Marten Robert, McIntyre Diane, Travassos Claudia, Shishkin Sergey, Longde Wang, Reddy Srinath, Vega Jeanette
The Rockefeller Foundation, New York, NY, USA; London School of Hygiene & Tropical Medicine, London, UK.
Health Economics Unit, University of Cape Town, Cape Town, South Africa.
Lancet. 2014 Dec 13;384(9960):2164-71. doi: 10.1016/S0140-6736(14)60075-1. Epub 2014 Apr 30.
Brazil, Russia, India, China, and South Africa (BRICS) represent almost half the world's population, and all five national governments recently committed to work nationally, regionally, and globally to ensure that universal health coverage (UHC) is achieved. This analysis reviews national efforts to achieve UHC. With a broad range of health indicators, life expectancy (ranging from 53 years to 73 years), and mortality rate in children younger than 5 years (ranging from 10·3 to 44·6 deaths per 1000 livebirths), a review of progress in each of the BRICS countries shows that each has some way to go before achieving UHC. The BRICS countries show substantial, and often similar, challenges in moving towards UHC. On the basis of a review of each country, the most pressing problems are: raising insufficient public spending; stewarding mixed private and public health systems; ensuring equity; meeting the demands for more human resources; managing changing demographics and disease burdens; and addressing the social determinants of health. Increases in public funding can be used to show how BRICS health ministries could accelerate progress to achieve UHC. Although all the BRICS countries have devoted increased resources to health, the biggest increase has been in China, which was probably facilitated by China's rapid economic growth. However, the BRICS country with the second highest economic growth, India, has had the least improvement in public funding for health. Future research to understand such different levels of prioritisation of the health sector in these countries could be useful. Similarly, the role of strategic purchasing in working with powerful private sectors, the effect of federal structures, and the implications of investment in primary health care as a foundation for UHC could be explored. These issues could serve as the basis on which BRICS countries focus their efforts to share ideas and strategies.
巴西、俄罗斯、印度、中国和南非（金砖国家）的人口占世界近一半，最近这五个国家的政府均承诺在国家、区域和全球层面开展工作，以确保实现全民健康覆盖（UHC）。本分析回顾了各国为实现全民健康覆盖所做的努力。通过一系列广泛的健康指标、预期寿命（从53岁到73岁不等）以及5岁以下儿童死亡率（每1000例活产中死亡10.3至44.6例不等）对金砖国家各自取得的进展进行评估后发现，每个国家在实现全民健康覆盖方面都还有一段路要走。金砖国家在迈向全民健康覆盖的过程中面临着诸多重大且往往相似的挑战。基于对每个国家的评估，最紧迫的问题包括：公共支出不足；管理公私混合的卫生系统；确保公平；满足对更多人力资源的需求；应对不断变化的人口结构和疾病负担；以及解决健康的社会决定因素。增加公共资金投入可用于展示金砖国家的卫生部如何加速实现全民健康覆盖的进程。尽管所有金砖国家都已将更多资源投入到卫生领域，但增幅最大的是中国，这可能得益于中国经济的快速增长。然而，经济增长排名第二的金砖国家印度，其卫生领域的公共资金投入改善最少。未来开展研究以了解这些国家对卫生部门不同程度的优先重视情况可能会有所助益。同样，可以探讨战略采购在与强大的私营部门合作中的作用、联邦结构的影响以及将初级卫生保健投资作为全民健康覆盖基础的意义。这些问题可作为金砖国家集中精力分享想法和战略的基础。
