Yale New Haven Hospital, Department of Surgery, New Haven, Connecticut, USA.
Beth Israel Deaconess Medical Center, Department of Surgery, Boston, Massachusetts, USA.
J Glob Health. 2024 Oct 25;14:04173. doi: 10.7189/jogh.14.04173.
Historically, the US has been the largest contributor to development assistance for health (DAH), although its allocation has shifted in response to outside forces. This included, for example, the establishment of the Millennium Development Goals (MDGs) in 2000, which emphasised child mortality, maternal health, HIV/AIDS, and malaria. This led to funds being earmarked for disease-specific interventions rather than health system strengthening (HSS). In 2007, the World Health Organization (WHO) published six health system building blocks, representing essential components of strong health systems. In 2015, the MDGs were replaced by the Sustainable Development Goals (SDGs), which emphasised capacity-building as opposed to specific health problems. The Lancet Commission on Global Surgery, meanwhile, highlighted surgical capacity building as essential to achieving Universal Health Coverage (UHC). Given the renewed emphasis on a comprehensive approach rather than disease-specific interventions, one might anticipate the US aligning with this rhetoric in its allocation of DAH. However, we hypothesise that this is not the case.
We queried the Organization for Economic Co-operation and Development (OECD) database for allocation of US DAH to low- and middle-income countries between 1995 and 2019, thereby excluding data after 2019 to avoid the influence of the coronavirus disease 2019 pandemic. OECD entries were assigned to health systems strengthening (HSS) or disease-specific interventions categories. The WHO building blocks were used as a framework for health systems strengthening.
From 1995 to 1999, US DAH allocated to HSS decreased from 42% to 34%. The allocation decreased further from 34% in 2000 to 4% in 2007; correspondingly, DAH allocated to disease-specific interventions increased from 67% to 96%. Between 2008 and 2019, the distribution of US DAH remained relatively stable, with funds allocated to HSS versus disease-specific interventions ranging from 3-12% and 88-98% respectively.
While total US DAH contributions in the 1990s and early 2000s were significantly lower compared to the decade that followed, the distribution of these funds was more evenly divided between HSS and disease-specific interventions. Despite attempts by the WHO and United Nations to redirect attention to HSS as the path to achieving UHC, the US continues to largely support disease-specific interventions and overlook the importance of HSS, including surgical capacity building.
历史上，美国一直是卫生发展援助（DAH）的最大贡献者，尽管其分配因外部力量而发生了变化。例如，2000 年设立了千年发展目标（MDGs），强调儿童死亡率、孕产妇健康、艾滋病毒/艾滋病和疟疾。这导致资金专门用于针对特定疾病的干预措施，而不是加强卫生系统（HSS）。2007 年，世界卫生组织（WHO）发布了 6 个卫生系统组成部分，代表了强大卫生系统的基本组成部分。2015 年，MDGs 被可持续发展目标（SDGs）取代，该目标强调能力建设而不是具体的健康问题。与此同时，柳叶刀全球外科委员会强调外科能力建设对于实现全民健康覆盖（UHC）至关重要。鉴于人们重新强调全面的方法而不是针对特定疾病的干预措施，人们可能会预期美国在其 DAH 分配中与这一说法保持一致。然而，我们假设事实并非如此。
我们查询了经济合作与发展组织（OECD）数据库，以获取 1995 年至 2019 年期间美国对低收入和中等收入国家的 DAH 分配情况，从而排除了 2019 年以后的数据，以避免 2019 年冠状病毒病（COVID-19）大流行的影响。OECD 条目被分配到卫生系统加强（HSS）或针对特定疾病的干预类别。世卫组织的组成部分被用作卫生系统加强的框架。
1995 年至 1999 年，美国用于 HSS 的 DAH 从 42%降至 34%。这一分配比例在 2000 年进一步降至 34%，在 2007 年降至 4%；相应地，用于针对特定疾病的干预措施的 DAH 从 67%增加到 96%。2008 年至 2019 年，美国 DAH 的分配情况相对稳定，用于 HSS 与针对特定疾病的干预措施的资金分别占 3-12%和 88-98%。
尽管 20 世纪 90 年代和 21 世纪初美国的 DAH 捐款总额明显低于随后的十年，但这些资金的分配在 HSS 和针对特定疾病的干预措施之间更为平均。尽管世卫组织和联合国试图将注意力重新转向 HSS 作为实现 UHC 的途径，但美国仍在很大程度上支持针对特定疾病的干预措施，而忽视了 HSS 的重要性，包括外科能力建设。
