Xie Siwei, Du Sijin, Huang Yuxin, Luo Yan, Chen Ying, Zheng Zhijie, Yuan Beibei, Xu Ming, Zhou Shuduo
Department of Biostatistics, Peking University First Hospital, Beijing, China.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
BMJ Glob Health. 2025 Jan 11;10(1):e017818. doi: 10.1136/bmjgh-2024-017818.
Development assistance for health (DAH) plays a vital role in supporting health programmes in low- and middle-income countries. While DAH has historically focused on infectious diseases and maternal and child health, there is a lack of comprehensive analysis of DAH trends, strategic shifts and their impact on health systems and outcomes. This study aims to provide a comprehensive review of DAH from 1990 to 2022, examining its evolution and funding allocation shifts.
We conducted a mixed-methods review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search was performed across PubMed, Embase, Web of Science and the Cochrane databases, yielding 102 eligible studies. Quantitative data were obtained from the Institute for Health Metrics and Evaluation database, covering DAH data from 1990 to 2022. Qualitative data were analysed through thematic synthesis based on the WHO's six health system building blocks.
The DAH has predominantly focused on HIV/AIDS and maternal and child health. Despite the increasing global burden of non-communicable diseases (NCDs), the proportion of DAH allocated to NCDs remained low, increasing only from 1% in 1990 to 2% in 2022. Similarly, the overall funding for health system strengthening decreased from 19% in 1990 to 7% in 2022. Major contributors to DAH included the USA, the UK and the Bill & Melinda Gates Foundation. While associations between DAH and improvements in certain health outcomes were observed, establishing causality is challenging due to multiple influencing factors. The COVID-19 pandemic underscored the importance of robust health systems. However, DAH allocation did not show any substantial shift towards health system strengthening during this period. Economic evaluations calculated the median incremental cost-effectiveness ratio of DAH interventions, CONCLUSIONS: This study reviews DAH trends from 1990 to 2022, showing a predominant focus on HIV/AIDS and maternal and child health, with insufficient attention to NCDs and health system strengthening. Despite the increasing burden of NCDs and the impact of COVID-19, DAH priorities have not significantly shifted, highlighting the need for ongoing evaluation and strategic adjustments. To enhance DAH effectiveness, it is crucial to adopt a more balanced approach and also align interventions with needs from recipient countries and implement evidence-based strategies with continuous monitoring and evaluation.
卫生发展援助（DAH）在支持低收入和中等收入国家的卫生项目方面发挥着至关重要的作用。虽然历史上DAH主要关注传染病以及孕产妇和儿童健康，但缺乏对DAH趋势、战略转变及其对卫生系统和成果影响的全面分析。本研究旨在对1990年至2022年的DAH进行全面综述，考察其演变和资金分配变化。
我们遵循系统评价和荟萃分析的首选报告项目指南进行了一项混合方法综述。在PubMed、Embase、科学引文索引和考科蓝数据库中进行了系统的文献检索，得到102项符合条件的研究。定量数据来自健康指标与评估研究所数据库，涵盖1990年至2022年的DAH数据。定性数据通过基于世界卫生组织六个卫生系统组成部分的主题综合进行分析。
DAH主要集中在艾滋病毒/艾滋病以及孕产妇和儿童健康方面。尽管全球非传染性疾病（NCD）负担不断增加，但分配给非传染性疾病的DAH比例仍然很低，仅从1990年的1%增至2022年的2%。同样，用于加强卫生系统的总体资金从1990年的19%降至2022年的7%。DAH的主要捐助方包括美国、英国和比尔及梅琳达·盖茨基金会。虽然观察到DAH与某些健康成果改善之间存在关联，但由于多种影响因素，确定因果关系具有挑战性。COVID-19大流行凸显了强大卫生系统的重要性。然而，在此期间，DAH分配并未显示出向加强卫生系统的任何实质性转变。经济评估计算了DAH干预措施的中位数增量成本效益比。
本研究回顾了1990年至2022年的DAH趋势，表明主要关注艾滋病毒/艾滋病以及孕产妇和儿童健康，对非传染性疾病和卫生系统加强关注不足。尽管非传染性疾病负担不断增加以及COVID-19产生了影响，但DAH的优先事项并未显著转变，这突出表明需要持续评估和战略调整。为提高DAH的有效性，采取更平衡的方法并使干预措施与受援国需求相匹配，以及通过持续监测和评估实施循证战略至关重要。
