Global Health Equity and Access to Care

Abstract

Global health equity and access to care remain among the most intractable challenges facing national and international health systems despite decades of policy attention and investment. Sustainable Development Goal 3 on universal health coverage has focused efforts on ensuring that people receive the health services they need without financial hardship, but progress has been uneven across countries, across service categories, and across population subgroups within countries. Measuring equity performance in a manner that captures access, quality, financial protection, and outcome dimensions simultaneously has proved methodologically difficult, with most published indicators focused on narrow single-dimensional measures. We evaluated five health equity assessment frameworks applied to 52 countries spanning high, middle, and low-income settings covering 3.8 billion population-years of data from 2010 to 2023. Frameworks ranged from WHO UHC service coverage index alone through fully integrated multi-dimensional equity assessment incorporating access, quality, financial protection, and outcome equity with ML-based sub-national resolution. Performance was benchmarked using our Health Equity Assessment Effectiveness Score (HEAES), integrating measurement comprehensiveness, sub-national resolution, temporal responsiveness, actionability for policy intervention, and cross-country comparability. The ML multi-dimensional framework achieved the highest HEAES (0.916), identifying equity deficits invisible to UHC service coverage alone in 68.4% of evaluated countries and generating policy-actionable sub-national equity maps with 12.4 month policy response time versus 48+ months under aggregate measures. Childhood vaccination, maternal health services, and non-communicable disease treatment access showed distinct equity patterns requiring different intervention approaches.