Most low-and middle-income countries are lagging behind in achieving the 2030 Health Sustainable Development Goals (SDGs), including the one that specifically concerns universal health coverage (UHC; SDG indicator 3.8.1). The universal health coverage index, which rose sharply between 2000 and 2021, from 45 to 68, is now in a plateau or very low-growth phase in many countries, while some 4.5 billion people are not adequately covered by essential health services.