Taylor C E, Cutts F, Taylor M E
Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, MD 21205, USA.
Am J Public Health. 1997 Jun;87(6):922-5. doi: 10.2105/ajph.87.6.922.
Intensification of polio eradication efforts worldwide raises concerns about costs and benefits for poor countries. A major argument for global funding is the high benefit-cost ratio of eradication; however, financial benefits are greatest for rich countries. By contrast, the greatest costs are borne by poor countries; the Pan American Health Organization has estimated that host countries bore 80% of costs for polio eradication in the Americas. The 1988 World Health Assembly resolution setting up the Polio Eradication Initiative carried the proviso that programs should strengthen health infrastructures. Drastic cuts in donor funding for health make this commitment even more important. Two international evaluations have reported both positive and negative effects of polio and Expanded Programme on Immunization programs on the functioning and sustainability of primary health care. Negative effects were greatest in poor countries with many other diseases of public health importance. If poor countries are expected to divert funds from their own urgent priorities, donors should make solid commitments to long-term support for sustainable health development.
全球加强脊髓灰质炎根除工作引发了对贫穷国家成本与收益的担忧。全球资助的一个主要论据是根除工作的高成本效益比；然而，经济收益对富裕国家最为可观。相比之下，最大的成本由贫穷国家承担；泛美卫生组织估计，美洲的脊髓灰质炎根除工作中，东道国承担了80%的成本。1988年世界卫生大会设立根除脊髓灰质炎倡议的决议附带条件，即各项计划应加强卫生基础设施。捐助方大幅削减对卫生领域的资金投入，使得这一承诺变得更加重要。两项国际评估报告了脊髓灰质炎及扩大免疫规划对初级卫生保健的运作和可持续性产生的正面和负面影响。在存在许多其他具有公共卫生重要性疾病的贫穷国家，负面影响最为严重。如果期望贫穷国家从自身紧迫的优先事项中挪用资金，那么捐助方应做出坚定承诺，为可持续的卫生发展提供长期支持。
