The availability and accessibility of health insurance is an important factor that determines the decision to seek care. In many African countries, there are inequalities in health, which are marked more so between the privileged and under privileged. Health insurance schemes have alleviated the burden to some degree, but those who are not able to afford the premiums find themselves being covered for basic services only. Paying out of pocket places financial stresses on individuals and families. Women and children under-5 years old are the most affected group, especially when women do not have the autonomy over their health choices.

Universal Health Coverage (UHC) means that everyone has access to health services, whether preventive, treatment, rehabilitative or palliative, and regardless of his or her financial status. UHC denotes that the quality of services delivered is good enough to improve the health outcomes of those who seek them, and the health staff is equipped with the skills.

UHC protects people from poverty caused by the costs of unexpected disease burdens. There is a need to focus on the quality and reach of maternal and child health services to achieve UHC. The WHO has outlined indicators to monitor the coverage of maternal and child health services for countries as they strive for UHC. These are: family planning, antenatal and delivery care, full child immunization, and health-seeking behavior for pneumonia.

Women and children who do not have access to services are placed in a disadvantaged position and most likely to suffer the consequences of illness. Pregnancy and childbirth complications are among the leading causes of death in women in low-income countries. Inequalities contribute to the delay of the decision to seek care, and the delay of reaching a health facility.

As low-income countries move towards UHC, a special focus should be put on maternal, newborn and child health. Countries can move forward by strengthening health systems, specifically primary health care, addressing socioeconomic barriers and providing social protection such as maternity and childhood coverage. Health financing is an integral component of quality care, and health staff, as frontlines should be prioritized in underserved communities. Marginalized groups such as women and children with disabilities need social protection and policies in place for their unique needs. As outlined by the WHO, monitoring progress towards UHC ought to focus on: the proportion of a population that can access essential quality health services (SDG 3.81), and the proportion of the population that spends a large amount of household income on health (SDG 3.8.2).