of digital tools that support more connected and reliable care. The country’s new National Digital Strategy includes major commitments to digital health, such as developing a secure national platform for Digital Health Records, telemedicine, and mobile health applications. These investments aim to improve continuity of care and make it easier for people in remote and island communities to receive timely services. By 2029, Fiji also plans to introduce a nationwide Health Information Exchange to link facilities and improve referrals and clinical decision-making. The strategy includes expanding e-health services and exploring the use of AI-supported diagnostics in major hospitals. These digital reforms complement Fiji’s publicly funded essential health services, helping improve quality, reduce delays, and strengthen coordination across the system. Together, they position digital health as an important driver of Fiji’s progress toward a more inclusive and resilient UHC system. The recently launched National Health Compact outlines high-level government support for priorities, reforms and investment needs in health.
 

Under the leadership of Ghana's President, there has been a push for major reforms in the National Health Insurance. This includes the establishment by the President of the Ghana Medical Trust Fund (known as the Mahama Cares Fund) and associated bill voted by Parliament. The aim is to cover treatment costs outside the current National Health Insurance Scheme (chronic NCDs and other conditions inadequately covered). There are also measure to achieve greater equity and guarantee access to the most vulnerable groups. The removal of the cap on the excise tax amount earmarked for NHIA resulting in 60% increase in 2025. The recently launched National Health Compact outlines high-level government support for priorities, reforms, and investment needs in health.

Indonesia is redefining what rapid progress toward universal health coverage looks like. In just a decade, it expanded the JKN scheme to cover more than 98% of its vast, archipelagic population—an achievement that has taken some countries generations to reach. This momentum now extends into digital transformation. Indonesia is scaling digital primary care nationwide, with more than 600 facilities connected to hospitals through telemedicine, ensuring patients can access timely care closer to home. By pairing expansive coverage with innovative service delivery, Indonesia is demonstrating how a large, diverse, and geographically dispersed country can modernize its health system at speed. Its approach offers a compelling model for countries aiming to close coverage gaps while strengthening the quality and accessibility of primary care. The recently launched National Health Compact outlines high-level government support for priorities, reforms, and investment needs in health.

Mexico’s 2026 Economic Package reinforces the government’s commitment to advancing UHC through expanded public financing and strengthened primary care. Health spending rises significantly, with IMSS Bienestar, the public system that provides free services and medicines for people without social security, receiving a major increase to support its ongoing expansion. President Claudia Sheinbaum emphasized that health is treated as a strategic investment and that social programs for vulnerable populations will remain fully financed. The package avoids raising VAT or income taxes. Instead, new revenues will come from customs reforms, anti corruption measures, strengthened domestic production, and tighter enforcement against tax evasion. The proposal also increases the tax on sugary drinks, with additional revenue directed to health programs and prevention initiatives. The recently launched National Health Compact outlines high-level government support for priorities, reforms, and investment needs in health.

Morocco continued expanding population coverage under its mandatory health insurance system in 2025, with government figures indicating that around 88 percent of the population is now enrolled. This reflects the integration of previously uninsured groups, including self-employed workers and low-income households, as part of the country’s multi-year social protection reforms. Alongside coverage expansion, Morocco is implementing broader health sector changes outlined in recent legislation, including efforts to strengthen governance, improve service delivery, and address workforce gaps. Digital transformation has also advanced, with initiatives focused on interoperability, cybersecurity, and the development of national health information platforms intended to support more efficient management of patient data and system performance. While the reforms remain in progress and operational challenges persist, developments in 2025 point to continued movement toward a more structured, digitised, and inclusive health system. The recently launched National Health Compact outlines high-level government support for priorities, reforms, and investment needs in health.

In February 2025, Namibia's cabinet approved a universal health coverage policy to ensure all Namibians can access healthcare services without financial hardship. This initiative aligns with the country’s Vision 2030 and the SDGs and aims to address existing challenges in healthcare access, particularly in rural areas. This initiative, announced during a media conference outlining the cabinet’s decisions for 2025, is designed to guarantee healthcare access for all Namibians across the country at any time. An inter-ministerial committee, spearheaded by the Ministry of Works and Transport along with the Ministries of Health, Finance, and the National Planning Commission, will develop the framework for implementation and funding. Currently, around 3 million people benefit from free healthcare at public facilities, but challenges in expanding access, especially in rural regions, persist.  

In 2023, the President launched the Nigerian Health Sector Renewal Investment Initiative which provides the political framework for UHC reforms. The Ministry of Health has then put in place a sector wide approach to aligning federal, state and partner investments within a unified platform that strengthens governance and regulation, expands insurance coverage toward 50 million Nigerians, and   builds local manufacturing and research ecosystems. Nigeria is channeling newly available resources into a major primary healthcare push. An additional ₦32.9 billion has been approved under the revised Basic Health Care Provision Fund (BHCPF), unlocking support for more than 8,000 primary health centres—rising to 13,000 next year—and covering essential operating costs, health worker incentives, emergency care and essential medicines. Alongside this, the government is investing in long-term system strength: training 10,000 pharmaceutical and biotech professionals, establishing Centres of Excellence, and offering tax incentives to expand local production of vaccines, medicines, diagnostics and health technologies.

Early gains from the BHCPF reforms are already visible. Primary care utilisation has quadrupled, maternal mortality at facility level has fallen by 12%, and immunisation campaigns in northern states have reached 92% coverage. Together, these measures reflect Nigeria’s commitment to a more resilient, self-reliant health system. In 2023, the President launched the Nigerian Health Sector Renewal Investment Initiative which provides the political framework for UHC reforms. The Ministry of Health has then put in place a sector wide approach to aligning federal, state and partner investments within a unified platform that strengthens governance and regulation, expands insurance coverage toward 50 million Nigerians, and   builds local manufacturing and research ecosystems. The recently launched National Health Compact outlines high-level government support for priorities, reforms and investment needs in health.

The Philippines is advancing a wide agenda to strengthen universal health coverage, investing in system wide reforms across infrastructure, service delivery, human resources, prevention, and financial protection. The country is also modernizing its primary health care network, upgrading facilities and ensuring they are digitally connected so that services become more coordinated, more efficient, and more accessible to all communities. The recently launched National Health Compact outlines high-level government support for priorities, reforms and investment needs in health.

At the same time, civil society has played a crucial role in defending the integrity of UHC reforms. When the national budget proposed removing the subsidy for PhilHealth, it was not a single organization that raised concern. A broad constellation of health groups, labor unions, student networks, migrant rights advocates, and public finance watchdogs filed cases in court and kept the issue alive in the media. Their collective effort succeeded. The Supreme Court has now ordered that the funds be returned to PhilHealth, reinforcing the principle that government support for vulnerable populations cannot quietly be withdrawn.
 

Sierra Leone has set an ambitious goal: to ensure every person can reach quality primary care within five kilometers of home. New facilities are rising across the country—300 planned—and 1,800 more are being equipped with solar power and digital tools. But while the bricks are being laid, the Ministry of Health is also bringing care directly to people’s doorsteps.

The Nationwide Health Train Campaign 2025 sends mobile teams—“hospitals on wheels”—into each of the 16 districts for a month at a time. They listen, assess, treat, and problem-solve alongside communities, helping children get their vaccines on time, supporting pregnant women, screening adults for disease, and reaching the elderly who often struggle to travel.

In Moyamba, the first stop, hundreds received same-day care and communities rallied around their health workers. The train is moving on, carrying with it a simple promise: health services should find people, not the other way around.
 

In 2025, Syria introduced the National Health Compact, a new strategy aimed at rebuilding core health system functions and advancing progress toward universal health coverage by 2030. The Compact outlines priorities including rehabilitation of damaged health facilities, capacity-building for health workers, strengthened health financing, improved health security, and digital transformation. A central objective is to ensure access to essential services without financial hardship. Alongside this policy step, UN agencies and health partners continued to support the restoration of primary health centres and the delivery of essential services—such as maternal and child health care, basic chronic disease management, and routine immunisation—particularly in underserved areas. While significant challenges persist, the launch of the Compact provides a more structured framework for guiding future investments and coordinating national and partner efforts. These actions represent early steps toward reinforcing a more resilient and equitable health system aligned with UHC goals.

Tajikistan made significant strides toward UHC in 2025, beginning with the launch of a major health-financing pilot in Sughd region. The pilot introduces new payment and purchasing mechanisms for primary healthcare facilities designed to expand access, reduce out-of-pocket costs, and strengthen financial protection for households. This shift is part of a broader national effort to modernize the health system by redesigning the state-guaranteed benefit package for primary care, expanding the use of digital tools such as electronic medical records and patient registries, and laying the groundwork for a future mandatory health insurance programme. The recently launched National Health Compact outlines high-level government support for priorities, reforms and investment needs in health.

Uganda’s progress toward UHC in 2025 includes continued upgrades of primary health facilities, with the Ministry of Health implementing a phased plan to elevate Health Centre IIs to Health Centre IIIs. These upgrades introduce outpatient departments, maternity and general wards, improved infrastructure, and expanded budgets for staffing and medicines, aiming to increase service readiness and reduce access barriers for rural populations. Alongside these structural investments, Uganda is also advancing digital health technologies that support more efficient and equitable care. As highlighted in local commentary, tools such as electronic data systems, mobile reporting platforms, telemedicine, digital supply-chain management, and electronic health records are increasingly used to improve service continuity, strengthen surveillance, enhance decision-making, and reduce delays in care. Together, the expansion of primary care infrastructure and the adoption of digital health solutions reflect Uganda’s ongoing efforts to build a more connected, resilient, and accessible health system aligned with UHC goals. The recently launched National Health Compact outlines high-level government support for priorities, reforms and investment needs in health.

In 2025, Uzbekistan made important advances in digital health, expanding its unified electronic medical record system to cover most of the population and connecting thousands of facilities through a national digital network. Electronic prescriptions and other digital tools are improving transparency, continuity of care, and system efficiency. Looking ahead, Uzbekistan aims to strengthen primary health care as the core of its system, with plans for family polyclinics to provide up to 70% of all services by 2030. The country has also set targets to improve quality, aiming for at least 85% of beneficiaries and PHC staff to be satisfied with services delivered. To support this shift, Uzbekistan intends to reduce administrative workload in PHC by 30% through digitalisation and improved task distribution. These reforms signal strong momentum toward a more accessible and effective health system. Through its National Health Compact, Uzbekistan aims to raise the UHC Service Coverage Index from 75% to 85% and reduce out-of-pocket spending from 65% to 47% of current health expenditure by 2027. 

All citizens in Vietnam to receive basic medical care free of charge by 2030. Resolution 72 of the Communist Party of Việt Nam (9 September 2025) demonstratey the Party’s profound concern for the health of every citizen, aiming towards the goal of building a healthy Vietnam. It sets out a comprehensive vision to transform the country’s healthcare system, reflecting decades of consistent attention by the Party and State to public health. It aims to ensure equitable, high-quality healthcare for all citizens and places healthcare firmly within national development policy. Despite achievements, the sector still faces limitations, requiring breakthroughs in thinking, structures and practice. A key thrust is the shift from treatment to prevention, making preventive medicine and grassroots health stations the foundation of healthcare delivery. By 2030, every commune-level station will be staffed according to official standards, aided by preferential policies for doctors and midwives in underserved areas. 

From 2025, at least 1,000 doctors will be seconded annually to communes, with permanent staffing gradually scaled up. Infrastructure and equipment will also be upgraded. All commune health stations will be provided with essential facilities, medicines and vaccines. The most widely anticipated policy is the “free hospital fees” initiative. By 2030, essential healthcare costs will be covered through health insurance, with citizens entitled to at least one free annual check-up starting in 2026. The state and insurance funds will cover basic health services, particularly for vulnerable groups, while co-payment will apply to non-essential or high-demand treatments to ensure both fairness and efficiency. This approach establishes universal health insurance as the backbone of financial protection, reducing out-of-pocket payments, enabling earlier detection of disease and ensuring risks are shared equitably across society. It reflects a humane and people-centred healthcare policy, 

Zambia has made notable progress in the past two decades, largely due to investments in primary health care, immunization programmes, maternal and child health interventions, and large-scale disease-specific investments, including for HIV, TB and Malaria. As a result, life expectancy has increased from 42.5 in 2000 to 63.0 years in 2023. The under-five mortality rate fell from 119 in 2007 to 42 deaths per 1,000 live births in 2024, while the maternal mortality ratio decreased from 591 to 187 deaths per 100,000 live births. Zambia spends about 2.5 percent of its Gross  Domestic Product (GDP) on health. The budget  allocations to the health sector have increased  over the years from approximately US$875 million in 2023 to US$ 1.1 billion in 2026. However, the share of health sector allocation as a proportion  of total government budget has decreased from 11.8% in 2023 to 10.3% in 2026. 

Additionally,  the country has benefited from donor funding, accounting for close to half of the total health expenditure in 2022 (49.4%4). A significant share of external funds is off budget, which undermines the health sector’s ability to plan strategically. The National Health Compact launched on 6 December under the President's leadership embodies a renewed commitment between the government, our cooperating partners, the private sector, and the people of Zambia to place health at the heart of our social and economic agenda. It focuses on 5 pillars: 

1. Strengthen service delivery to increase access to people centred PHC services.
2. Improve access to essential medicines, vaccines and medical products.
3. Invest in a skilled, equitably distributed and productive health workforce.
4. Enhance use of digital technologies for transparency, efficiency and accountability.
5. Mobilize private sector investment and innovation across the health value chain.