Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Centre for Adolescent Health, Murdoch Children's Research Institute and University of Melbourne, Parkville, Victoria, Australia.
JAMA Netw Open. 2018 Aug 3;1(4):e181072. doi: 10.1001/jamanetworkopen.2018.1072.
Growth in financing has underpinned progress in most areas of health. Adolescent health has recently become a global priority, with inclusion in the Global Strategy for Women's, Children's and Adolescents' Health, but little is known about patterns of financing and development assistance for adolescent health (DAAH).
To provide estimates of DAAH at global, regional, and country levels.
DESIGN, SETTING, AND PARTICIPANTS: In this quality improvement study, data from the Creditor Reporting System were used to estimate flows of total DAAH and per-adolescent DAAH and to assess its distribution by donors, regions, and countries and the leading causes of burden of disease (ie, disability-adjusted life-years) in 132 developing countries between January 1, 2003, and December 31, 2015. Through use of a key word search and various funding allocation methods, 2 sets of estimates were produced: adolescent-targeted DAAH that included disbursements to projects with a primary adolescent health target and adolescent-inclusive DAAH that included disbursements to projects with either a primary or partial adolescent health target, as well as projects that could benefit adolescent health but did not include age-related key words.
Estimates of DAAH distinguishing between adolescent-targeted and adolescent-inclusive DAAH.
There were 19 921 projects in 132 countries in the adolescent-targeted estimation between 2003 and 2015, with a total funding amount of $3634.6 million, accounting for 1.6% of total development assistance for health. The top 5 donors (Global Fund to Fight AIDS, Tuberculosis and Malaria, $806.8 million; United Nations Population Fund, $401.3 million; United States, $389.9 million; United Kingdom, $251.8 million; and International Development Association, $218.6 million) together provided 56.9% of all adolescent-targeted DAAH. Sub-Saharan Africa received the largest cumulative DAAH per adolescent ($5.37) during the period. In 2015, among the 10 leading causes of disability-adjusted life-years, HIV and AIDS received the largest DAAH, followed by interpersonal violence, tuberculosis, and diarrheal diseases. Other leading causes, including road injuries and depressive disorders, received few disbursements, especially among the low-income countries.
Despite an increasing rate, DAAH composed a small proportion of total development assistance for health, suggesting that adolescent health has gained little donor attention. Moreover, recent allocations of DAAH have not aligned well with either the burden of disease or the areas where the benefits of investment are likely to be high.
在大多数卫生领域，资金的增长都为其发展提供了支撑。青少年健康最近已成为全球重点，被纳入《全球妇女、儿童和青少年健康战略》，但对于青少年健康的融资和发展援助（DAAH）模式却知之甚少。
在全球、区域和国家层面提供 DAAH 的估计数。
设计、环境和参与者：在这项质量改进研究中，使用了债权报告系统的数据来估计 DAAH 的总额和每名青少年的 DAAH，并评估其在捐助者、区域和国家之间的分布情况，以及在 2003 年 1 月 1 日至 2015 年 12 月 31 日期间，132 个发展中国家的 13 个主要疾病负担原因（即伤残调整生命年）。通过使用关键字搜索和各种资金分配方法，产生了 2 套估计数：以青少年为目标的 DAAH，包括向主要针对青少年健康的项目的支出；以及包括主要或部分针对青少年健康的项目支出的青少年包容的 DAAH，以及可能有益于青少年健康但不包括与年龄相关的关键字的项目支出。
区分以青少年为目标和包容青少年的 DAAH 的 DAAH 估计数。
在 2003 年至 2015 年期间，在以青少年为目标的估计数中，有 132 个国家的 19921 个项目，总资金为 36.346 亿美元，占卫生发展援助总额的 1.6%。前 5 大捐助方（全球抗击艾滋病、结核病和疟疾基金，8.068 亿美元；联合国人口基金，4.013 亿美元；美国，3.899 亿美元；英国，2.518 亿美元；以及国际开发协会，2.186 亿美元）共同提供了所有以青少年为目标的 DAAH 的 56.9%。撒哈拉以南非洲在这一时期每个青少年获得的累积 DAAH 最多（5.37 美元）。2015 年，在 10 大导致残疾调整生命年的主要原因中，艾滋病毒和艾滋病获得的 DAAH 最多，其次是人际暴力、结核病和腹泻病。其他主要原因，包括道路伤害和抑郁障碍，获得的拨款很少，特别是在低收入国家。
尽管增长速度不断加快，但 DAAH 在卫生发展援助总额中所占比例仍然很小，这表明青少年健康问题几乎没有得到捐助者的关注。此外，最近的 DAAH 拨款与疾病负担或投资收益可能较高的领域并不一致。
