Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA.
Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA.
Lancet Glob Health. 2021 Feb;9(2):e181-e188. doi: 10.1016/S2214-109X(20)30420-4.
The Global Fund to Fight AIDS, Tuberculosis and Malaria is a robust vertical global health programme. The extent to which vertical programmes financially support health security has not been investigated. We, therefore, endeavoured to quantify the extent to which the budgets of this vertical programme support health security. We believe this is a crucial area of work as the global community works to combine resources for COVID-19 response and future pandemic preparedness.
We examined budgets for work in Kenya, Uganda, Vietnam, Democratic Republic of the Congo, Guatemala, Guinea, India, Indonesia, Nigeria, and Sierra Leone from January, 2014 to December, 2020. These ten countries were selected because of the robustness of investments and the availability of data. Using the International Health Regulations Joint External Evaluation (JEE) tool as a framework, we mapped budget line items to health security capacities. Two researchers independently reviewed each budget and mapped items to the JEE. Budgets were then jointly reviewed until a consensus was reached regarding if an item supported health security directly, indirectly, or not at all. The budgets for the study countries were inputted into a single Microsoft Excel spreadsheet and line items that mapped to JEE indicators were scaled up to their respective JEE capacity. Descriptive analyses were then done to determine the total amount of money budgeted for activities that support health security, how much was budgeted for each JEE capacity, and how much of the support was direct or indirect.
The research team reviewed 37 budgets. Budgets totalled US$6 927 284 966, and $2 562 063 054 (37·0%) of this mapped to JEE capacities. $1 330 942 712 (19·2%) mapped directly to JEE capacities and $1 231 120 342 (17·8%) mapped indirectly to JEE capacities. Laboratory systems, antimicrobial resistance, and the deployment of medical countermeasures and personnel received the most overall budgetary support; laboratory systems, antimicrobial resistance, and workforce development received the greatest amount of direct budgetary support.
Over one-third of the Global Fund's work also supports health security and the organisation has budgeted more than $2 500 000 000 for activities that support health security in ten countries since 2014. Although these funds were not budgeted specifically for health security purposes, recognising how vertical programmes can synergistically support other global health efforts has important implications for policy related to health systems strengthening.
Resolve to Save Lives: An Initiative of Vital Strategies.
全球抗击艾滋病、结核病和疟疾基金是一个强大的垂直全球卫生方案。尚未对该垂直方案在财政上支持卫生安全的程度进行调查。因此，我们努力量化该垂直方案预算支持卫生安全的程度。我们认为，这是一个至关重要的工作领域，因为全球社会正在努力整合资源，以应对新冠疫情和未来的大流行防范。
我们检查了肯尼亚、乌干达、越南、刚果民主共和国、危地马拉、几内亚、印度、印度尼西亚、尼日利亚和塞拉利昂从 2014 年 1 月至 2020 年 12 月的工作预算。选择这十个国家是因为投资力度大，数据可用性高。我们使用《国际卫生条例》联合外部评估（JEE）工具作为框架，将预算项目与卫生安全能力相对应。两名研究人员独立审查了每个预算，并将项目与 JEE 进行了对应。然后，对预算进行了联合审查，直到就项目是否直接、间接或根本不支持卫生安全达成共识。研究国家的预算被输入到一个单独的 Microsoft Excel 电子表格中，与 JEE 指标相对应的项目被扩展到各自的 JEE 能力。然后进行描述性分析，以确定用于支持卫生安全的活动预算总额、为每个 JEE 能力预算的金额，以及直接或间接支持的金额。
研究小组审查了 37 份预算。预算总额为 69.272.849.66 美元，其中 256206.305.4 美元（37.0%）与 JEE 能力相对应。1330942712 美元（19.2%）直接对应 JEE 能力，1231120342 美元（17.8%）间接对应 JEE 能力。实验室系统、抗菌素耐药性以及医疗对策和人员的部署获得了最多的总体预算支持；实验室系统、抗菌素耐药性和劳动力发展获得了最多的直接预算支持。
全球基金工作的三分之一以上也支持卫生安全，自 2014 年以来，该组织已为十个国家支持卫生安全的活动预算超过 25 亿美元。尽管这些资金不是专门为卫生安全目的预算的，但认识到垂直方案如何协同支持其他全球卫生努力，对与加强卫生系统相关的政策具有重要意义。
拯救生命的决心：Vital Strategies 的倡议。
