The World Health Organization's (WHO) guidance to the Middle East and North Africa (MENA) region, alongside post-Arab Spring legal reforms, has prompted many countries to prioritize Universal Health Coverage (UHC). Despite these efforts, progress remains uneven, and reforms have not consistently translated into improved population health outcomes. While global monitoring data reveal wide variation in UHC advancement, academic analysis of the factors behind these differences—particularly across countries with varying performance levels—remains limited. This paper addresses this gap through two objectives: first, to identify general enablers and barriers to UHC and assess the usefulness of these categories; and second, to examine how these factors operate in the MENA context. A scoping review, guided by PRISMA-ScR, was conducted using a six-dimension analytical framework. MENA countries were classified as low, middle, and high UHC performers based on the WHO Service Coverage Index (SCI), with one representative country from each category selected for in-depth review. Findings highlight six dimensions shaping UHC progress—social infrastructure, economic infrastructure, service delivery, governance, health resources, and financing—revealing both shared and context-specific influences. While financial inputs remain critical, strong governance and political commitment are equally essential for advancing coverage, equity, and quality. The study provides a nuanced understanding of UHC implementation in the MENA region and offers actionable guidance for designing context-sensitive and sustainable health reforms. • Although, MENA region is considered homogenous, there are variations across countries' progress on UHC. • Governance serves as the foundational entry point for all other policy dimensions, with political will—expressed through leadership commitment and effective enforcement—acting as a critical driver of UHC progress. • The six-dimensions framework of enablers and barriers should be contextualized.
Mahmoud et al. (Sun,) studied this question.