6.1 Universal Health Coverage and TB determinants

Fig. 6.1.1 Trends in the UHC service coverage index in WHO regions and World Bank income groups, 2000–2019

Fig. 6.1.2 UHC service coverage index by country, 2019

In contrast to improvements in the SCI, the level of financial protection for expenditures on health has been worsening globally, at least between 2010 and 2019 (global estimates for later years are not currently available). Worldwide, the proportion of the general population facing catastrophic expenditures on health (using a threshold of >10% annual household income or expenditure) rose from 9.4% in 2000 to 13% (996 million people) in 2017 (3). National values are available for different years and there is more geographical variability compared with the SCI, including within regions (Fig. 6.1.3).

Fig. 6.1.3 Percentage of the general population facing catastrophic health expenditure^a at country level, latest available year of data^b

The distribution of the two UHC indicators in the 30 high TB burden countries and three global TB watchlist countries shows that, in general, values improve with income level; this is especially evident for the SCI (Fig. 6.1.4). Nonetheless, the risk of catastrophic health expenditures is high (15 or above) in several middle-income countries, including Angola, Bangladesh, Cambodia, China, India, and Nigeria. Thailand stands out as a high TB burden country with both a high SCI (80 or above) and a high level of financial protection (2% of households facing catastrophic health expenditures). A UHC scheme was established in 2002, supported by domestic funding and a strong primary health care system (4). Although data post-2019 are not yet available, the COVID-19 pandemic is likely to have caused progress towards UHC to stall or reverse since 2020 in many countries.

Fig. 6.1.4 UHC service coverage index (SDG 3.8.1)^a and percentage of the general population facing catastrophic health expenditures (SDG 3.8.2),^b 30 high TB burden countries and three global TB watchlist countries,^c stratified by income group^d

To achieve UHC, substantial increases in investment in health are critical. From 2000 to 2019 there was a striking increase in health expenditure (from all sources) per capita in a few high TB burden countries, especially the upper-middle-income countries of Brazil, China, South Africa and Thailand (Fig. 6.1.5). A steady upward trend was evident in Bangladesh, Ethiopia, India, Indonesia, Lesotho, Mongolia, Mozambique, the Philippines and Viet Nam, and there was a noticeable rise from 2012 to 2017 in Myanmar. Elsewhere, however, levels of spending have been relatively stable, and at generally much lower levels.

Fig. 6.1.5 Current health expenditure per capita, 30 high TB burden countries, 2000–2019