Bureau of Health Administration, Ministry of Public Health, Nonthaburi, Thailand.
HITAP International Unit, Ministry of Public Health, Nonthaburi, Thailand.
Int J Health Policy Manag. 2017 Sep 1;6(9):529-533. doi: 10.15171/ijhpm.2017.25.
It has been debated whether the Global Fund (GF), which is supporting the implementation of programs on the prevention and control of HIV/AIDS, tuberculosis (TB) and malaria, should consider the value-for-money (VFM) for programs/interventions that they are supporting. In this paper, we critically analyze the uses of economic information for GF programs, not only to ensure accountability to their donors but also to support country governments in continuing investment in cost-effective interventions initiated by the GF despite the discontinuation of financial support after graduation. We demonstrate that VFM is not a static property of interventions and may depend on program start-up cost, economies of scales, the improvement of effectiveness and efficiency of providers once the program develops, and acceptance and adherence of the target population. Interventions that are cost-ineffective in the beginning may become cost-effective in later stages. We consider recent GF commitments towards value for money and recommend that the GF supports interventions with proven cost-effectiveness from program initiation as well as interventions that may be cost-effective afterwards. Thus, the GF and country governments should establish mechanisms to monitor cost-effectiveness of interventions invested over time.
全球基金（GF）一直在支持艾滋病、结核病（TB）和疟疾防治项目的实施，人们对其是否应考虑所支持项目/干预措施的成本效益（VFM）存在争议。本文批判性地分析了经济信息在 GF 项目中的使用，不仅是为了确保对捐助者负责，也是为了支持国家政府在 GF 毕业后停止财政支持后，继续对由 GF 启动的具有成本效益的干预措施进行投资。我们证明了 VFM 不是干预措施的静态属性，它可能取决于项目启动成本、规模经济、一旦项目发展提供方的效果和效率的提高，以及目标人群的接受和坚持。在开始时不具有成本效益的干预措施可能在后期变得具有成本效益。我们考虑了 GF 最近对成本效益的承诺，并建议 GF 从项目启动开始就支持具有成本效益的干预措施，以及以后可能具有成本效益的干预措施。因此，GF 和国家政府应建立机制，以随时间监测投资干预措施的成本效益。
