Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands.
Trop Med Int Health. 2012 Aug;17(8):1044-6. doi: 10.1111/j.1365-3156.2012.03023.x. Epub 2012 Jun 12.
The literature suggests that crowding-out effects of government funding for health happen in low-income countries with a high HIV burden. In a survey, we investigated the hypothesis that domestic funding for TB control has fallen in 11 low-income, high-TB-burden countries in the context of changes in gross domestic product (GDP), development assistance inflows and national health expenditures. We found that despite rises in GDP per capita between 2003 and 2009, health expenditure as per cent of GDP fell or stayed the same for the majority of these countries. Although TB control budgets increased for all 11 countries in absolute terms, 6 countries reduced government contribution to TB control. For health programmes to become sustainable in the long run, we suggest increases in donor funding for health to be accompanied by requirements to increase domestic funding for health. We thereby attribute responsibility to avoid crowding-out effects to donors and governments alike. Moreover, it is the responsibility of both to ensure essential items to be funded by government sources to avoid a collapse of programmes once aid is withdrawn.
文献表明，在艾滋病毒负担沉重的低收入国家，政府卫生资金的挤出效应较为明显。我们在一项调查中检验了这样一个假设，即在国内生产总值（GDP）、发展援助流入和国家卫生支出发生变化的情况下，11 个低收入、高结核负担国家的结核病控制国内资金是否减少。我们发现，尽管 2003 年至 2009 年期间人均 GDP 有所上升，但这些国家中的大多数国家的卫生支出占 GDP 的比例却有所下降或保持不变。尽管所有 11 个国家的结核病控制预算绝对值都有所增加，但有 6 个国家减少了政府对结核病控制的拨款。为了使卫生规划在长期内具有可持续性，我们建议在增加卫生方面的捐助资金的同时，也要求增加国内卫生资金。因此，我们认为，避免挤出效应的责任应由捐助者和政府共同承担。此外，双方都有责任确保政府来源资助基本项目，以避免援助一旦撤出方案就崩溃。
