Shen Angela K, Farrell Marguerite M, Vandenbroucke Mary F, Fox Elizabeth, Pablos-Mendez Ariel
Bureau for Global Health, US Agency for International Development, Washington, DC, USA, US Department of Health and Human Services, Washington, DC, USA, Office of Population and Reproductive Health, US Agency for International Development, Washington, DC, USA, Office of Country Support, US Agency for International Development, Washington, DC, USA and Office of Health Infectious Disease and Nutrition, US Agency for International Development, Washington, DC, USA Bureau for Global Health, US Agency for International Development, Washington, DC, USA, US Department of Health and Human Services, Washington, DC, USA, Office of Population and Reproductive Health, US Agency for International Development, Washington, DC, USA, Office of Country Support, US Agency for International Development, Washington, DC, USA and Office of Health Infectious Disease and Nutrition, US Agency for International Development, Washington, DC, USA
Bureau for Global Health, US Agency for International Development, Washington, DC, USA, US Department of Health and Human Services, Washington, DC, USA, Office of Population and Reproductive Health, US Agency for International Development, Washington, DC, USA, Office of Country Support, US Agency for International Development, Washington, DC, USA and Office of Health Infectious Disease and Nutrition, US Agency for International Development, Washington, DC, USA.
Health Policy Plan. 2015 Jul;30(6):687-95. doi: 10.1093/heapol/czu045. Epub 2014 Jun 28.
As low income countries experience economic transition, characterized by rapid economic growth and increased government spending potential in health, they have increased fiscal space to support and sustain more of their own health programmes, decreasing need for donor development assistance. Phase out of external funds should be systematic and efforts towards this end should concentrate on government commitments towards country ownership and self-sustainability. The 2006 US Agency for International Development (USAID) family planning (FP) graduation strategy is one such example of a systematic phase-out approach. Triggers for graduation were based on pre-determined criteria and programme indicators. In 2011 the GAVI Alliance (formerly the Global Alliance for Vaccines and Immunizations) which primarily supports financing of new vaccines, established a graduation policy process. Countries whose gross national income per capita exceeds $1570 incrementally increase their co-financing of new vaccines over a 5-year period until they are no longer eligible to apply for new GAVI funding, although previously awarded support will continue. This article compares and contrasts the USAID and GAVI processes to apply lessons learned from the USAID FP graduation experience to the GAVI process. The findings of the review are 3-fold: (1) FP graduation plans served an important purpose by focusing on strategic needs across six graduation plan foci, facilitating graduation with pre-determined financial and technical benchmarks, (2) USAID sought to assure contraceptive security prior to graduation, phasing out of contraceptive donations first before phasing out from technical assistance in other programme areas and (3) USAID sought to sustain political support to assure financing of products and programmes continue after graduation. Improving sustainability more broadly beyond vaccine financing provides a more comprehensive approach to graduation. The USAID FP experience provides a window into understanding one approach to graduation from donor assistance. The process itself-involving transparent country-level partners well in advance of graduation-appears a valuable lesson towards success.
随着低收入国家经历经济转型，其特点是经济快速增长以及政府在卫生领域的支出潜力增加，它们有了更多财政空间来支持和维持更多本国的卫生项目，对捐助方发展援助的需求也在减少。外部资金的逐步退出应是系统性的，为此所做的努力应集中于政府对国家自主权和自我可持续性的承诺。2006年美国国际开发署（USAID）的计划生育（FP）毕业战略就是这种系统性逐步退出方法的一个例子。毕业的触发条件基于预先确定的标准和项目指标。2011年，主要支持新疫苗融资的全球疫苗免疫联盟（GAVI Alliance，前身为全球疫苗和免疫联盟）制定了毕业政策程序。人均国民总收入超过1570美元的国家在5年时间里逐步增加对新疫苗的共同融资，直到它们不再有资格申请新的GAVI资金，不过此前获得的支持仍将继续。本文比较并对比了美国国际开发署和GAVI的程序，以便将从美国国际开发署计划生育毕业经验中学到的经验教训应用于GAVI程序。审查结果有三点：（1）计划生育毕业计划通过关注六个毕业计划重点领域的战略需求发挥了重要作用，以预先确定的财务和技术基准推动毕业；（2）美国国际开发署在毕业前寻求确保避孕药具的供应，在从其他项目领域的技术援助中退出之前，先逐步停止避孕药具捐赠；（3）美国国际开发署寻求维持政治支持，以确保毕业后产品和项目的融资能够继续。在疫苗融资之外更广泛地提高可持续性，为毕业提供了更全面的方法。美国国际开发署计划生育的经验为理解从捐助方援助毕业的一种方法提供了一个窗口。这个过程本身——在毕业前很早就让透明的国家层面伙伴参与进来——似乎是取得成功的宝贵经验。
