This opinion piece was first published in Jornal de Angola, a copy of which can be found here: https://www.jornaldeangola.ao/noticias/9/opini%C3%A3o/654144/cobertura-universal-de-sa%C3%BAde:-um-imperativo-para-angola-e-para-o-mundo.

By: Dr. Tomas Valdez, WHO Health Policy and Systems Coordinator in Angola.

There are choices that no head of household should have to face. Think about Mr. Figueira, who suffers from high blood pressure and diabetes. Every month, he has to juggle the cost of food, his children’s schooling, and the price of his medication. When money is tight, illness waits for no one, and treatment is postponed. This cruel reality, which forces families to sacrifice healthcare to meet their basic needs, is precisely what Universal Health Coverage (UHC) aims to eliminate, i.e., to guarantee access to essential services without financial risk.

12 December marks Universal Health Coverage Day, a date that goes beyond symbolism and calls us to action. Health is a fundamental human right, enshrined in the Universal Declaration of Human Rights and reaffirmed in the constitutions of most countries, including Angola. However, this right remains out of reach for millions of people.

According to the WHO and World Bank’s 2025 Global Report, global progress is far short of what is needed to meet the 2030 Agenda targets. The warning is clear: the slowdown is worrying and requires immediate political action.

Between 2000 and 2023, the Service Coverage Index (SCI) rose from 54 to 71 points — real progress, but insufficient. Still, 4.6 billion people remain without access to essential services, and 2.1 billion face financial hardship due to out-of-pocket health expenditure. Financial hardship means spending more than 40% of the household’s discretionary budget on healthcare. In three-quarters of countries with available data, medicines account for more than 55% of these expenses; in the poorest countries, they account for 60%, diverting resources away from essential needs such as food, transportation, and education.

The slow response to ensuring quality healthcare has devastating human costs: maternal mortality has not declined since 2015, with nearly 300,000 women dying each year during pregnancy or childbirth; child immunisation has stagnated; and non-communicable diseases such as hypertension, diabetes, cancer, and mental illness cause 17 million premature deaths per year, mainly in low- and middle-income countries. 

Without acceleration, global SCI is expected to reach only 74/100 by 2030, leaving one in four people facing financial hardship at the end of the SDG era.

What practical measures should we take to change this scenario? The evidence is clear: strengthening Primary Health Care (PHC) is the fastest, most effective, and equitable strategy for achieving Universal Health Coverage. PHC can address up to 90% of health needs, save 60 million lives, and increase global life expectancy by 3.7 years by 2030. In Angola, Primary Health Care means having functional, well-equipped health posts and centers close to communities, motivated and trained health professionals with incentives to work in rural areas, accessible and available medicines, and simple healthcare pathways without barriers that discourage people from seeking medical assistance.

What concrete actions should be reinforced to ensure PHC? First, secure sustainable financing, approaching 15% of the General State Budget for health, in line with the African commitment in Abuja. 

Second, implement a sustainable financing strategy to ensure the provision of essential healthcare to vulnerable groups. Third, guarantee access to affordable medicines through centralised purchasing, with transparency and clinical protocols that ensure the provision of free medication or with symbolic co-payments. Fourth, implement a functional PHC network, with the refurbishment of facilities, training, and retention of professionals, especially in rural areas. Fifth, invest in prevention and literacy through simple screening and community campaigns. Sixth, implement data-driven governance with monitoring of HCI and expenditure by province and publish performance dashboards. Seventh, adopt a multisectoral approach, as health also depends on access to water, sanitation, nutrition, education, and social protection.

Every day without action means pushing more families into poverty due to healthcare costs. Health cannot be a privilege, nor a cause of impoverishment. Universal Health Coverage is simultaneously a moral imperative, sound public policy, and a wise economic decision. 

Economies with robust health systems are better equipped to absorb shocks and produce more robust outcomes. Countries that treat health as a right strengthen social cohesion and trust in institutions.

So as we celebrate Universal Health Coverage Day, the message is urgent and straightforward: no one should fall ill and into poverty. Investing in health is investing in development, equity, and human dignity. We must all work together — families, the private sector, the media, politicians, and the national and international community — to ensure that no citizen, like Mr Figueira, has to choose between eating and taking the necessary medication.