Rodríguez Daniela C, Whiteside Alan, Bennett Sara
Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States of America .
Centre for International Governance Innovation, Balsillie School of International Affairs, Waterloo, Canada .
Bull World Health Organ. 2017 Feb 1;95(2):121-127. doi: 10.2471/BLT.16.179861.
The responsibilities for the programmatic, technical and financial support of health programmes are increasingly being passed from external donors to governments. Programmes for family planning, human immunodeficiency virus, immunization, malaria and tuberculosis have already faced such donor transition, which is a difficult and often political process. Wherever programmes and services aimed at vulnerable populations are primarily supported by donors, the post-transition future is uncertain. Overreliance on donor support is often a reflection of limited domestic political commitment. Limited commitment, which is frequently expressed as the persecution of vulnerable groups, poses a risk to individuals as well as to the effectiveness and sustainability of health programmes. We argue that, for reasons linked to human rights, the social contract and the cost-effectiveness of health promotion, prevention and treatment programmes, it is critical that governments sustain health services for vulnerable populations during and after donor transition. Although civil society organizations could help by engaging with government stakeholders, pushing to change social norms and supporting mechanisms that demand accountability, they may be constrained by economic, political and social factors. Vulnerable populations need to be actively involved in the planning and implementation of donor transition - to ensure that their voice and needs are taken into account and to establish a platform that improves visibility and accountability. As transitions spread across all aspects of global health, transparent conversations about the building and sustainment of political commitment for health services for vulnerable populations become a critical human rights issue.
卫生项目的规划、技术和财政支持责任正越来越多地从外部捐助者转移到各国政府。计划生育、人类免疫缺陷病毒、免疫接种、疟疾和结核病项目已经经历了这种捐助者的转变，这是一个艰难且往往带有政治色彩的过程。凡是针对弱势群体的项目和服务主要由捐助者提供支持的地方，过渡后的未来都不确定。过度依赖捐助者支持往往反映出国内政治承诺有限。有限的承诺，常常表现为对弱势群体的迫害，对个人以及卫生项目的有效性和可持续性都构成风险。我们认为，出于与人权、社会契约以及健康促进、预防和治疗项目的成本效益相关的原因，各国政府在捐助者过渡期间及之后维持针对弱势群体的卫生服务至关重要。尽管民间社会组织可以通过与政府利益相关者接触、推动改变社会规范以及支持要求问责的机制来提供帮助，但它们可能会受到经济、政治和社会因素的制约。弱势群体需要积极参与捐助者过渡的规划和实施，以确保他们的声音和需求得到考虑，并建立一个提高透明度和问责制的平台。随着这种过渡在全球卫生的各个方面蔓延，关于为弱势群体建立和维持对卫生服务的政治承诺的透明对话成为一个关键的人权问题。
