HIV and Hepatitis Department, World Health Organization, Geneva, Switzerland.
Curr Opin HIV AIDS. 2019 Sep;14(5):433-438. doi: 10.1097/COH.0000000000000570.
There is renewed focus at global and national level to adopt commitments to ensure universal access to health services. The present study highlights key considerations to ensure that the commitment to 'leave no one behind' includes key populations, recognizing the specific impact of marginalization, stigma, discrimination, and criminalization on their access to health.
Universal health coverage (UHC) means that all people can use the promotive, preventive, curative, rehabilitative, and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. Countries commit to UHC through Sustainable Development Goals (SDG Target 3.8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to well tolerated, effective, quality, and affordable essential medicines).
UHC cannot be achieved without addressing the needs of key populations. At the same time, the goal of UHC provides new opportunities to improve health equity and the health of key populations. Political commitment, defining and including essential high-impact, evidence-based interventions for key populations, and their full integration into national health benefit packages; integrated, decentralized, and differentiated health services with involvement, ownership, and acceptance of communities to ensure equity and quality; ensuring financing for UHC provides coverage for key populations, including those who may be undocumented, are needed. Developing more effective interventions and service delivery approaches, providing a supportive policy and legal environment; and measuring progress against clear targets for accountability and programme adjustment will also be required for key populations to benefit fully from UHC.
综述目的：全球和国家层面重新关注对确保普遍获得卫生服务的承诺。本研究强调了确保“不让任何人掉队”承诺包括重点人群的关键考虑因素，认识到边缘化、耻辱、歧视和刑事定罪对其获得卫生服务的具体影响。
最近的发现：全民健康覆盖意味着所有人都可以使用足够质量的促进、预防、治疗、康复和姑息治疗服务，这些服务是有效的，同时也确保使用这些服务不会使使用者陷入经济困难。各国通过可持续发展目标（SDG 目标 3.8 实现全民健康覆盖，包括财务风险保护、获得优质基本医疗服务以及获得耐受良好、有效、优质和负担得起的基本药物）承诺实现全民健康覆盖。
总结：不解决重点人群的需求，就无法实现全民健康覆盖。与此同时，全民健康覆盖的目标为改善重点人群的健康公平和重点人群的健康状况提供了新的机会。政治承诺、确定和纳入针对重点人群的基本高影响力、循证干预措施，并将其充分纳入国家健康福利计划；综合、分散和差异化的卫生服务，让社区参与、拥有和接受，以确保公平和质量；确保全民健康覆盖的资金覆盖重点人群，包括那些可能没有证件、被忽视的人群，这些都是必要的。还需要制定更有效的干预措施和服务提供方法，提供支持性的政策和法律环境；并针对明确的目标进行衡量，以确保问责制和方案调整，使重点人群能够从全民健康覆盖中充分受益。
