Institute of Public Health, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany.
World Bank, Zambia Country Office, Atlas Mara House, Church Road, Lusaka, Zambia.
Health Policy Plan. 2018 Sep 1;33(7):811-820. doi: 10.1093/heapol/czy046.
Development assistance for health (DAH) remains a significant and important source of health financing in many low and lower middle-income countries. However, this assistance has not been fully effective. This study explores the effect of currency exchange rate fluctuations on volatility of DAH in Zambia using a mixed methods approach. Data covering the period 1997-2008 were collected from various financial and programmatic reports, while six key informant interviews were conducted to validate and translate findings from the quantitative analysis. Results show fluctuations in the volume of funds disbursed to the Ministry of Health by donors due to changes in the exchange rates between non-US$ currencies and the US$, ranging from -11.1% to +13.4% during the period 1997-2008. The overall effect was a loss of US$ 13.4 million over the period 1997-2008 which is equivalent to an annual average loss of US$ 1.1 million per annum. There were also fluctuations in the US$ amount that was converted to the Zambian Kwacha to fund districts ranging from -22% to +22% over the same period. The monthly average loss that was incurred was US$ 302 214 per month, but large gains and losses were observed when individual months were analysed. Information from key informants suggest that currency exchange rate losses contribute to reductions in the health workforce, quantity and quality of health services, while currency exchange rate gains can contribute to reduced absorption capacity and/or low utilization of financial resources. The study concludes that fluctuations in currency exchange rates contribute to volatility in DAH, reduces financial stability and leads to unpredictability of DAH which ultimately affects health service delivery. For DAH to be effective, governments and donors should increase awareness and work systematically to mitigate currency exchange risks.
卫生发展援助仍然是许多低收入和中低收入国家卫生融资的重要来源。然而，这种援助并没有充分发挥作用。本研究采用混合方法探讨了汇率波动对赞比亚卫生发展援助波动性的影响。数据涵盖了 1997 年至 2008 年期间，收集自各种财务和方案报告，同时进行了六次关键知情人访谈，以验证和翻译定量分析的结果。结果表明，由于非美元货币与美元之间汇率的变化，1997 年至 2008 年期间，捐助者向卫生部发放的资金数量波动，幅度在-11.1%至+13.4%之间。总体影响是在 1997 年至 2008 年期间损失了 1340 万美元，相当于每年平均损失 110 万美元。同期，用于资助地区的美元金额转换为赞比亚克瓦查的金额也出现波动，幅度在-22%至+22%之间。在此期间，每月平均损失为 302214 美元，但在分析个别月份时，出现了较大的收益和损失。关键知情人的信息表明，汇率损失导致卫生劳动力减少、卫生服务的数量和质量下降，而汇率收益可能导致吸收能力下降和/或财政资源利用不足。该研究得出结论，汇率波动导致卫生发展援助波动，降低了财政稳定性，并导致卫生发展援助的不可预测性，最终影响了卫生服务的提供。为了使卫生发展援助有效，政府和捐助者应提高认识，并系统地努力减轻汇率风险。
