Ottersen Trygve, Moon Suerie, Røttingen John-Arne
1Department of Global Public Health and Primary Care,University of Bergen,Bergen,Norway.
4Harvard T.H. Chan School of Public Health,Harvard University,Boston, MA,USA.
Health Econ Policy Law. 2017 Apr;12(2):245-263. doi: 10.1017/S1744133116000487.
After years of unprecedented growth in development assistance for health (DAH), the DAH system is challenged on several fronts: by the economic downturn and stagnation of DAH, by the epidemiological transition and increase in non-communicable diseases and by the economic transition and rise of the middle-income countries. Central to any potent response is a fair and effective allocation of DAH across countries. A myriad of criteria has been proposed or is currently used, but there have been no comprehensive assessment of their distributional implications. We simulated the implications of 11 quantitative allocation criteria across countries and country categories. We found that the distributions varied profoundly. The group of low-income countries received most DAH from needs-based criteria linked to domestic capacity, while the group of upper-middle-income countries was most favoured by an income-inequality criterion. Compared to a baseline distribution guided by gross national income per capita, low-income countries received less DAH by almost all criteria. The findings can inform funders when examining and revising the criteria they use, and provide input to the broader debate about what criteria should be used.
在卫生领域发展援助（DAH）经历多年前所未有的增长之后，DAH体系在多个方面面临挑战：经济衰退和DAH停滞、流行病学转变以及非传染性疾病增加，还有经济转型和中等收入国家的崛起。任何有力应对措施的核心都是在各国之间公平有效地分配DAH。已经提出或目前正在使用无数标准，但尚未对其分配影响进行全面评估。我们模拟了11种定量分配标准在各国和国家类别中的影响。我们发现，这些分配差异极大。低收入国家群体从与国内能力相关的基于需求的标准中获得了最多的DAH，而中高收入国家群体则最受收入不平等标准的青睐。与以人均国民总收入为指导的基线分配相比，几乎所有标准下低收入国家获得的DAH都更少。这些发现可以为资助者在审查和修订他们使用的标准时提供参考，并为关于应使用何种标准的更广泛辩论提供依据。
