De Los Ríos Rebecca, Arósquipa Carlos, Vigil-Oliver William
Relaciones Externas, Movilización de Recursos y Asociaciones, Organización Panamericana de la Salud, Washington, DC, USA.
Rev Panam Salud Publica. 2011 Aug;30(2):133-43.
The purpose of this study is (a) to examine the ways in which Latin America and the Caribbean (LAC) have benefited from increases in international development assistance for health (DAH) at the global level and whether the trend observed after the Millennium Summit has also applied to the Region; (b) to determine whether there are differences in the distribution of this assistance, based on the gross per capita income of each country; (c) to identify the possible effects of the 2008 international financial crisis on official bilateral assistance; and (d) to compare trends in public health expenditure in relation to DAH before and after the Millennium Summit. The study has found that DAH in LAC follows a very different pattern than in other regions of the world. The period from 1997 to 2008 was one of fluctuating stagnation, with average annual disbursements of US$ 1 200 million. Multilateral financial institutions accounted for 79% of the average disbursements in the upper-middle income countries between 2002 and 2008, while official bilateral assistance held the greatest share (61%) in the low- and lower-middle income countries. Bilateral assistance grew at an annual rate of 13% during this period, but in the year after the crisis, disbursements fell to US$ 20 million. Sixty-four percent of bilateral assistance came from the United States, Spain, and Canada, with 29% of it being directed to HIV/AIDS and sexually transmitted diseases. After the Millennium Summit DAH channeled to governments decreased 30% in the period 2001-2006, and its share of public health expenditure in the region was 0.3% for the same period, with an equally marginal proportion in relation to total health expenditure for 2008 (0.37%; US$ 2 per capita). The study concludes that after the Millennium Summit, DAH in LAC did not grow nor did it equal the trends prior to 2000, and public health expenditure followed its historical growth trend, without further increases in relation to the regional gross domestic product. Given these realities and the fact that LAC is the world's most unequal region, but not its poorest, it is imperative to reconsider the concepts, management, and delivery of cooperation in the development of health, using innovative approaches and alternative financing mechanisms that respond more effectively to the realities of the region.
（a）考察拉丁美洲和加勒比地区（LAC）在全球层面上从国际卫生发展援助（DAH）增加中受益的方式，以及千年峰会后观察到的趋势是否也适用于该地区；（b）根据每个国家的人均总收入，确定这种援助的分配是否存在差异；（c）确定2008年国际金融危机对官方双边援助可能产生的影响；（d）比较千年峰会前后公共卫生支出与DAH的趋势。该研究发现，LAC地区的DAH模式与世界其他地区截然不同。1997年至2008年期间是波动停滞期，年均支出为1.2亿美元。2002年至2008年期间，多边金融机构在中高收入国家的平均支出中占79%，而官方双边援助在低收入和中低收入国家中占最大份额（61%）。在此期间，双边援助以每年13%的速度增长，但在危机后的一年，支出降至2000万美元。64%的双边援助来自美国、西班牙和加拿大，其中29%用于艾滋病毒/艾滋病和性传播疾病。千年峰会后，2001年至2006年期间流向各国政府的DAH减少了30%，同期其在该地区公共卫生支出中的份额为0.3%，与2008年的总卫生支出相比比例同样微乎其微（0.37%；人均2美元）。该研究得出结论，千年峰会后，LAC地区的DAH没有增长，也没有达到2000年之前的趋势，公共卫生支出遵循其历史增长趋势，与地区国内生产总值相比没有进一步增加。鉴于这些现实情况以及LAC是世界上最不平等但并非最贫穷的地区这一事实，必须重新考虑卫生发展合作的理念、管理和提供方式，采用创新方法和替代融资机制，以更有效地应对该地区的实际情况。
