全民健康，全民健康：优化服务提供，初级卫生保健和全民健康覆盖的驱动力

BackgroundUniversal health coverage (UHC) is vitalfor ensuring that everyone can achievetheir highest attainable standard of health,contributing to stronger economies, healthiersocieties and a more equitable world. At thecore of UHC is the commitment to ensuring thathealth services are accessible, affordable, safe,effective, and centred around people’s needs.Improving how services are designed,delivered, and measured is critical to placingquality at the heart of UHC, providing the full range of care—from prevention to palliativeservices, removing barriers to access andreaching marginalized populations. Thismeans a shift is needed from health systemsdesigned around diseases and institutions tohealth systems designed by people, for people.By reimagining health services provision,health outcomes and trust in health systemsimprove, gender equality, human rights, andhealth equity advance, and resilient heathsystems are built. Global targets and current progressIn the past five years (2019-2023), an estimated477 million additional people have beencovered by essential health services withoutexperiencing financial hardship(1). However,progress has stalled. More than half the world’spopulation is still not covered by essentialhealth services and, when accessible, poor-quality care puts patients and health and careworkers at risk, erodes people’s trust and comesat an unbearable cost (Box 1).Improving access to quality health servicesis, therefore, not just a moral imperative, it isa strategic necessity for achieving UHC andfostering healthier, more prosperous societies.Recognizing this, the World Health Assembly (WHA)has consistently prioritized quality of care andpatient safety, with most resolutions since 2002addressing these issues. In 2019, the UN High-LevelDeclaration identified primary health care (PHC) asthe most inclusive, equitable and efficient approachto achieving UHC(2). PHC prioritizes primary care asthe first point of contact, integrates services aroundpeople’s needs, and ensures continuity of care.In 2020, the Assembly called on WHO MemberStates to adopt PHC-oriented models of careto strengthen health systems and accelerateprogress toward UHC.Global strategies and action plans (Box2) provide countries with clear policy andimplementation pathways to reorient andstrengthen health services and systems.477millionmore people have been covered by essentialhealth services in the past five years (2019-2023) Box 1Key facts and figuresThe proportion of the global population not covered byessential health services decreased by about 15% between2000 and 2021, though with only limited progress madefrom 2015 onwards. This indicates that in 2021, about 4.5billion people (ranging from approximately 14–87% of thepopulation at the country level) were not fully covered byessential health services(1). Moreover, since 2000, financialhardship resulting from accessing health services hascontinuously increased, with an estimated 2 billion peopleexperiencing catastrophic health spending, impoverishinghealth spending or both(1).The lack of access to health services and unmet healthcare needs among older persons is concerning. Incountries where rapid population ageing is projected overthe coming decades, alongside the rise of concurrentchronic conditions, most health systems are not preparedto manage multimorbidity Survey data show that themedian percent of adults aged 60+ reporting unmethealth care needs is nearly 40% in lower-middle-incomecountries, compared to 20% in upper-middle incomecountries and under 5% in high-income countries(1).Barriers to accessing health services exist in all countries,often exacerbating existing inequalities. Using householdsurvey data from low- and middle-income countries, themost commonly cited barriers to accessing services amongwomen aged 15–49 were the distance to a health facility(45% in rural versus 19% in urban areas), getting moneyfor treatment (66% from the poorest wealth quintile versusUkraine: 11-month-old Jasmin with congential heart condition. © WHO 29% from the richest), and permission to go for treatment(20% of women with no education versus 8% of womenwith at least some higher education)(1).Between 5.7 and 8.4 million deaths are attributed topoor quality care each year in low- and middle-incomecountries. High-quality health systems could prevent2.5 million deaths from cardiovascular disease, 900 000deaths from tuberculosis, 1 million newborn deathsand half of all maternal deaths each year(3). It is alsoestimated that in OECD countries, approximately 15%of hospital expenditure can be attributed to treatingpatient safety failures(4).Health care-associated infections (HAIs) are among themost frequent adverse events occurring in the contextof health service delivery. In acute care facilities in theEuropean Union and European Economic Area, HAIs affect8% of patients, on average. HAI frequency is significantlyhigher in low- and middle-income than in high-incomecountries, ranging from