Moitra Modhurima, Cogswell Ian, Maddison Emilie, Simpson Kyle, Stutzman Hayley, Tsakalos Golsum, Dieleman Joseph, Micah Angela E
Department of Health Metrics Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.
BMJ Glob Health. 2021 Apr;6(4). doi: 10.1136/bmjgh-2020-004858.
In 2017, development assistance for health (DAH) comprised 5.3% of total health spending in low-income countries. Despite the key role DAH plays in global health-spending, little is known about the characteristics of assistance that may be associated with committed assistance that is actually disbursed. In this analysis, we examine associations between these characteristics and disbursement of committed assistance.
We extracted data from the Creditor Reporting System of the Organization for Economic Co-operation and Development, Institute for Health Metrics and Evaluation, and the WHO National Health Accounts database. Factors examined were off-budget assistance, administrative assistance, publicly sourced assistance and assistance to health systems strengthening. Recipient-country characteristics examined were perceived level of corruption, civil fragility and gross domestic product per capita (GDPpc). We used linear regression methods for panel of data to assess the proportion of committed aid that was disbursed for a given country-year, for each data source.
Factors that were associated with a higher disbursement rates include off-budget aid (p<0.001), lower administrative expenses (p<0.01), lower perceived corruption in recipient country (p<0.001), lower fragility in recipient country (p<0.05) and higher GDPpc (p<0.05).
Substantial gaps remain between commitments and disbursements. Characteristics of assistance (administrative, publicly sourced) and indicators of government transparency and fragility are also important drivers associated with disbursement of DAH. There remains a continued need for better aid flow reporting standards and clarity around aid types for better measurement of DAH.
2017年，卫生领域发展援助（DAH）占低收入国家卫生总支出的5.3%。尽管DAH在全球卫生支出中发挥着关键作用，但对于可能与实际支付的承诺援助相关的援助特征却知之甚少。在本分析中，我们研究了这些特征与承诺援助支付之间的关联。
我们从经济合作与发展组织的债权人报告系统、健康指标与评估研究所及世界卫生组织国家卫生账户数据库中提取数据。所考察的因素包括预算外援助、行政援助、公共来源援助以及对卫生系统加强的援助。所考察的受援国特征包括感知到的腐败水平、国内脆弱性和人均国内生产总值（GDPpc）。我们使用面板数据的线性回归方法，针对每个数据源评估给定国家年份中承诺援助的支付比例。
与较高支付率相关的因素包括预算外援助（p<0.001）、较低的行政费用（p<0.01）、受援国较低的感知腐败水平（p<0.001）、受援国较低的脆弱性（p<0.05）以及较高的GDPpc（p<0.05）。
承诺与支付之间仍存在巨大差距。援助的特征（行政、公共来源）以及政府透明度和脆弱性指标也是与DAH支付相关的重要驱动因素。仍持续需要更好的援助流动报告标准以及关于援助类型的明确界定，以便更好地衡量DAH。
