J Health Care Poor Underserved. 2020;31(1):56-74. doi: 10.1353/hpu.2020.0008.
Despite high health expenditures, Lesotho had some of the world's worst health indicators between 2000 and 2014. Official development assistance tripled from $37 to $107 million. PEPFAR funding rose from $3.8 to $32.4 million. Yet, deaths from TB, HIV, infant mortality, and maternal mortality remained unchanged. Lesotho had declining health outcomes amidst increased disease-focused financing and several large infrastructure projects. A World Bank loan financed the state-of-the-art Mamohato Hospital, and the U.S.-supported $362.5 million Millennium Challenge Corporation Project supported primary and secondary health infrastructure. This analysis uses the WHO Health Systems Framework to explore the unintended consequences of health financing on Lesotho's health outcomes. The WHO Health Systems Framework can be used to optimize health financing through investments in health service delivery, health workforce, health information, essential medicines, leadership, and equitable financial strategies. This approach can support governments to achieve universal health coverage and develop comprehensive health systems.
尽管卫生支出很高，但 2000 年至 2014 年期间，莱索托的一些健康指标仍是世界上最差的。官方发展援助从 3700 万美元增加到 1.07 亿美元，增加了两倍。PEPFAR 资金从 3800 万美元增加到 3.24 亿美元。然而，结核病、艾滋病毒、婴儿死亡率和孕产妇死亡率的死亡人数仍保持不变。在疾病重点融资和几个大型基础设施项目增加的情况下，莱索托的健康状况却在下降。世界银行的一笔贷款为最先进的马莫哈托医院提供了资金，美国支持的 3.625 亿美元千年挑战公司项目支持了初级和二级卫生基础设施。本分析使用世卫组织卫生系统框架来探讨卫生筹资对莱索托健康结果的意外后果。世卫组织卫生系统框架可通过投资于卫生服务提供、卫生人力、卫生信息、基本药物、领导力和公平的财务战略来优化卫生筹资。这种方法可以支持政府实现全民健康覆盖并制定全面的卫生系统。
