A Transparent Universal Health Coverage Index with Decomposition by Socioeconomic Groups: Application in Asian and African Settings



Health and wellbeing as one of the Sustainable Development Goals requires all countries to achieve Universal Health Coverage (UHC). That is, all people must have access to healthcare when needed at an affordable price. While several indices were developed recently to assess UHC status, these indices appeared to be difficult for practitioners to apply without statistical knowledge.


This paper presents a transparent and step-by-step practical calculation method of such an index using Excel spreadsheets, applied to some Asian and African countries. We also decompose the contribution of socioeconomic groups to UHC index values.


We utilized the well known UHC illustration (three-dimensional box, showing population coverage, service coverage and financial protection) to calculate the UHC index. We also broke down the index into socioeconomic groups. For validation, correlation coefficients between our index and other UHC indices were calculated and the relationship of our index with out-of-pocket (OOP) payments was estimated.


World Bank data from six Asian and 15 African countries on health-service coverage of people in five socioeconomic quintiles with financial protection were used to calculate our UHC index. Among the Asian countries, indices ranged between 26.0% (Nepal) and 58.7% (Kazakhstan), while in African countries indices ranged between 8.9% (Chad) and 55.3% (Namibia). Decomposition of the UHC index showed a higher contribution to the index by richer socioeconomic groups. The correlation coefficients between our estimated UHC index values and those of others ranged between 0.774 and 0.900. Our index reduced by 1.4% in response to a 1% increase in OOP payments.


This spreadsheet approach for calculating the UHC index appeared to be useful, where the interrelation of UHC dimensions was easily observed. Decomposition of the index could be useful for policy-makers to identify the subpopulations and health services with need for further interventions towards UHC achievement.

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  1. 1.

    Mathematical expression for technical readers:

    $${\text{UHC}}\;{\text{Index}} = \left\{ {\left( {\mathop \sum \limits_{i}^{{}} \mathop \sum \limits_{j}^{{}} U_{j}^{i} \times FR_{j}^{i} } \right) \div \left( {\mathop \sum \limits_{i}^{{}} \mathop \sum \limits_{j}^{{}} FU \times NFR } \right)} \right\} \times 100$$

    \(U_{j}^{i}\) is the Utilization rate of health service i in socioeconomic quintile j, \(FR_{j}^{i}\) is the proportion of population (range between 0 and 1) who faced financial risk (hardship) for utilizing any health service, \(FU_{{}}^{{}}\) is the full utilization of health service i in the socioeconomic quintile j and \(NFR\) is the no financial risk faced by any people (value 1).


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We are grateful to Mohammad Wahid Ahmed of icddr,b for organizing the dataset for analysis. We express our gratitude to the reviewers and editor of the journal for their valuable comments for improvement of the paper.

Author information




JK generated the idea, developed the methods and analytical techniques, identified data requirements, analysed data, interpreted results and wrote the first draft of the manuscript. SA identified relevant literature and data, analysed data and interpreted results. TC specified models for statistical inference tests and interpreted the results in the context of Universal Health Coverage. ET contributed to the concept and to quantifying the index values, interpreted the results and revised the manuscript. LN contributed to the development of the concept, interpreted the results and put the study into the context of Universal Health Coverage and Sustainable Development Goals. All authors contributed to writing the manuscript, responded to reviewers’ comments and approved the final version of the manuscript.

Corresponding author

Correspondence to Jahangir A. M. Khan.

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This research was not funded by any organization.

Data availability statement

Data used in this study are available for the readers of the journal as supplementary data in an Excel file.

Conflict of interest

None of the authors (Jahangir A.M. Khan, Sayem Ahmed, Tao Chen, Ewan M. Tomeny and Louis W. Niessen) have any conflicts of interest related to this article. This article used only publicly available secondary data and consequently was not subject to ethical approval.

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Khan, J.A.M., Ahmed, S., Chen, T. et al. A Transparent Universal Health Coverage Index with Decomposition by Socioeconomic Groups: Application in Asian and African Settings. Appl Health Econ Health Policy 17, 399–410 (2019). https://doi.org/10.1007/s40258-019-00464-9

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