Johns Benjamin, Sigurbjörnsdóttir Kristjana, Fogstad Helga, Zupan Jelka, Mathai Matthews, Tan-Torres Edejer Tessa
World Health Organization, Jakarta, Indonesia.
Bull World Health Organ. 2007 Apr;85(4):256-63. doi: 10.2471/blt.06.032037.
To estimate the amount of additional resources needed to scale up maternal and newborn health services within the context of the Millennium Development Goals, and to inform countries, donors and multilateral agencies about the resources needed to achieve these goals.
A costing model based on WHOs clinical guidelines was used to estimate the incremental resource needs for maternal and newborn health care in 75 countries. The model estimated the costs for care during pregnancy, childbirth, the neonatal period and the postpartum period, as well as the costs for postpartum family planning and counselling, abortion and post-abortion care; programme-level costs were also estimated. An ingredients-based approach, with financial costs for the years 2006 to 2015 as the output, allowed estimates to be made of country-specific and year-specific populations, unit costs and scale-up rates. Two scenarios using different scale-up rates were used (moderate and rapid).
The results show that a minimum yearly average increase in resources of US$ 3.9 billion is needed, although annual costs increase over the time period of the model. When more rapid rates of scale-up are assumed, this minimum figure may be as high as US$ 5.6 billion per year. The 10-year estimated incremental costs range from US$ 39.3 billion for a moderate scale-up scenario to US$ 55.7 billion for the rapid scale-up scenario.
These projections of future financial costs may be used as a starting point for mobilizing global resources. Countries will have to further refine these estimates, but these figures may serve as goals towards which donors can direct their plans. Further research is needed to measure the costs of health system reforms, such as recruiting, training and retaining a sufficient number of personnel.
在千年发展目标背景下，估算扩大孕产妇和新生儿保健服务所需的额外资源数量，并告知各国、捐助方和多边机构实现这些目标所需的资源。
采用基于世界卫生组织临床指南的成本核算模型，估算75个国家孕产妇和新生儿保健的增量资源需求。该模型估算了孕期、分娩期、新生儿期和产后护理的成本，以及产后计划生育和咨询、堕胎及堕胎后护理的成本；还估算了项目层面的成本。采用基于构成要素的方法，以2006年至2015年的财务成本为产出，能够对特定国家和特定年份的人口、单位成本及扩大规模率进行估算。使用了两种不同扩大规模率的情景（适度和快速）。
结果显示，每年至少需要平均增加39亿美元的资源，不过在模型所涉时间段内年度成本会增加。若假设扩大规模的速度更快，这一最低数字可能高达每年56亿美元。10年的估计增量成本范围从适度扩大规模情景下的393亿美元到快速扩大规模情景下的557亿美元。
这些对未来财务成本的预测可作为调动全球资源的起点。各国将必须进一步完善这些估算，但这些数字可作为目标，供捐助方据此制定其计划。需要开展进一步研究，以衡量卫生系统改革的成本，比如招聘、培训和留住足够数量人员的成本。
