A/71/304 universal health coverage, even while some of their most vulnerable subgroups are left with health care that is abusive, coercive and/or of poor quality. 38 77. The prioritization and participation of the world’s most vulnerable is vital to both defining and achieving equitable universal health coverage. This is also consistent with core obligations under the right to health to guarantee access to health services without discrimination and to take deliberate, targeted and concrete steps to ensure the effective realization of that guarantee, especially for the most marginalized. 39 Likewise, States have a core obligation to ensure effective and meaningful participation in the development of national health plans, including strategies for universal health coverage, that at the very minimum ensures that the views of the poor and most marginalized are incorporated. If the furthest behind are not prioritized and progressive strategies for expa nding coverage for the most marginalized are not immediately established with their active participation, there is a real risk that the target could go unmet by 2030. Towards a rights-based universal health coverage 78. The Special Rapporteur wishes to emphasize that universal health coverage must be understood as consistent with the right to health. While some components of targets 3.7 and 3.8, namely universal coverage, financial risk protection, access to quality essential health-care services, access to safe, effective, quality and affordable essential medicines and vaccines, and universal access to sexual and reproductive health-care services, can be read as consistent with the right to health, 40 they obscure vital right-to-health standards. 79. Universal health coverage cannot be achieved without meeting the core requirements of availability, accessibility, acceptability and quality under the right to health. Among other things, services must be safely and geographically accessible without discrimination. The right to health requires that essential services include those for populations with specialized needs, such as sexual and reproductive health services adapted to the needs of women, girls, including those with disabilities, and transgender persons. Health services and access to underlying determinants must also be economically accessible. Even where there is widespread access to health services, the right to health demands that they be of sufficient quality, including in good working condition and medically and scientifically appropriate. 80. The right to health also requires that progress towards universal health coverage be monitored to assess who is covered, what services are covered, and the extent of financial protection, with data disaggregated to measure progress across sectors and groups. Focusing on coverage averages (indicator 3.8.1) without disaggregating data can mask exclusion, especially of those most marginalized. Using insurance coverage as a proxy indicator for financial protection (indicator 3.8.2) fails to address the impoverishing impact of health expenditures. 41 __________________ 38 39 40 41 16-13597 Oxfam International, Universal Health Coverage: Why Health Insurance Schemes Are Leaving the Poor Behind, Briefing Paper, No. 176 (Oxford, 2013). Committee on Economic, Social and Cultural Rights, general comment No. 20. Committee on Economic, Social and Cultural Rights, general comment No. 14, paras. 43 -44, and general comment No. 22, para. 49 (c), (e) and (f). Audrey R. Chapman, “The problems with the proposed indicators for monitoring universal health coverage in the Sustainable Development Goals”, Health and Human Rights Journal, blog, 17 March 2016. 19/26