The role of universal health coverage in overcoming the covid-19 pandemic

Amirhossein Takian, Mohsen Aarabi and Hajar Haghighi analyse covid-19’s effect on the global economy and what it means for the sustainable development agenda and universal health coverage 

The dramatic impact of covid-19 is a pertinent reminder for all countries, regardless of their income, of the need to renew political commitment to improving health as a central component of the sustainable development goals (SDGs) agenda.

The World Health Organization views universal health coverage (UHC) as key to ensuring health and wellbeing for all people of all ages and made it the fundamental objective for all countries for attaining equitable and sustainable health outcomes.1 UHC requires health system strengthening around people, institutions, and resources to build resilience.2 A resilient health system is able to provide a timely response to emergencies through detection and prevention, while maintaining peace and protecting the economy. 

The covid-19 pandemic is illustrating, albeit on a much larger stage, the lessons learned from past outbreaks; that resilience is an essential and cost-effective feature of a health system addressing complex challenges. Those countries with effective universal health coverage, such as South Korea3 and Singapore,4 have performed better during the covid-19 pandemic.

The impact of both natural and manmade disasters is exacerbated by weak health systems,5 and covid-19 has overwhelmed the health systems of affected countries, including some of the world’s wealthiest nations.6 It has put the spotlight on inadequate health security and preparedness, including inadequate healthcare facilities and resources such as shortages of hospital beds, medicines, ventilators and healthcare workforce.7

The pandemic is burning out national health systems in countries that have strived to provide UHC, hampering their pathways and ambitions to achieve the ethos of universal health coverage which is “to leave no one behind.” But the countries most affected by the pandemic are the ones that have done little in the past to strengthen their health system through appropriate investment in universal health coverage, such as the United States. 

Iran is facing a unique paradox. It has transformed its health system to reach universal health coverage,8 insured more than 90% of its 83 million population, has a well-established primary healthcare network, and increased access to quality care and comprehensive programmes for prevention and control of non-communicable diseases.9 And yet, Iran is the most affected Asian nation from covid-19, after China.10 This is due not only to shortcomings in integrating emergency and preparedness response into primary health care, but also to US sanctions hampering investment in and access to medicines and essential equipment.11

As the global coordinator of the current pandemic, WHO should, now more than ever, strengthen its mission to promote health, keep the world safe and serve the vulnerable, through advocating universal health coverage among its member states. Specific treatments and a vaccine for covid-19 seem at least one year away,12 and in a few months the task will become much more complex when the flu hits and many nations face  “Covi-Flu”, having to deal with the impact of seasonal influenza at the same time as the consequences of the covid-19 crisis. 

Strengthening communities with surveillance systems built into primary health care; providing extra financial resources; expanding insurance coverage; increasing public awareness; ensuring sufficient medicines, diagnostics and equipment are available; and recruiting more healthcare staff are the essential steps towards universal health coverage needed in many countries over the next few months to prepare for Covi-Flu. Most importantly better governmental stewardship for creating strong and resilient health systems is required, a whole-of-government approach that must target all social determinants of health, and emergency investment in healthcare research and innovation.

We are all in this together and need to act now. The dangers of “Covi-Flu” to the global economy and sustainable development is closer and more devastating than it might look. 

Amirhossein Takian is associate dean, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.

Mohsen Aarabi is faculty of Department of Family Medicine, Mazandaran University of Medical Sciences, Sari, Iran.

Hajar Haghighi is a PhD Candidate in health policy, Department of Health Economics and Management, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 

Competing interests: none.


  1. World-Health-Organization. Thirteenth general programme of work 2019−2023; 2018 [cited 2020 Apr 2]. Available from:—2023.
  2. Ghebreyesus T-A. Healthcare for all: every country can do it—an essay by Tedros Adhanom Ghebreyesus. BMJ. 2019;367
  3. Reuters. South Korea’s emergency exercise in December facilitated coronavirus testing, containment; 29 March 2020 [cited 2020 Apr 1]. Available from:
  4. Ng Y, Li Z, Chua Y-X, Chaw W-L, Zhao Z, Er B, et al. Evaluation of the effectiveness of surveillance and containment measures for the first 100 patients with COVID-19 in Singapore–January 2–February 29, 2020. 2020.
  5. Organization PAH. Resilient health systems CE158/14. In: One hundred fifty-eighth session of the Executive Committee, Washington, 20-24 June 2016. Washington, 2016 [cited 2020 Apr 1]. Available from:
  6. Horton R. Offline: COVID-19 and the NHS—“a national scandal”. The Lancet. 2020;395(10229):1022.
  7. World-Health-Organization. Critical preparedness, readiness and response actions for COVID-19; 19 March 2020 [cited 2020 Apr 2]. Available from:
  8. Doshmangir L, Bazyar M, Majdzadeh R, Takian A. So Near, so far: four decades of health policy reforms in Iran, achievements and challenges. Archives of Iranian medicine. 2019;22(10):592.
  9. ix Bakhtiari A, Takian A, Majdzadeh R, Haghdoost A-A. Assessment and prioritization of the WHO “best buys” and other recommended interventions for the prevention and control of non-communicable diseases in Iran. BMC Public Health. 2020;20(1):1-16.
  10. x Raoofi A, Takian A, Akbari Sari A, Olyaeemanesh A, Haghighi H, Aarabi M. COVID-19 pandemic and comparative health policy learning in Iran. Archives of Iranian Medicine. 2020;23(4):220–234. doi: 10.34172/aim.2020.02. 
  11. Takian A, Raoofi A, Kazempour-Ardebili S. COVID-19 battle during the toughest sanctions against Iran. The Lancet. 2020.
  12. TED-Talks. Bill Gates: How we must respond to the COVID-19 pandemic; 25 march 2020 [cited 2020 Apr 1].Available from: