Stenberg Karin, Johns Benjamin, Scherpbier Robert W, Edejer Tessa Tan-Torres
Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland.
Bull World Health Organ. 2007 Apr;85(4):305-14. doi: 10.2471/blt.06.032052.
To estimate the additional resources required to scale up interventions to reduce child mortality and morbidity within the context of the fourth Millennium Development Goals aim to reduce mortality among children aged<5 years by two-thirds by 2015.
A costing model was developed to estimate the financial resources needed in 75 countries to scale up priority interventions that address the major causes of mortality among children aged < 5 years, including malnutrition, pneumonia, diarrhoea, malaria and key newborn causes of death such as sepsis. Calculations were made using bottom-up and ingredients-based approaches; this allowed financial costs to be estimated for each intervention, country and year. Costs reflect WHO guidelines on inputs and delivery strategies and encompass the delivery of interventions at community and facility levels. These costs also include programme-specific investments needed at national level and district level.
The scale-up scenario predicts that an additional US$ 52.4 billion will be required for the period 2006-2015. This represents an increase in total per-capita health expenditure in the 75 countries of US$ 0.47 in 2006; this is projected to increase to US$ 1.46 in 2015. Projected costs in 2015 are equivalent to increasing the average total health expenditure from all financial sources in the 75 countries by 8% and raising general government health expenditure by 26% over 2002 levels. (The latest data available at the time of the study were for 2002.) The scale-up scenario indicates that countries with weak health systems may experience difficulties mobilizing enough domestic public funds.
While the results are approximate estimates, they show a substantial investment gap that low- and middle-income countries and their development partners need to bridge to reach the fourth Millennium Development Goal.
在千年发展目标4（到2015年将5岁以下儿童死亡率降低三分之二）的背景下，估算扩大干预措施以降低儿童死亡率和发病率所需的额外资源。
开发了一种成本核算模型，以估算75个国家扩大优先干预措施所需的财政资源，这些干预措施旨在解决5岁以下儿童死亡的主要原因，包括营养不良、肺炎、腹泻、疟疾以及败血症等关键的新生儿死亡原因。采用自下而上和基于要素的方法进行计算；这使得能够估算每项干预措施、每个国家和每年的财务成本。成本反映了世界卫生组织关于投入和实施策略的指南，涵盖了在社区和医疗机构层面实施干预措施的费用。这些成本还包括国家和地区层面所需的特定项目投资。
扩大规模的设想预测，2006 - 2015年期间将需要额外的524亿美元。这意味着2006年75个国家的人均卫生总支出将增加0.47美元；预计到2015年将增至1.46美元。2015年预计成本相当于将75个国家所有资金来源的平均卫生总支出在2002年水平基础上提高8%，并将政府卫生总支出提高26%。（研究时可获得的最新数据为2002年的数据。）扩大规模的设想表明，卫生系统薄弱的国家在筹集足够的国内公共资金方面可能会遇到困难。
虽然结果是近似估计值，但它们显示出低收入和中等收入国家及其发展伙伴为实现千年发展目标4需要弥合的巨大投资差距。
