Office of the Deputy Director, Programme Branch, UNAIDS Secretariat, Geneva, Switzerland.
Pharmacoeconomics. 2012 Oct 1;30(10):887-902. doi: 10.2165/11596500-000000000-00000.
The HIV pandemic continues to be one of our greatest contemporary public health threats. Policy makers in many middle- and low-income countries are in the process of scaling up HIV prevention, treatment and care services in the context of a reduction in international HIV funding due to the global economic downturn. In order to scale up services that are sustainable in the long term, policy makers and implementers need to have access to robust and contemporary strategic information, including financial information on expenditure and cost, in order to be able to plan, implement, monitor and evaluate HIV services. A major problem in middle- and low-income countries continues to be a lack of basic information on the use of services, their cost, outcome and impact, while those few costing studies that have been performed were often not done in a standardized fashion. Some researchers handle this by transposing information from one country to another, developing mathematical or statistical models that rest on assumptions or information that may not be applicable, or using top-down costing methods that only provide global financial costs rather than using bottom-up ingredients-based costing. While these methods provide answers in the short term, countries should develop systematic data collection systems to store, transfer and produce robust and contemporary strategic financial information for stakeholders at local, sub-national and national levels. National aggregated information should act as the main source of financial data for international donors, agencies or other organizations involved with the global HIV response. This paper describes the financial information required by policy makers and other stakeholders to enable them to make evidence-informed decisions and reviews the quantity and quality of the financial information available, as indicated by cost studies published between 1981 and 2008. Among the lessons learned from reviewing these studies, a need was identified for providing countries with practical guidance to produce reliable and standardized costing data to monitor performance, as countries want to improve programmes and services, and have to demonstrate an efficient use of resources. Finally, the issues raised in this paper relate to the provision of all areas of healthcare in countries and it is going to be increasingly important to leverage the lessons learned from the HIV experience and use resources more effectively and efficiently to improve health systems in general.
艾滋病病毒大流行仍然是我们当代面临的最大公共卫生威胁之一。由于全球经济下滑，国际艾滋病病毒供资减少，许多中低收入国家的政策制定者正在扩大艾滋病病毒预防、治疗和关爱服务。为了长期扩大可持续的服务，政策制定者和执行者需要获得关于支出和成本的稳健和现代的战略信息，以便能够规划、实施、监测和评估艾滋病病毒服务。中低收入国家的一个主要问题仍然是缺乏关于服务的使用、成本、结果和影响的基本信息，而少数进行的成本研究往往不是以标准化的方式进行的。一些研究人员通过将信息从一个国家转移到另一个国家来处理这个问题，开发基于假设或可能不适用的信息的数学或统计模型，或者使用仅提供全球财务成本而不使用基于投入的自下而上成本核算的自上而下的成本核算方法。虽然这些方法在短期内提供了答案，但各国应开发系统的数据收集系统，以存储、传递和生成稳健和现代的战略财务信息，供地方、国家以下和国家各级的利益攸关方使用。国家汇总信息应作为国际捐助者、机构或参与全球艾滋病病毒应对工作的其他组织的主要财务数据来源。本文描述了政策制定者和其他利益攸关方所需的财务信息，以使他们能够做出基于证据的决策，并审查了 1981 年至 2008 年期间发表的成本研究报告中可用的财务信息的数量和质量。在审查这些研究报告的过程中吸取的教训之一是，需要为各国提供实用指南，以生成可靠和标准化的成本数据来监测绩效，因为各国希望改进方案和服务，并必须证明资源的有效利用。最后，本文提出的问题涉及各国所有卫生保健领域的提供，借鉴艾滋病病毒经验并更有效地利用资源来改善一般卫生系统将变得越来越重要。
