Associations between the universal health coverage service coverage index and the human development index: A country-level longitudinal panel study

Universal health coverage (UHC) and human development are closely linked, but whether this relationship differs across UHC domains remains unclear. We conducted a retrospective country-level longitudinal panel study using publicly available data from 2000 to 2021 to examine associations of the UHC service coverage index (SCI) and its four sub-indices with the Human Development Index (HDI) and its component indices for gross national income (GNI), education, and life expectancy. We also quantified differences in the UHC SCI, its sub-indices, and the HDI across World Bank income groups and World Health Organization regions using population-averaged generalized estimating equation models. UHC service coverage improved over time across income groups and regions, but progress was uneven. Persistent income-group disparities were observed for the overall UHC SCI, infectious diseases (IDs), service capacity and access (SCA), and the HDI, whereas disparities were smaller for reproductive, maternal, newborn, and child health (RMNCH) and less pronounced for noncommunicable diseases (NCDs). After covariate adjustment, regional differences were generally smaller than income-group disparities; RMNCH showed little regional variation, whereas SCA remained significantly lower in the African Region. Higher HDI was associated with better UHC performance, with adjusted increases of 6.8 points (95% CI 5.6-8.1) for the UHC SCI, 11.7 (95% CI 9.2-14.1) for SCA, 6.2 (95% CI 4.2-8.1) for ID, and 4.9 (95% CI 3.2-6.7) for RMNCH per 0.1-unit increase, whereas the increase for NCD was smaller (2.2 points, 95% CI 0.4-4.0). Among HDI components, the education index was not associated with NCD after adjustment, whereas the GNI and life expectancy indices were positively associated with NCD, although the estimated increases were smaller than those for most other sub-indices. These findings may help policymakers interpret the UHC SCI and its sub-indices in the context of their countries' broader development trajectories.