Kraus Jessica, Yamey Gavin, Schäferhoff Marco, Petitjean Hugo, Hale Jessica, Karakulah Kenan, Kardish Chris, Pineda Estuardo, Sanders Francesca, Beyeler Naomi, Fewer Sara, Nugent Rachel, Jamison Dean T, Oppenheim Ben, Gill Indermit
SEEK Development, Berlin, Germany.
Duke Global Health Institute, Duke University, Durham, North Carolina, USA.
F1000Res. 2020 Jun 9;9:584. doi: 10.12688/f1000research.24012.1. eCollection 2020.
: Health systems strengthening (HSS) and health security are two pillars of universal health coverage (UHC). Investments in these areas are essential for meeting the Sustainable Development Goals and are of heightened relevance given the emergence of the 2019 novel coronavirus disease (COVID-19). This study aims to generate information on development assistance for health (DAH) for these areas, including how to track it and how funding levels align with country needs. : We developed a framework to analyze the amount of DAH disbursed in 2015 for the six building blocks of the health system ('system-wide HSS') plus health security (emergency preparedness, risk management, and response) at both the global (transnational) and country level. We reviewed 2,427 of 32,801 DAH activities in the Creditor Reporting System (CRS) database (80% of the total value of disbursements in 2015) and additional public information sources. Additional aid activities were identified through a keyword search. : In 2015, we estimated that US$3.1 billion (13.4%) of the US$22.9 billion of DAH captured in the CRS database was for system-wide HSS and health security: US$2.5 billion (10.9%) for system-wide HSS, mostly for infrastructure, and US$0.6 billion (2.5%) for system-wide health security. US$567.1 million (2.4%) was invested in supporting these activities at the global level. If responses to individual health emergencies are included, 7.5% of total DAH (US$1.7B) was for health security. We found a correlation between DAH for HSS and maternal mortality rates, and we interpret this as evidence that HSS aid generally flowed to countries with greater need. Achieving UHC by 2030 will require greater investments in system-wide HSS and proactive health emergency preparedness. It may be appropriate for donors to more prominently consider country needs and global functions when investing in health security and HSS.
卫生系统强化（HSS）和卫生安全是全民健康覆盖（UHC）的两大支柱。对这些领域的投资对于实现可持续发展目标至关重要，鉴于2019年新型冠状病毒病（COVID-19）的出现，其相关性更加凸显。本研究旨在生成有关这些领域卫生发展援助（DAH）的信息，包括如何跟踪援助以及资金水平如何与国家需求相匹配。
我们制定了一个框架，以分析2015年在全球（跨国）和国家层面为卫生系统的六个组成部分（“全系统HSS”）以及卫生安全（应急准备、风险管理和应对）所支付的DAH金额。我们审查了债权国报告系统（CRS）数据库中32801项DAH活动中的2427项（占2015年支付总额的80%）以及其他公共信息来源。通过关键词搜索确定了其他援助活动。
2015年，我们估计CRS数据库中记录的229亿美元DAH中，有31亿美元（13.4%）用于全系统HSS和卫生安全：25亿美元（10.9%）用于全系统HSS，主要用于基础设施建设；6亿美元（2.5%）用于全系统卫生安全。5.671亿美元（2.4%）投资于全球层面的这些活动支持。如果将对个别卫生紧急情况的应对包括在内，DAH总额的7.5%（17亿美元）用于卫生安全。我们发现HSS的DAH与孕产妇死亡率之间存在相关性，我们将此解释为HSS援助通常流向需求更大国家的证据。
到2030年实现全民健康覆盖将需要对全系统HSS和积极的卫生应急准备进行更多投资。在投资卫生安全和HSS时，捐助方更突出地考虑国家需求和全球职能可能是合适的。
