Trend analysis and modelling of universal health coverage, Ethiopia.

Objective: To investigate the attainability of the 2030 universal health coverage (UHC) target of 80% using Ethiopia as a case study. Methods: We examined trends in Ethiopia's universal health service coverage index and its subindices between 2000 and 2021 in Ethiopia. To assess long-term progress, we projected coverage to 2030 and 2040 using Bayesian models. Simulation models evaluated the effect of expanding health system inputs, including service capacity and funding, on UHC. Findings: Ethiopia's universal health service coverage index increased steadily from 2000 to 2015 and slowed between 2015 and 2019 before progress stalled between 2019 and 2021. Projections indicate the country will achieve a UHC index of 64.7% by 2030, failing to meet the 80% target. Projected subindex values for 2030 were 68.4% for reproductive, maternal, neonatal and child health and 66.1% for infectious diseases but only 58.5% for noncommunicable diseases. Simulation modelling indicated that doubling health system inputs would only modestly increase UHC and that the 80% target is unlikely to be reached before 2040. Conclusion: The trajectory of UHC in Ethiopia reflects both achievements and persistent gaps in health services. Modelling suggests that boosting health system inputs alone will be insufficient to reach the 80% coverage target by 2030. Structural reforms, better governance and greater system integration are required. The modelling framework used could help other countries assess progress and design context-specific, equitable pathways towards UHC.