Health Systems Strengthening, Clinton Health Access Initiative (CHAI), Lilongwe, Private Bag 341, Malawi.
Sustainable Health Financing and Health Workforce, Clinton Health Access Initiative (CHAI), Lilongwe, Private Bag 341, Malawi.
Health Policy Plan. 2024 Jan 23;39(Supplement_1):i118-i124. doi: 10.1093/heapol/czad102.
Development assistance is a major source of financing for health in least developed countries. However, persistent aid fragmentation has led to inefficiencies and health inequities and constrained progress towards Universal Health Coverage (UHC). Malawi is a case study for this global challenge, with 55% of total health expenditure funded by donors and fragmentation across 166 financing sources and 265 implementing partners. This often leads to poor coordination and misalignment between government priorities and donor projects. To address these challenges, the Malawi Ministry of Health (MoH) has developed and implemented an architecture of aid coordination tools and processes. Using a case study approach, we documented the iterative development, implementation and institutionalization of these tools, which was led by the MoH with technical assistance from the Clinton Health Access Initiative. We reviewed the grey literature, including relevant policy documents, planning tools and databases of government/partner funding commitments, and drew upon the authors' experiences in designing, implementing and scaling up these tools. Overall, the iterative use and revision of these tools by the Government of Malawi across the national and subnational levels, including integration with the government's public financial management system, was critical to successful uptake. The tools are used to inform government and partner resource allocation decisions, assess financing and gaps for national and district plans and inform donor grant applications. As Malawi has launched the Health Sector Strategic Plan 2023-2030, these tools are being adapted for the 'One Plan, One Budget and One Report' approach. However, while the tools are an incremental mechanism to strengthen aid alignment, success has been constrained by the larger context of power imbalances and misaligned incentives between the donor community and the Government of Malawi. Reform of the aid architecture is therefore critical to ensure that these tools achieve maximum impact in Malawi's journey towards UHC.
发展援助是最不发达国家卫生筹资的主要来源。然而，援助碎片化问题持续存在，导致效率低下和卫生不公平，并限制了全民健康覆盖（UHC）的进展。马拉维就是这一全球挑战的一个案例，其总卫生支出的 55%由捐助者提供，碎片化问题涉及 166 个供资来源和 265 个执行伙伴。这往往导致政府优先事项与捐助者项目之间缺乏协调和错位。为了解决这些挑战，马拉维卫生部（MoH）开发并实施了援助协调工具和流程架构。我们采用案例研究方法，记录了这些工具的迭代开发、实施和制度化过程，由 MoH 牵头，克林顿健康倡议（Clinton Health Access Initiative）提供技术援助。我们审查了灰色文献，包括相关政策文件、规划工具以及政府/伙伴供资承诺数据库，并借鉴了作者在设计、实施和扩大这些工具方面的经验。总体而言，马拉维政府在国家和次国家各级对这些工具的迭代使用和修订，包括将其纳入政府公共财务管理系统，对成功采用至关重要。这些工具用于为政府和伙伴的资源分配决策提供信息，评估国家和地区计划的供资和差距，并为捐助者赠款申请提供信息。随着马拉维推出了 2023-2030 年卫生部门战略计划，这些工具正在适应“一个计划、一个预算和一个报告”的方法。然而，虽然这些工具是加强援助一致性的一种渐进机制，但由于捐助方社区和马拉维政府之间权力不平衡以及激励措施不一致的更大背景，成功受到了限制。因此，改革援助架构对于确保这些工具在马拉维实现全民健康覆盖的道路上发挥最大影响至关重要。
