Ly Caroline, Eozenou Patrick, Nandakumar Allyala, Pablos-Mendez Ariel, Evans Timothy, Adeyi Olusoji
a U.S. Agency for International Development , Arlington , VA , USA.
b The World Bank , Washington , DC , USA.
Health Syst Reform. 2017 Oct 2;3(4):290-300. doi: 10.1080/23288604.2017.1325549.
Abstract-The new financing landscape for the Sustainable Development Goals has a larger emphasis on domestic resource mobilization. But, given the significant role of donor assistance for health, the fungibility of government health spending, and the downward revision of global growth, this article looks at what is possible with regard to a country's own ability to finance priority health services. Using cross-sectional and longitudinal economic and health spending data, we employ a global multilevel model with regional and country random effects to develop gross domestic product (GDP) projections that inform a dynamic panel data model to forecast health spending. We then assess sub-Saharan African countries' abilities to afford to finance their own essential health needs and find that there are countries that will still rely on high out-of-pocket or donor spending to finance an essential package of health services. To address this, we discuss policy opportunities for each set of countries over the next 15 years. This longer-term view of the economic transition of health in Africa stresses the imperative of engaging policy now to prioritize customized strategies and institutional arrangements to increase domestic financing, improve value for money, and ensure fairer and sustainable health financing. We address the need for rhetoric on UHC to incorporate "progressive pragmatism," a proactive joint approach by developing country governments and their development partners to ensure that policies designed to achieve universal health coverage align with the economic reality of available domestic and donor financing.
摘要——可持续发展目标的新融资格局更加强调国内资源调动。但是，鉴于援助方对卫生领域援助的重要作用、政府卫生支出的可替代性以及全球经济增长的下调，本文探讨了一个国家依靠自身能力为优先卫生服务筹资的可能性。利用横断面和纵向经济及卫生支出数据，我们采用了一个具有区域和国家随机效应的全球多层次模型来制定国内生产总值（GDP）预测，为动态面板数据模型提供信息以预测卫生支出。然后，我们评估撒哈拉以南非洲国家为自身基本卫生需求筹资的能力，发现有些国家仍将依赖高额自付费用或援助方支出为基本卫生服务包筹资。为解决这一问题，我们讨论了未来15年每组国家的政策机遇。这种对非洲卫生经济转型的长期看法强调，现在必须采取政策行动，优先制定定制化战略和体制安排，以增加国内融资、提高资金使用效益，并确保实现更公平和可持续的卫生筹资。我们强调全民健康覆盖的理念需要融入“渐进实用主义”，即发展中国家政府及其发展伙伴采取积极的联合方法，确保旨在实现全民健康覆盖的政策与国内和援助方现有融资的经济现实相符。
