Hill Peter S
Australian Centre for International and Tropical Health and Nutrition, University of Queensland, Herston, Australia.
Reprod Health Matters. 2002 Nov;10(20):29-37. doi: 10.1016/s0968-8080(02)00082-4.
Since 1995, sector-wide approaches (SWAps) to health development have significantly influenced health aid to developing countries. SWAps offer guidelines for new partnerships with international donors led by government, new relationships between donors and shared financing, development and implementation of agreed packages of health sector reforms. These structural and funding changes have significant implications for reproductive health. The early experience of SWAps suggests that the extent of donor commitment is constrained for administrative, philosophical and political reasons, with vertical programmes (including those relevant to reproductive health) protecting their 'core' business, and reproductive health, as an integrative concept, lacking strong advocates. Defining the sector in terms of government health systems focuses resources on building effective district health systems, but with uncertain outcomes for elements of reproductive health that depend on multi-sectoral strategies, e.g. safe motherhood. The context of the reforms remains a determining factor in their success, but despite savings available through increased efficiencies and coordinated services, the total per capita expenditure on health to ensure minimum clinical and public health services often remains beyond the budget available to least developed nations. Despite this, many of the elements of SWAps--government leadership, new donor relationships, better coordination, sectoral reform and service integration--offer the potential for more effective and efficient health services, including those for reproductive health.
自1995年以来，卫生发展的全部门办法（SWAps）对向发展中国家提供的卫生援助产生了重大影响。全部门办法为与由政府牵头的国际捐助方建立新伙伴关系、捐助方之间的新关系以及共同供资、制定和实施商定的卫生部门改革一揽子计划提供了指导方针。这些结构和资金方面的变化对生殖健康具有重大影响。全部门办法的早期经验表明，由于行政、理念和政治原因，捐助方的承诺程度受到限制，垂直项目（包括与生殖健康相关的项目）保护其“核心”业务，而作为一个综合概念的生殖健康缺乏有力的倡导者。以政府卫生系统来界定部门，会将资源集中用于建设有效的地区卫生系统，但对于依赖多部门战略的生殖健康要素（如安全孕产）而言，其结果并不确定。改革的背景仍然是其成功的决定性因素，但是尽管通过提高效率和协调服务可以节省资金，但为确保最低限度的临床和公共卫生服务而进行的人均卫生总支出往往仍超出最不发达国家的可用预算。尽管如此，全部门办法的许多要素——政府领导、新的捐助方关系、更好的协调、部门改革和服务整合——为提供更有效和高效的卫生服务（包括生殖健康服务）提供了潜力。
