Universal Health Coverage: Challenges and Sustainable Solutions

Universal Health Coverage (UHC) remains a central aspiration within global public health. Despite political commitments and strategic roadmaps, health systems are under mounting strain, juggling fiscal constraints, demographic shifts, climate vulnerabilities, the aftermath of pandemics, and persistent health inequities. Recent scholarship has highlighted promising approaches to financing and primary health care delivery, as well as innovative models that aim to close inclusion gaps. However, a large body of evidence also reveals uneven progress in safeguarding financial protection, expanding essential services, and ensuring equitable access—especially for marginalized populations and communities in fragile settings. Ongoing debates center around the sustainability of health financing and the ability of political and governance structures to support rapid and resilient scale-up of UHC principles. International Universal Health Coverage Day, observed on 12 December, is an important annual rallying cry for realization of UHC globally.

Significant research efforts have expanded our understanding of pooled financing, payment reform, and the political economy influencing benefit package design, but evidence gaps remain concerning their translation into impact and scalability across different country contexts. Studies on digital health and integrated social protection have introduced new possibilities, yet the effectiveness of such innovations under real-world constraints is still under-explored. Implementing policy changes at scale, monitoring quality, and optimizing fiscal allocations are active areas of investigation, further complicated by the evolving landscape of global health emergencies and climate threats. There is a critical need for comparative, equity-sensitive, and implementation-oriented research that bridges health economics and public health policy to drive further progress on UHC.

This Research Topic aims to gather robust evidence, foster critical reflection and reform, and provide policy guidance to accelerate the realization of UHC by 2030. Its core objectives are to identify barriers and enablers to equitable UHC advancement, explore sustainable financing and governance models, assess implementation strategies, and connect new research insights directly to policy action. The scope of the collection covers economic, policy, and governance challenges relevant to accelerating UHC in diverse settings, with a focus on practical and scalable innovations. Both successes and failures in LMICs, fragile states, and high-income subnational systems are welcome, provided they offer generalizable insights.

To gather further insights in advancing Universal Health Coverage, we welcome articles addressing, but not limited to, the following themes:

1. Sustainable UHC financing: Health policy and governance
2. Healthcare policies and programs: Designs, implementation, and outcomes
3. Strategies to reach underserved and marginalized populations
4. Integration of health with social protection systems
5. Transformation of primary health care and community health service delivery
6. Digital health and technology for sustainable and equitable UHC expansion
7. Quality measurement, performance accountability, and patient engagement
8. Health system resilience for pandemics, conflict, and climate-related shocks
9. Implementation research, scale-up strategies, and cross-country learning
10. UHC in low- and middle-income countries
11. UHC and Sustainable Development Goals (SDGs)