Ensuring healthy lives and promoting well-being at all ages is essential to sustainable development. As the Covid-19 crisis illustrates all too vividly, not only is health important in itself, but healthy people are better able to learn, be productive and contribute to their communities. Achieving universal health coverage (UHC) is critical to this and essential to ensuring that no one is ‘left behind’ in accessing quality health services because of who they are, where they live or their socio-economic situation.  

Using ODI research on access to health for left-behind groups and contemporary case studies on moves towards UHC in low- and middle-income countries, we discuss the constraints, enabling factors and strategies used in the roll-out of UHC, as well innovative approaches and interventions to reach left-behind groups and achieve UHC in a progressively universal manner. We will also incorporate reflections on how the current Covid-19 outbreak is highlighting the need for universality, and how it might help or hinder progress towards UHC.