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如果外部资源减少,埃塞俄比亚能否为其初级卫生保健系统的持续发展提供资金?

Can Ethiopia Finance the Continued Development of Its Primary Health Care System If External Resources Decline?

机构信息

a Global Health and Population Department , Harvard T.H. Chan School of Public Health , Boston , MA , USA.

出版信息

Health Syst Reform. 2018;4(3):227-238. doi: 10.1080/23288604.2018.1448240. Epub 2018 Jun 21.

Abstract

Ethiopia's recent improvements in health outcomes benefited from the large increase in development assistance for health received in recent years, most of which supported its primary care system. Increased domestic resource mobilization for health will be needed to sustain progress given recent and likely future declines in external support. We estimate a projection model of Ethiopian government domestic resource mobilization potential compared with future health care delivery costs in order to assess Ethiopia's ability to finance its planned primary health care system. For the period of Ethiopia's current five-year health sector plan (2016-2020), the projection model indicates that if real external resources remain at the levels of 2011, domestic resource mobilization may only provide half of the estimated funds needed. Including out-of-pocket spending currently captured as retained user fees, Ethiopia is more likely to successfully finance continued delivery of primary care. Over 20 years, 2016-2035, the future sustainability of primary care services without increasing contributions from households will depend largely on significant economic growth and more government funding for primary care. Our modeling suggests that Ethiopia can substantially support further development of primary care services, even in the face of declining external support. However, it is unlikely to achieve its goals solely through "business as usual." Ethiopia is already moving forward with timely adoption of sound strategies to maintain progress. External partners should support these trends to enable transition plans to greater domestic funding with minimal disruption to positive progress that has been and is being made.

摘要

埃塞俄比亚在卫生成果方面的近期改善得益于近年来收到的大量增加的卫生发展援助,其中大部分用于支持其初级保健系统。鉴于最近和可能未来对外援的减少,需要增加国内卫生资源调动,以维持进展。我们估计了埃塞俄比亚政府国内资源调动潜力与未来医疗保健提供成本的预测模型,以评估埃塞俄比亚为其规划的初级保健系统提供资金的能力。在埃塞俄比亚当前五年卫生部门计划(2016-2020 年)期间,预测模型表明,如果实际外部资源保持在 2011 年的水平,国内资源调动可能只能提供估计所需资金的一半。包括目前作为留存用户费用捕获的自付费用,埃塞俄比亚更有可能成功为持续提供初级保健提供资金。在 2016-2035 年的 20 多年中,如果不增加家庭缴款,初级保健服务的未来可持续性将在很大程度上取决于显著的经济增长和政府对初级保健的更多供资。我们的模型表明,埃塞俄比亚可以大力支持进一步发展初级保健服务,即使在外部支持下降的情况下也是如此。然而,它不太可能仅通过“照常营业”来实现其目标。埃塞俄比亚已经在及时采取健全的战略来维持进展。外部伙伴应支持这些趋势,以便在不中断已取得和正在取得的积极进展的情况下,过渡计划向更多国内供资过渡。

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