Why Financial Protection Matters for Achieving UHC: Civil Society Perspectives from the CSEM for UHC2030 Advisory Group

Dic 18, 2025

Introduction: The human impact behind the UHC Day 2025 theme

Around the world, millions of people are being priced out of their right to health. According to the 2025 Global Monitoring Report on ?Tracking universal health coverage?, nearly half of the world?s population still lack access to essential health services, and 2 billion face financial hardship because of out-of-pocket spending – with many pushed into poverty by the simple act of seeking care. Recent freezes and cuts in overseas development assistance have further reduced access to essential health services, endangering millions of lives and affecting progress on many health priorities. These realities sit at the heart of 2025 Universal Health Coverage (UHC) Day theme: ?Unaffordable Health Costs? We?re Sick of It!?

For civil society organizations, these numbers are not abstract, they represent the daily struggles of people forced to choose between health and other basic needs. Financial hardship determines whether a young person gets tested for HIV, whether a displaced family in Ukraine receives essential medicines, whether a Nigerian farmer survives a chronic condition, whether a woman in Argentina can access the full range of care she needs, or whether a family in the United States is pushed into long-term financial insecurity, as medical bills remain a leading cause of personal debt and bankruptcy.

On the occasion of UHC Day 2025, the CSEM Advisory Group –  composed of 18 civil society leaders and advocates for the right to health for all from across the world – shared how unaffordable health costs are affecting their communities, and what leaders must do to ensure real financial protection for all.

Our message is clear: there can be no meaningful progress on UHC without strong, equitable financial protection.

I. Why financial protection is non-negotiable

Financial protection is one of the core pillars of UHC. Without it, health systems may offer services in theory, yet deny access in practice. For civil society, financial protection is not merely a technical issue of health financing:  it is a question of equity, justice, and the right to health. 

Across regions, a common reality emerges: when people must pay out of pocket, health systems stop working for them and begin working against them. Without financial protection, households are pushed into poverty, forced to choose between health and basic needs such as food, or compelled to forgo health care entirely due to out-of-pocket health expenses. In May 2025, Member States endorsed the World Health Assembly Resolution on strengthening health financing globally (WHA78.12), calling for investments that protect people from financial hardship and make better use of limited resources. Taken together, global commitments and community experience point clearly to what must change, including ensuring accessible health for all a reality. 

Financial protection is essential to ensuring equity and dignity

Out-of-pocket payments disproportionately impact vulnerable and marginalized populations facing structural discrimination, such women, LGBTQ+ communities, people living with chronic conditions, people in prisons, people living in poverty, migrants, and groups marginalized by stigma. Affordability is not only an economic concern, it is central to the right to health and to ensuring that people can access quality care without fear, shame, or unequal treatment.

Financial barriers not only prevent people from accessing essential health services, but also shape how people are treated by health providers and health facilities .The fear of being judged, humiliated, or turned away because one  can?t afford care often keeps people from seeking help, especially those already facing discrimination. In many contexts, multiple forms of marginalization intersect, such as gender, poverty, migration status, disability, or stigma related to HIV or criminalization, reinforcing the risk of exclusion and deepening inequities in access. Without robust financial risk protection, health systems risk reinforcing existing inequities instead of correcting them.

We must remind leaders to actively prioritize equity, intersectionality, and non-discrimination, ensuring that everyone, regardless of income, gender identity, social status, or legal situation, can access quality health services with dignity and confidence.

Financial protection strengthens health systems and prevents poverty 

When people cannot afford early care, they wait until illness becomes more severe, which can lead  to overcrowded health facilities and higher treatment costs. With financial protection, people are protected from catastrophic and impoverishing health costs. They don?t have to sell their or pull their children out of school to pay for care. 

?When out-of-pocket payments are reduced, more people seek timely diagnosis and treatment.?

Zahed Islam, Alliance for Public Health (APH), Ukraine

These dynamics are not limited to low- and middle-income countries. In high-income settings as well, gaps in financial protection expose households to significant economic risk and undermine access to care.

?Unaffordable health costs are not only a problem for low- and middle-income countries. In the United States, many people delay or forgo needed care due to cost, and medical bills remain a leading cause of personal debt and bankruptcy, creating long-term financial insecurity for families.?

Eliana Monteforte, Global Health Council, United States

This vision mirrors the priorities laid out in the 2025 World Health Assembly Resolution (WHA78.12), which calls for countries to strengthen domestic resource mobilization (DRM) and risk-pooling mechanisms as foundations for sustainable UHC. Efficient health financing must shift investment toward primary health care, reduce fragmentation, and prioritize preventive, people-centered services. By ensuring that people can seek care early and consistently, countries improve health outcomes while making better use of limited resources.

Financial protection builds trust and strengthens accountability in health systems

Trust is a critical ingredient to make real and tangible progress toward UHC. People are far more likely to seek care, follow treatment, participate in prevention, and engage in health governance when they believe the health system will protect them. Social participation for health – which refers to meaningful involvement of people, communities and civil society in decision-making across the entire policy cycle and at all levels of the health system –  plays a key role in building this trust, by ensuring that people?s lived experiences, priorities, and barriers to care are heard and reflected in health policies and financing decisions. 

When people know they can access services without catastrophic costs or humiliation, health systems become more people-centered, accountable, and inclusive. Through institutionalization of social participation, communities can identify which services they are delaying or foregoing due to cost, which populations are most affected by out-of-pocket payments, and where financial barriers undermine access to care. Conversely, systems that impose high out-of-pocket costs send a clear message: health is conditional, dependent on ability to pay, and not a right for all. This erosion of trust is particularly harmful for communities already facing exclusion.

Transparent governance, accountability, and inclusive policy processes are central to effective financial protection. To ensure this, governments should embed social participation in their processes to ensure the meaningful engagement of civil society and communities in planning, implementation, and monitoring.

?In most healthcare facilities where costs are high and borne directly by patients, the system becomes stratified: those with resources move through the system quickly, receive comprehensive care, and benefit from respect and attention. Those without resources face delays, limited services, and – too often – avoidable complications.?

Danjuma Adda, Centre for Initiative and Development (CFID), Nigeria 

Financial protection is, ultimately, a commitment to fairness: a guarantee that health systems will treat people with respect, uphold their rights, and ensure that care is safe to seek and affordable to sustain.

II. Stories from the ground: How health costs impact people?s lives

Across contexts, we are seeing the same patterns repeating themselves, regardless of geography or health system model. These stories shared by our AG members show that financial barriers are not abstract, they shape people?s lives in real and often devastating ways.

Delaying care until it is too late

People routinely postpone care because they cannot afford fees for consultations, diagnostics, or medicines. What begins as a manageable health issue can escalate into a life-threatening condition.

In Bangladesh, where out-of-pocket payments account for nearly 70% of total health spending,  among the highest in Asia, unaffordable costs routinely delay care until conditions become catastrophic. People routinely delay care for injuries, reproductive health, mental health, and NCDs, not because services don?t exist, but because transport, diagnostics, medicines, and informal fees are unaffordable. 

?From my work with urban poor and climate-vulnerable communities, I have seen too many young people delay care not because services don?t exist, but because they cannot afford to reach them.  Adolescents, informal workers, and young women are especially affected, until conditions become catastrophic.That is what unaffordable health costs really look like.?,

SM Shaikat, SERAC-Bangladesh

One story shared from Nigeria describes a young teacher who delayed seeking care because of the costs associated with specialist diagnostics and travel. By the time he was able to seek help, his condition had progressed too far. His story is not an exception and  reflects what happens when financial protection fails: treatable illnesses become fatal simply because care is unaffordable.

Similar dynamics are evident in conflict settings. In Ukraine, one woman experiencing severe pain delayed seeking medical attention because her household income was too limited amid displacement and economic instability. When she finally sought care, her condition had worsened, requiring costly surgery – far more expensive than the early testing she could not afford.

?Many of people living in areas of conflict face the same difficult choice today?,

Zahed Islam, Alliance for Public Health (APH), Ukraine

Living without continuity of care

For people living with HIV, hepatitis, TB, or chronic conditions such as hypertension and diabetes, continuity of care is a matter of survival. Yet for many, cost barriers interrupt treatment plans or force people to ration medicines. 

In Argentina, rising costs of diagnostics and medications mean people skip doses or delay follow-up visits. In Ukraine, displacement and loss of income during conflict leave people unable to afford essential medicines, forcing them to make painful trade-offs.

Such interruptions undermine individual health, increase the risk of complications, and erode trust in the system

Exclusion by design: when costs reinforce inequality

Stories from Europe and Eastern Europe and Central Asia (EECA), show how financial barriers intersect with other forms of exclusion.  Women who already face economic marginalization are often unable to afford follow-up physiotherapy, nutritional support, or sexual and reproductive health care not covered by national schemes.

?Financial protection is fundamental to achieving UHC. It helps correct the economic discrimination and injustices that disproportionately affect the poorest people – who are, most often, women. Without financial protection, these communities continue to face structural barriers to health, perpetuating cycles of inequality.?

Flore Ganon, Action contre la Faim, France 

In prisons across Eastern Europe and Central Asia, people are structurally excluded from health services available in the community, and minimal budgets mean that even basic care is out of reach. Without financial protection, these inequities do not simply persist, they widen.

?Prison health care is frequently treated as a leftover priority. When governments face funding choices, people in prisons are excluded, leaving them without access to the same services available in the community.?

Anna Koshikova, Movimiento Euroasiático por el Derecho a la Salud en las Prisiones

Intersectional forms of discrimination amplify the impact of financial hardship, isolating people who already experience stigma.

These stories demonstrate that health costs do not only affect health outcomes. They destabilize every aspect of life, pushing households into poverty and eroding social protection gains.

III. What needs to change: civil society?s calls to action

When leaders prioritize people?s health as a foundation for national development, they lay the groundwork for sustainable progress across all sectors. This UHC Day, let?s remind leaders of what needs to be done to turn commitments into action and make health for all a reality for everyone, everywhere.

We request the governments to introduce laws, budgets, policies and programmes to reduce financial barriers and protect people from financial hardship when accessing essential health services, prioritizing those in the most marginalized and vulnerable situations. In particular, we call on world leaders to:   

  • Make UHC, inclusive of financial protection, a national priority.   
  • Adopt and implement laws to protect people from unaffordable health costs.  
  • Establish a budget for an affordable package of essential health services.  
  • Strengthen publicly funded health schemes to cover costs for the entire population.  
  • Eliminate health costs for those most in need.  
  • Embed social participation at all levels of health decision-making to make everyone?s voice count when shaping our health systems

When governments reduce or eliminate out-of-pocket payments for health services and products and guarantee access to an affordable package of essential health services, education improves as healthy children learn better, equality of women and girls increases, worker absenteeism declines, and health-related poverty decreases. Furthermore, when populations are healthy, economies thrive. 

IV. Join us to amplify UHC calls to action

Join us in calling on leaders to act: send a letter, deliver a statement, or amplify these demands on social media. All resources are available in the UHC Day Toolkit.

Real stories help transform statistics into action. By joining the #HealthCostsHurt campaign and sharing your experience on video, you can help make financial protection a political priority. Across countries, these stories are strengthening civil society advocacy and influencing health financing reforms, essential benefits packages, and legislation aimed at ending financial hardship. More information available here.

If you are a civil society representative and would like to explore more opportunities to engage in UHC advocacy, join the CSEM membership.

Together, let?s raise a unified message to leaders to make health affordable for all!

We call on decision-makers at every level, local, national, regional, and global,  to act with the ambition and courage this moment demands. The commitments made at the last UN High-level meeting in 2023 – with the adoption of the Political Declaration on UHC – and at the World Health Assembly – with the endorsement of the Resolution on strengthening health financing globally (WHA78.12) and thmi Resolution on social participation for universal health coverage, health and well-being (WHA77.2) , must translate into real reforms ahead of the 2027 UN High-Level Meeting on UHC, where countries will again be accountable for progress. Communities cannot wait another cycle for promises to become reality.

At a time of declining overseas development assistance and major shifts in the global health landscape, advancing universal health coverage is the most effective way to promote health equity and ensure that all disease areas benefit, rather than deepening fragmentation and silos.

Civil society will continue to push, mobilize, and hold leaders accountable. But achieving UHC requires collective voices and collective action. 

Together, we can send a message that leaders cannot ignore: Health is a human right – and no should be left behind!

Lean more on the stories shared by our AG members:

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