Objective Universal health coverage (UHC) is about ensuring that people have access to the health care they need without suffering financial hardship (WHO, 2021). With rising noncommunicable disease burdens, low-income countries are increasingly challenged to close the gap between demand for health spending and available public resources. The aim of the study is to assess the challenges of attaining UHC in low-income countries.

Methods The paper has followed an integrative review of the literature an approach which summarize empirical literature to provide a more comprehensive understanding of a healthcare problem (Whittemore & Knafl, 2005). A search strategy was developed and a search in Scopus, ScienceDirect, CINAHL, PubMed databases yielded 247 documents from the year 2011 to 2021 covering a full 10-year period. 66 duplicates and irrelevant articles were removed and 181 articles were considered for abstract review. 128 articles were not related to UHC. Only 53 were analysed thematically.

Results There are financial aspects related to heavy underfunding of the health care system in low income countries. There are significant gaps in countries’ health systems and populations. For every 1,000 people in Malawi, there are .019 physicians and .283 nurses and midwives against the recommended 2.5 physicians per 1,000 people by WHO. Funders’ priorities are at odds with what is required on the ground. UHC policies are poorly developed and implemented as they are engulfed in poor governance. Management, leadership, and organizational culture are all interconnected issues that affect UHC.

Conclusions and Implications UHC in the sub Saharan Africa faces multiple challenges. By implications, establishing UHC is dependent on improving infrastructure, training the healthcare workforce, expanding and improving existing healthcare facilities, developing information services, and ensuring the supply of medicines and medical technologies.