A/79/177 affordable essential medicines and vaccines for all. 205 Models for universal health coverage must ensure that all people and communities have access to the health services that they need, that care is of sufficient quality to be effective, and that the use of services does not expose the user to financial hard ship. 206 In line with the principle of leaving no one behind, harm reduction services within models for universal health coverage are a key way to help ensure that many groups who are pushed to the fringes of society are not left behind. 95. Comprehensive harm reduction programmes and services within models for universal health coverage occur in primary care settings where people receive other health-care services. For people who use drugs, this would include services such as needle and syringe programmes, opioid agonist therapy, drug consumption rooms and supervised injection facilities, drug checking, and overdose prevention and reversal. 207 Currently, only 23 countries provide comprehensive tobacco cessation services that are fully or partially covered under public health services, representing less than a third of the world’s population. 208 96. Criminalization can pose several barriers to universal health coverage. Where such coverage is employment-based or provided through the private sector, a number of challenges arise for marginalized communities such as sex workers, who are kept outside the formal economy. 209 Where enrolment in health coverage, or receiving services, requires providing information such as a permanent address, personal information and other disclosures, confidentiality concerns can drive a person to forgo care for fear of repercussions. 210 97. The Special Rapporteur supports models for universal health coverage that extend beyond health care programmes and services to encompass the social determinants of health, such as housing, employment and education – basic needs that should be accessible and of quality without driving people to financial hardship. Legal and political environments that allow for a criminal record, serve as a barrier to accessing the social determinants of health and are antagonistic to comprehensive coverage. 98. The world remains off track for achieving the universal health coverage envisioned in target 3.8 by 2030. 211 A lack of dedicated domestic financing, along with reluctance to direct funds towards criminalized and stigmatized groups, leaves a large gap in financing for harm reduction services that is often filled only through international assistance. 212 States need to scale up efforts to set appropriate spending targets on health services, including for harm reduction. 213 __________________ 205 206 207 208 209 210 211 212 213 22/28 See www.who.int/data/gho/data/themes/theme-details/GHO/universal-health-coverage. Ibid. See A/HRC/56/52. See www.who.int/activities/quitting-tobacco. International Network of People Who Use Drugs, “What does universal health coverage mean for people who use drugs: a technical brief”, 2019. Ibid. WHO, “Universal health coverage (UHC)”, 5 October 2023. Submission from Drug Free America Foundation. Ibid. 24-13226