Moon Suerie, Omole Oluwatosin
1Lecturer on Global Health,Department of Global Health and Population,Harvard T.H. Chan School of Public Health,Boston,MA,USA.
2Resident Physician,Department of Community and Family Medicine,Howard University Hospital,Washington,DC,USA.
Health Econ Policy Law. 2017 Apr;12(2):207-221. doi: 10.1017/S1744133116000463.
After a 'golden age' of extraordinary growth in the level of development assistance for health (DAH) since 1990, funding seems to have reached a plateau. With the launch of the Sustainable Development Goals, debate has intensified regarding what international financing for health should look like in the post-2015 era. In this review paper, we offer a systematic overview of problems and proposals for change. Major critiques of the current DAH system include: that the total volume of financing is inadequate; financial flows are volatile and uncertain; DAH may not result in additional resources for health; too small a proportion of DAH is transferred to recipient countries; inappropriate priority setting; inadequate coordination; weak mechanisms for accountability; and disagreement on the rationale for DAH. Proposals to address these critiques include: financing-oriented proposals to address insufficient levels and high volatility of DAH; governance-oriented proposals to address concerns regarding additionality, proportions reaching countries, priority setting, coordination and accountability; and proposals that reach beyond the existing DAH system. We conclude with a discussion of prospects for change.
自1990年以来，卫生发展援助（DAH）水平经历了一段高速增长的“黄金时代”，之后资金似乎已趋于平稳。随着可持续发展目标的推出，关于2015年后时代国际卫生融资应呈现何种面貌的辩论愈演愈烈。在这篇综述论文中，我们对问题及变革提议进行了系统概述。对当前DAH体系的主要批评包括：融资总量不足；资金流动波动且不确定；DAH可能不会带来额外的卫生资源；转至受援国的DAH比例过小；优先事项设定不当；协调不足；问责机制薄弱；以及对DAH基本原理存在分歧。针对这些批评的提议包括：以融资为导向的提议，以解决DAH水平不足和高波动性问题；以治理为导向的提议，以解决有关额外性、到达各国的比例、优先事项设定、协调和问责等问题；以及超越现有DAH体系的提议。我们最后讨论了变革的前景。
