Health systems around the world share common goals, but attainment is widely variable. Universal Health Coverage (UHC) has emerged as a consolidated response to bridge the gap between what a health system should be doing and what it does. Drawing from global best evidence, this chapter explores how countries in practice could translate and achieve UHC, focusing on two central questions: What services and policies should be covered and be implemented; and second, how can health financing meet the UHC requirements? These include both health sector as well as intersectoral policies and interventions prioritized in the DCP3 package. The health sector interventions are distributed across four clusters – age-related, non-communicable disease and injury, Infectious diseases, and health services. The intersectoral interventions and policies fall under four domains – fiscal, regulatory, information and education, and built environment. The second question looks at the key challenges of country-level implementation capacity. It concludes by drawing out generalizable themes of country responses to the UHC Sustainable Development Goal targets to inform the way forward.

The Chapter describes the status of health financing in low- and middle-income countries (L&MICs) and their health financing transition over the past two decades. Advancing Universal Health Coverage (UHC) requires an expansion of coverage over three dimensions: (i) health care benefits, (ii) population coverage, and (iii) cost coverage using prepaid/pooled funds. As national incomes rise, countries undergo a health financing transition, increasing total levels of health expenditure while increasing the publicly financed share of health spending and reducing the external- and OOP-financed share of spending. Two pro-poor paths are common for the expansion of health coverage. Many countries implement health insurance schemes for the poor. Others expand platforms of public providers that are mostly used by the poor, often focusing on community and primary care services. Countries choosing the pro-poor health insurance path develop targeting and enrolment instruments. Targeting tends to be stricter with social security purchasers, compared with ministerial purchasers. Fragmented systems, while suboptimal, can sometimes be more pro-poor than integrated systems.