全民健康覆盖议程的全球发展历程、现状及挑战

The global development history,current status,and challenges of the universal health coverage agenda

全民健康覆盖议程有助于促进居民健康与社会公平,是WHO与各国政府的优先事项。本文就全民健康覆盖议程的基本概念、发展历程、涵盖内容、评价指标、全球进展以及所面临的挑战进行梳理。全民健康覆盖议程在经过半个多世纪的发展后,全球对其定义与内容已形成共识,即认为应从服务人口覆盖比例、医疗卫生服务与经济保护力度3个方面来定义全民健康覆盖;全民健康覆盖议程的实施原则是在资源受限的情况下优先为全民提供健康收益与社会价值较高的医疗卫生服务项目,但WHO与其他国际组织所提出的卫生服务推荐清单与评价框架更倾向于低收入国家,忽略了伤害与精神健康等服务内容,并不适用于所有国家;全民健康覆盖议程各维度间发展不均衡,低收入国家发展严重落后,非传染性疾病与伤害等防控工作进度滞后,低收入群体、弱势群体在服务获取与经济保护方面均处于劣势。建议全球建立一套用于确定高优先级医疗卫生服务的标准方法和流程,各国根据自身需求与能力逐渐扩展卫生服务内容与人口覆盖范围;提高医疗系统资源投入与国际协作,以推动低收入国家卫生系统建设与技术进步;建设高质量的初级卫生服务系统,加强对弱势群体的关注与保护。

The universal health coverage agenda promotes population health and social equity and is a priority for the WHO and governments worldwide.This article outlines the basic concept,development,content,monitoring indicators,global progress,and challenges of the universal health coverage agenda.After over half a century of development,a global consensus has been reached on the definition and content of the universal health coverage agenda which emphasizes coverage proportion of the population,content of healthcare services,and economic protection measures.The implementation principle of the agenda for universal health coverage is to prioritize providing healthcare services of high health benefits and social value to the entire population under resource constraints.However,the healthcare service recommendations and evaluation frameworks proposed by the WHO and other international organizations tend to favor low-income countries,neglecting services related to injury prevention and mental health,and therefore may not be suitable for all countries.The development across various dimensions of the agenda for universal health coverage is uneven,with low-income countries lagging.Progress in the prevention and control of non-communicable diseases and injuries is delayed.Low-income groups and vulnerable populations are at a disadvantage in accessing services and economic protection.It is suggested that a globally applicable set of standards,methods,and processes be used to identify high-priority healthcare services.Countries should gradually expand the scope of healthcare services and population coverage based on their needs and capabilities.Additionally,efforts should be made to increase investment in healthcare system resources and international collaboration to promote the development and technological advancement of healthcare systems in low-income countries.Furthermore,it is also necessary to build a high-quality primary healthcare service system and strengthen protection for vulnerable groups.