Background Regular and timely measurement provides the basis for evaluating how effectively health systems are advancing toward universal health coverage (UHC). In Ethiopia, comprehensive and recent assessments that measure UHC progress across both national and subnational levels remain limited. This study aims to estimate Ethiopia’s UHC Service Coverage Index for 2024 at national and regional levels and identify regional disparities. Methods UHC service coverage was estimated using WHO’s UHC measurement framework. The UHC Service Coverage Index (SCI) was computed using standard 14 tracer indicators, categorized into four domains consistent with global UHC monitoring framework. Data from 2024 national surveys and administrative sources were used. Estimation of the UHC SCI was computed from geometric mean of tracer indicators. Sub-national analysis was done to determine regional disparity in UHC progress Results The overall UHC SCI for Ethiopia in 2024 was 44%, substantially far from Ethiopia’s target of 58% by 2026 and global target of 80% by 2030. It ranges from 23% in Somali region to 64% in Addis Ababa. By domain, the national UHC SCI for infectious diseases was 66%, ranging from25% in Somali to 71% in Dire Dawa. Reproductive, maternal, neonatal and child health (RMNCH) domain scored 53%, ranging from 17% in Somali to 78% in Addis Ababa. The national service capacity and access domain scored 39%, and the non-communicable diseases (NCDs) scored the lowest at 27%. Conclusion The UHC SCI of Ethiopia was found to be low in 2024 and highlights both progress and critical gaps in the delivery of essential health services. The overall and domain specific UHC SCI scores differs at sub-national levels. Ethiopia has achieved progress in infectious disease control and RMNCH, but significant gaps persist in NCDs and service capacity and access. The low performance in NCDs, along with capacity challenges such as limited health workforce density and uneven facility readiness constrains the country’s journey toward equitable and comprehensive health coverage. There are substantial regional disparities, urban administrative areas demonstrating markedly higher service coverage compared to rural settings. Addressing these inequities will require integrated and context-specific strategies that simultaneously strengthen health system capacity, improve geographic access, expand NCD management, and address underlying socioeconomic and cultural barriers.