Marty Robert, Dolan Carrie B, Leu Matthias, Runfola Daniel
AidData, The College of William and Mary, Williamsburg, Virginia, USA.
Department of Biology, The College of William and Mary, Williamsburg, Virginia, USA.
BMJ Glob Health. 2017 Jan 11;2(1):e000129. doi: 10.1136/bmjgh-2016-000129. eCollection 2017.
Cross-national studies provide inconclusive results as to the effectiveness of foreign health aid. We highlight a novel application of using subnational data to evaluate aid impacts, using Malawi as a case study.
We employ two rounds of nationally representative household surveys (2004/2005 and 2010/2011) and geo-referenced foreign aid data. We examine the determinants of Malawi's traditional authorities receiving aid according to health, environmental risk, socioeconomic and political factors. We use two approaches to estimate the impact of aid on reducing malaria prevalence and increasing healthcare quality: difference-in-difference models, which include traditional authority and month-of-interview fixed effects and control for individual and household level time-varying factors, and entropy balancing, where models balance on health-related and socioeconomic baseline characteristics. General health aid and four specific health aid sectors are examined.
Traditional authorities with greater proportions of individuals living in urban areas, more health facilities and greater proportions of those in major ethnic groups were more likely to receive aid. Difference-in-difference models show health infrastructure and parasitic disease control aid reduced malaria prevalence by 1.20 (95% CI -0.36 to 2.76) and 2.20 (95% CI 0.43 to 3.96) percentage points, respectively, and increased the likelihood of individuals reporting healthcare as more than adequate by 12.1 (95% CI 1.51 to 22.68) and 14.0 (95% CI 0.11 to 28.11) percentage points. Entropy balancing shows similar results.
Aid was targeted to areas with greater existing health infrastructure rather than areas most in need, but still effectively reduced malaria prevalence and enhanced self-reported healthcare quality.
关于外国卫生援助的有效性，跨国研究得出的结果尚无定论。我们以马拉维为例，重点介绍一种利用次国家级数据评估援助影响的新应用。
我们采用了两轮具有全国代表性的家庭调查（2004/2005年和2010/2011年）以及地理参考的外国援助数据。我们根据健康、环境风险、社会经济和政治因素，研究了马拉维传统当局获得援助的决定因素。我们使用两种方法来估计援助对降低疟疾流行率和提高医疗质量的影响：差分模型，其中包括传统当局和访谈月份固定效应，并控制个人和家庭层面的时变因素；以及熵平衡法，即模型在与健康相关的社会经济基线特征上进行平衡。我们研究了一般卫生援助和四个特定的卫生援助部门。
城市地区居住人口比例更高、卫生设施更多且主要族群人口比例更大的传统当局更有可能获得援助。差分模型显示，卫生基础设施和寄生虫病控制援助分别使疟疾流行率降低了1.20（95%置信区间为-0.36至2.76）和2.20（95%置信区间为0.43至3.96）个百分点，并使报告医疗服务充足的个人比例分别提高了12.1（95%置信区间为1.51至22.68）和14.0（95%置信区间为0.11至28.11）个百分点。熵平衡法显示了类似的结果。
援助的目标是现有卫生基础设施较好的地区，而非最需要援助的地区，但仍有效降低了疟疾流行率并提高了自我报告的医疗质量。
