Newbrander William, Yoder Richard, Debevoise Anne Bilby
Management Sciences for Health, Kabul, Afghanistan.
Int J Health Plann Manage. 2007 Oct-Dec;22(4):319-36. doi: 10.1002/hpm.878.
After the fall of the Taliban in 2001, the Afghan transitional government and international donors found the health system near collapse. Afghanistan had some of the worst health indicators ever recorded. To begin activities that would quickly improve the health situation, the Ministry of Health (MOH) needed both a national package of health services and reliable data on the costs of providing those services. This study details the process of determining national health priorities, creating a basic package of services, and estimating per capita and unit costs for providing those services, with an emphasis on the costing exercise. Strategies for obtaining a rapid yet reasonably accurate estimate of health service costs nationwide are discussed. In 2002 this costing exercise indicated that the basic package of services could be provided for US dollars 4.55 per person. In 2006, the findings were validated: the four major donors who contracted with non-governmental organizations (NGOs) to provide basic health services for nearly 80% of the population found per capita costs ranging from dollars 4.30 to dollars 5.12. This study is relevant for other post-conflict countries that are re-establishing health services and seeking to develop cost-effective and equitable health systems.
2001年塔利班倒台后，阿富汗过渡政府和国际捐助者发现该国卫生系统几近崩溃。阿富汗拥有一些有史以来最糟糕的健康指标。为开展能够迅速改善健康状况的活动，阿富汗卫生部既需要一套全国性的卫生服务套餐，也需要有关提供这些服务成本的可靠数据。本研究详细介绍了确定国家卫生重点、创建基本服务套餐以及估算提供这些服务的人均成本和单位成本的过程，重点是成本核算工作。文中讨论了在全国范围内快速获得合理准确的卫生服务成本估算的策略。2002年的这项成本核算工作表明，基本服务套餐每人的成本可为4.55美元。2006年，研究结果得到验证：与非政府组织签约为近80%的人口提供基本卫生服务的四大捐助者发现人均成本在4.30美元至5.12美元之间。本研究对其他正在重建卫生服务并寻求建立具有成本效益和公平性的卫生系统的冲突后国家具有借鉴意义。
