Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States.
RTI International, United States.
Econ Hum Biol. 2021 May;41:100935. doi: 10.1016/j.ehb.2020.100935. Epub 2020 Nov 18.
Foreign health aid forms a substantial portion of health spending in many low- and middle-income countries (LMICs). It can be either vertical (funds earmarked for specific diseases) or horizontal (funds used for broad health sector strengthening). Historically, most health aid has been disbursed vertically toward key infectious diseases, with minimal allocations to noncommunicable diseases (NCDs). High NCD burden in LMICs underscores a need for increased assistance toward NCD objectives, but evidence on the outcomes of health aid for NCDs is sparse. We obtained annual data on cause-specific deaths and disability-adjusted life years (DALYs) for four leading NCDs across 116 countries, 2000-2016, and evaluated the relationship between these indicators and vertical and horizontal health aid using country fixed-effects models with 1-to-5-year lagged effects. After adjusting for fixed and time-variant country heterogeneity, vertical assistance for NCDs was significantly associated with subsequent reductions in NCD morbidity and mortality, particularly for persons under age 70 and for cardiovascular and chronic respiratory diseases. An additional dollar in per-capita NCD vertical assistance corresponded to reductions in the average annual NCD burden of 7,459 DALYs/281 deaths after one year, 7,728 DALYs/319 deaths after two years, and 8,957 DALYs/346 deaths after three years. The findings suggest that vertical assistance for NCD programs may be an appropriate mechanism for addressing short-term NCD needs in LMICs, where it may help to fill health sector gaps in NCD care, but longer-term evaluation is needed for assessing the role of horizontal assistance.
在许多中低收入国家（LMICs），国外卫生援助构成了卫生支出的重要组成部分。它可以是垂直的（专门用于特定疾病的资金），也可以是水平的（用于广泛的卫生部门加强的资金）。从历史上看，大多数卫生援助都是针对主要传染病的垂直分配，对非传染性疾病（NCDs）的分配最少。LMICs 中 NCD 负担高，凸显出需要增加对 NCD 目标的援助，但关于 NCD 卫生援助结果的证据很少。我们获得了 2000 年至 2016 年 116 个国家四种主要 NCD 的特定病因死亡和残疾调整生命年（DALYs）的年度数据，并使用具有 1 至 5 年滞后效应的国家固定效应模型评估了这些指标与垂直和水平卫生援助之间的关系。在调整了固定和时变的国家异质性后，NCD 垂直援助与 NCD 发病率和死亡率的后续降低显著相关，特别是对于 70 岁以下的人群以及心血管和慢性呼吸系统疾病。人均 NCD 垂直援助增加 1 美元，相当于在第 1 年、第 2 年和第 3 年分别减少 NCD 负担的年均 7459 个 DALYs/281 人死亡、7728 个 DALYs/319 人死亡和 8957 个 DALYs/346 人死亡。研究结果表明，NCD 计划的垂直援助可能是解决 LMICs 短期 NCD 需求的适当机制，因为它可能有助于弥补 NCD 护理方面的卫生部门差距，但需要进行更长期的评估，以评估水平援助的作用。
