Progress towards universal health coverage in South Asia, 2000-2030: an examination of the twin elements of primary healthcare provision and financial protection.

Abstract

<h4>Background</h4>Universal health coverage (UHC) is crucial for achieving Sustainable Development Goal (SDG) 3: Good Health and Well-being. This study projects UHC progress in seven South Asian countries by 2030, focusing on two crucial underpinning components, primary healthcare (PHC) service coverage and financial risk protection.<h4>Methods</h4>We applied Bayesian random-effects models to project UHC indicators linked to PHC and financial risk protection including the Composite Coverage Index, catastrophic health expenditures (CHE) and impoverishing health expenditures. Data were sourced from the WHO Global Health Observatory, Demographic Health Surveys, National Health Surveys and the WHO Global Health Expenditure database. Projections were made from 2000 to 2030, with PHC and government health expenditures as key predictors.<h4>Results</h4>The analysis showed notable disparities in current and projected service coverage and financial protection across the region. Health service coverage is projected to increase from 53.5% in 2000 to 81.5% by 2030, with Bhutan and Sri Lanka expected to achieve higher levels. However, Afghanistan and Pakistan will likely remain below the SDG target of 80% coverage. Despite progress in coverage, financial protection is a challenge, with CHE expected to rise from 7.2% in 2000 to 18.6% by 2030. Bhutan and Sri Lanka show strong protection measures, while Afghanistan and India will face higher CHE and impoverishment rates due to high out-of-pocket spending.<h4>Conclusion</h4>This is the first study to project trends towards UHC in South Asia using Bayesian estimates of both health coverage and financial risk protection. Progress towards UHC requires advances in both service coverage and health financing reform. Although service coverage is improving, financial protection remains insufficient, particularly in rural and conflict-affected areas. Targeted PHC investment, context-sensitive financing reforms and stronger risk-pooling mechanisms are essential-drawing lessons from stable settings (Bhutan, Sri Lanka) to guide strategies in fragile contexts (Afghanistan, Pakistan).