Cha Seungman, Mankadi Paul Mansiangi, Elhag Mousab Siddig, Lee Yongjoo, Jin Yan
a Department of Disease Control, Faculty of Infectious and Tropical Disease , London School of Hygiene & Tropical Medicine , London , UK.
b Environmental Health Department, School of Public Health , University of Kinshasa , Kinshasa , Democratic Republic of the Congo.
Glob Health Action. 2017;10(1):1327170. doi: 10.1080/16549716.2017.1327170.
As the Millennium Development Goals ended, and were replaced by the Sustainable Development Goals, efforts have been made to evaluate the achievements and performance of official development assistance (ODA) in the health sector. In this study, we explore trends in the expansion of water and sanitation coverage in developing countries and the performance of ODA.
We explored inequality across developing countries by income level, and investigated how ODA for water and sanitation was committed by country, region, and income level. Changes in inequality were tested via slope changes by investigating the interaction of year and income level with a likelihood ratio test. A random effects model was applied according to the results of the Hausman test.
The slope of the linear trend between economic level and sanitation coverage has declined over time. However, a random effects model suggested that the change in slope across years was not significant (e.g. for the slope change between 2000 and 2010: likelihood ratio χ = 2.49, probability > χ = 0.1146). A similar pro-rich pattern across developing countries and a non-significant change in the slope associated with different economic levels were demonstrated for water coverage. Our analysis shows that the inequality of water and sanitation coverage among countries across the world has not been addressed effectively during the past decade. Our findings demonstrate that the countries with the least coverage persistently received far less ODA per capita than did countries with much more extensive water and sanitation coverage, suggesting that ODA for water and sanitation is poorly targeted.
The most deprived countries should receive more attention for water and sanitation improvements from the world health community. A strong political commitment to ODA targeting the countries with the least coverage is needed at the global level.
随着千年发展目标的结束以及被可持续发展目标所取代，人们已努力评估官方发展援助（ODA）在卫生部门的成就和表现。在本研究中，我们探讨了发展中国家水和卫生设施覆盖范围扩大的趋势以及官方发展援助的表现。
我们按收入水平探究了发展中国家之间的不平等情况，并调查了按国家、地区和收入水平分配的水和卫生设施官方发展援助情况。通过调查年份与收入水平的相互作用并进行似然比检验，以斜率变化来检验不平等的变化情况。根据豪斯曼检验结果应用随机效应模型。
随着时间推移，经济水平与卫生设施覆盖范围之间线性趋势的斜率有所下降。然而，随机效应模型表明各年份斜率的变化并不显著（例如，2000年至2010年斜率变化：似然比χ = 2.49，概率>χ = 0.1146）。对于水覆盖情况，在发展中国家也呈现出类似的有利于富裕国家的模式，且与不同经济水平相关的斜率变化不显著。我们的分析表明，在过去十年中，全球各国之间水和卫生设施覆盖范围的不平等问题并未得到有效解决。我们的研究结果表明，覆盖范围最小的国家人均获得的官方发展援助持续远远少于水和卫生设施覆盖范围更广的国家，这表明水和卫生设施方面的官方发展援助目标定位不佳。
世界卫生界应更加关注最贫困国家在改善水和卫生设施方面的需求。在全球层面，需要对官方发展援助作出强有力的政治承诺，以援助覆盖范围最小的国家。
