部分发达国家卫生发展援助分析及对我国的启示

目的：分析美国、英国和日本三个发达国家卫生发展援助的资金分配特征与变化趋势,期望为中国参与国际卫生发展援助提供参考。方法：运用华盛顿大学卫生计量与评估研究所的卫生发展援助数据库,从三个国家卫生发展援助的规模、渠道、领域、区域、重点国家等维度进行描述性统计分析和比较分析。结果：自20世纪90年代以来,三个发达国家的卫生发展援助规模逐年扩大;美国以双边援助为主,主要援助领域是艾滋病;英国和日本以多边援助为主;英国主要关注妇幼健康领域,日本援助的主要领域是卫生体系建设;三个国家援助的重点区域均为撒哈拉以南非洲地区。结论：三个国家的卫生发展援助在基于各国利益、国家战略和自我优势的基础上,各有侧重。我国也应基于自身卫生发展援助的特点和现状,通过“四个融合”,形成有效合力,聚焦援助领域,开展精准援助,提高国际影响力。     

日本卫生发展援助及其对中国卫生合作的启示

目的梳理日本卫生发展援助现状及策略,探讨其对中国参与国际卫生合作的启示。方法使用PEST分析法,从政治(political)、经济(economic)、社会(social)和技术(technological)四方面分析日本卫生发展援助的外部环境,用近年日本卫生发展援助的统计数据分析日本卫生发展援助的特点,包括援助规模、途径、地区和领域。结果日本卫生发展援助具有有利的社会环境。2012—2016年日本卫生发展援助总额占官方发展援助总额的8.59%,卫生发展援助资金主要由多边机构提供,越南、印度等是援助资金的最大流入国,援助集中解决卫生政策、初级卫生保健等卫生问题。结论建议中国参与国际卫生合作时首先明确自身优势,注重打造国家品牌,通过双边卫生合作助力提升中国多边卫生议题的设置能力,进而提高中国全球卫生治理水平。     

2000—2021年中国对外卫生援助规模、渠道、区域和领域分析

目的 了解2000—2021年中国对外卫生援助的规模、渠道、区域和领域等实践状况，为完善中国对外卫生援助、融入全球卫生治理提供参考依据。方法 以《1990—2021卫生发展援助数据库》和《中国的对外援助（2014）》白皮书作为数据来源，运用IBM SPSS Statistics 26.0软件对中国2000—2021年对外卫生援助的规模、渠道、区域和领域进行描述性分析，并以此为依据分析中国对外卫生援助取得的成效。结果 2000—2021年中国对外卫生发展援助规模逐年扩大，援助金额由2000年的2.84亿美元增长至2021年的15.92亿美元，增幅达到460.56%。在援助渠道方面，中国对外卫生援助主要通过双边机构进行，通过该渠道进行援助的金额占援助总额的93.90%，通过政府和社会资本合作、开发银行、联合国机构对外援助的金额占比持续上升；在援助区域方面，撒哈拉以南非洲地区是中国对外卫生援助的重点区域，对该区域的援助金额占援助总额的58.59%；在援助领域方面，卫生系统加强是中国对外卫生援助最为重要的领域，对该领域的援助金额占援助总额的92.90%。结论 中国对外卫生援助渠道日益多元、专业...     

各国政府卫生投入及其对中国的启示

2000年9月联合国千年首脑会议通过了千年发展目标(MDGs) ,在18个千年发展目标中有5个是与健康直接相关的目标 ,另外还有3个目标与健康有间接关联。政府卫生投入是反映一个国家或地区政府对健康发展支持程度的重要指标之一 ,本文分析了各国卫生总支出、政府卫生投入占卫生总支出的比例、政府卫生投入方向以及对中国的启示。一、各国卫生总支出与政府卫生支出概况澳大利亚1998～1999年度澳洲卫生总费用为475亿澳元 ,其中联邦政府占49%,州与地方政府占20%,非政府部门支出占31 %。政府在卫生筹资领域起重要作用。联邦政府共支出235亿元 ,其中…     

中国与南太平洋国家卫生健康合作的实践、挑战与路径

中国与南太平洋国家的卫生合作是“一带一路”建设的重要组成部分。21世纪以来，中国与南太平洋国家的卫生合作已形成中央与地方、援助与合作相结合的援助格局，呈现出以卫生发展援助为主、卫生应急合作逐步加强和传染病防控合作逐渐深化等特点。同时也面临着合作机制不完善、参与主体单一、领域待拓展，以及南太平洋地区形势复杂影响合作等问题与挑战。因此，在习近平总书记构建人类命运共同体思想的引领下，中国应继续推动建立与南太平洋国家的卫生合作长效机制，加强在新冠肺炎疫情卫生应急和气候变化方面的合作，为南太平洋国家卫生健康治理贡献“中国智慧”,共同促进“一带一路”建设高质量发展。     

日本全球卫生策略及特点

日本是亚洲第一个出台全球卫生策略的国家,先后制定了四个全球卫生相关策略。本文从社会经济、卫生发展和卫生外交三方面分别介绍了日本全球卫生策略出台的背景,描述和比较日本在不同阶段全球卫生策略的目标、重点关注领域、援助措施和组织结构等,总结出日本全球卫生策略发展的基本特点:战略目标和优先领域随着国际国内形势发生变化;全球卫生策略是一个连续动态的过程;发挥高层国际会议在策略提出中的重要作用;强调多方伙伴关系;全球卫生人力资源是全球卫生策略实施的基础。本文还讨论了其对我国全球卫生策略的制定和实施的借鉴意义。     

金砖国家:国际卫生发展援助的新兴力量?

巴西、俄罗斯、印度、中国和南非五个金砖国家随着经济实力的增长,近年来在国际卫生发展援助领域逐渐成为不可忽视的力量。本文比较和分析了金砖五国在卫生发展援助方面的现状和特点,并与经济合作组织开发援助委员会成员国家进行对比,总结了金砖国家在卫生发展援助方面新的特点、优势及不足,并对于我国未来发展国际卫生发展援助提出相关政策建议。     

中国和印度对尼泊尔卫生发展援助模式的比较

目的：通过比较中国和印度对尼泊尔卫生发展援助模式的异同和引起差异的原因,探讨印度值得中国学习的援助策略.方法：利用文献综述和关键人深入访谈法实施研究.通过中国、印度和尼泊尔提供和接受援助的部门网站和官员,获取文献资料;以滚雪球式的寻找方式,对中国和印度在尼泊尔卫生发展援助项目的知情人进行个人深入访谈.结果：中国和印度具有共同的援助基本原则,但在实施政策时存在差异,印度的卫生发展援助同其整体援助目标更相关.中国和印度对卫生发展援助的组织管理机构不同、决策层不同,援助协调性有所差异.结论：南亚的地缘政治和历史因素影响到援助模式的选择,中国对尼泊尔的卫生发展援助同领域两部门管理的现状导致了援助协调问题.     

我国医疗援非中的伦理问题探究

中国对非洲国家的医疗援助是我国对外援助工作的重要组成部分,也是将我国构建人类卫生健康共同体共识理念付诸实际行动的有益探索。近年来,我国与非洲多国在卫生健康领域不断深化合作,取得突出成效的同时也彰显了中国对非医疗援助的道德坚守和伦理归宿。但是,我国在医疗援非的过程中也存在援助规模和力度受非议、援助措施可靠性受质疑、援助方案执行因风俗文化差异受阻碍等现实问题,从中反映出来的道德难题和伦理困境需得到权衡思考,并探究其中的伦理坚守与应对路径。     

政府卫生投入:国际经验与中国实践

中国卫生筹资主要来源于三个渠道:社会、政府和个人.其中,政府筹资是非常关键的渠道,对总的筹资发挥重要的导向作用.那么,政府卫生投入的变化趋势和总体特征有哪些?中国政府卫生投入要着力解决哪些问题,以更好地实现卫生公平?对此,结合其他国家及中国实践,展开分析.     

Juggling demands: Canadian health aid to Latin America since World War II

BACKGROUND: Since the development of the Commonwealth's 1950 Colombo Plan (Canada's first official aid program), health-related development assistance has been an important instrument of Canadian foreign policy, allowing it to gain a presence in a range of countries and help to shape international affairs. This pattern is evident in the history of Canadian multilateral and bilateral health aid to Latin America. METHODS: This analysis draws on historical material from the Departments of External Affairs and National Health and Welfare held at the Library and National Archives of Canada regarding Canadian involvement with the Pan American Health Organization (PAHO), and program information from the Canadian International Development Agency's (CIDA) Corporate Reporting Services Group. FINDINGS: Canada was initially a tentative player in the region. However, as Canadian foreign policy interests shifted towards the region in the 1970s, Canada used both multilateral and bilateral health aid to establish a presence in Latin America that was independent from, yet unthreatening to, United States hegemony in the region. CONCLUSION: The impact of Canada's provision of health aid to Latin America via PAHO and CIDA has been largely symbolic, allowing Canada to pursue an independent foreign policy in the region and to foster a positive international image for itself with minimal spending.     

The Role of Major Donors in Health Aid to the Democratic People's Republic of Korea

We investigated the major trends in health aid financing in the Democratic People''s Republic of Korea (DPRK) by identifying the primary donor organizations and examining several data sources to track overall health aid trends. We collected gross disbursements from bilateral donor countries and international organizations toward the DPRK according to specific health sectors by using the Organization for Economic Cooperation and Development creditor reporting system database and the United Nations Office for the Coordination of Humanitarian Affairs financial tracking service database. We analyzed sources of health aid to the DPRK from the Republic of Korea (ROK) using the official records from the ROK''s Ministry of Unification. We identified the ROK, United Nations Children''s Fund (UNICEF), World Health Organization (WHO), United Nations Population Fund (UNFPA), and The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) as the major donor entities not only according to their level of health aid expenditures but also their growing roles within the health sector of the DPRK. We found that health aid from the ROK is comprised of funding from the Inter-Korean Cooperation Fund, private organizations, local governments, and South Korean branches of international organizations such as WHO and UNICEF. We also distinguished medical equipment aid from developmental aid to show that the majority of health aid from the ROK was developmental aid. This study highlights the valuable role of the ROK in the flow of health aid to the DPRK, especially in light of the DPRK''s precarious international status. Although global health aid from many international organizations has decreased, organizations such as GFATM and UNFPA continue to maintain their focus on reproductive health and infectious diseases.     

中越卫生合作需求与策略

目的:通过分析越南的卫生合作需求,提出中越卫生合作的策略建议。方法:通过二手资料收集和定性访谈,收集健康相关可持续发展目标(SDG)数据、越南卫生发展规划、国际组织对越援助以及中越卫生合作现况。结果:越南以SDG为基础,规划优先发展领域。国际组织对越南卫生发展起到重要作用,但随着越南的经济发展,部分组织开始撤资。中越目前主要在多边合作框架下开展卫生合作,合作内容涉及卫生安全、卫生发展和医学创新。结论:中越卫生合作应根据两国卫生发展水平、卫生合作基础及国家发展规划决定合作的领域和方式。两国的卫生合作应随双方的发展进程和需求变化而动态调整。除了中越两国的资源,其他国际资源的有效利用也有助于卫生合作的推进。     

Counselling on breastfeeding: assessing knowledge and skills.

Reported are the results of a randomized controlled trial to assess the effectiveness of the WHO/UNICEF 40-hour course "Breastfeeding counselling: a training course". The course was conducted in a maternity hospital which provides care to a low-income population in a metropolitan area in São Paulo, Brazil. Health workers from 60 health units were randomly assigned to be either participants (20) or controls (40), and their breastfeeding knowledge and skills were assessed before and immediately after the course, as well as 3 months later. Immediately after the course the participants'' knowledge of breastfeeding had increased significantly compared to controls. Both their clinical and counselling skills also improved significantly. When assessed 3 months later, the scores remained high with only a small decrease. The implementation of the course was also evaluated. The methods used were participatory observation, key interviews and focus group discussion. In the 33 sessions of the course, the average score was 8.43 out of 10. Scores were highest for content and methodology of the theory sessions, and lowest for "use of time", "clinical management of lactation", and "discussion of clinical practice". "Breastfeeding counselling: a training course" therefore effectively increases health workers'' knowledge and their clinical and counselling skills for the support of breastfeeding. The course can be conducted adequately using the material and methodology proposed, but could be more satisfactory if the time allocated to exercises and clinical practice sessions were increased.     

Has the Swap Influenced Aid Flows in the Health Sector?

The sector wide approach (SWAp) emerged during the 1990s as a mechanism for managing aid from the multiplicity of development partners that operate in the recipient country's health, education or agricultural sectors. Health SWAps aim to give increased control to recipient governments, allowing greater domestic influence over how health aid is allocated and facilitating allocative efficiency gains. This paper assesses whether health SWAps have increased recipient control of health aid via increased general sector‐support and have facilitated (re)allocations of health aid across disease areas. Using a uniquely compiled panel data set of countries receiving development assistance for health over the period 1990–2010, we employ fixed effects and dynamic panel models to assess the impact of introducing a health SWAp on levels of general sector‐support for health and allocations of health‐sector aid across key funding silos (including HIV, ‘maternal and child health’ and ‘sector‐support’). Our results suggest that health SWAps have influenced health‐sector aid flows in a manner consistent with increased recipient control and improvements in allocative efficiency. Copyright © 2015 John Wiley & Sons, Ltd.     

俄罗斯卫生安全国际合作的经验和启示

本文通过分析俄罗斯卫生安全国际合作的战略政策及其开展的双边和多边行动,发现俄罗斯将卫生安全国际合作作为重要软实力工具来促进外交关系并提升国际影响力;并总体以外交战略的优先方向选择双边合作对象,通过以点带面、逐步扩散的策略,采用科技赋能的方式与各国建立有针对性的合作;同时,俄罗斯充分认识到多边机制对提升国际影响力的优势,...     

Transforming Primary Care Practices in a Hawai‘i Island Clinic: Obtaining Patient Perceptions on Patient Centered Medical Home

Health care access is a significant problem for residents of Hawai‘i Island who are experiencing a healthcare provider shortage crisis. Many residents must travel far for routine medical care, and in some cases to other islands. Hamakua Health Center, Inc., which operates from two clinical sites (Honokaa and Kapaau), is transitioning towards a Patient-Centered Medical Home care model. Through focus groups, a qualitative study was completed to obtain patient perceptions on Patient-Centered Medical Home. The Hamakua and Kohala Family Health Center staff were asked to recommend a list of patients from their respective health centers for focus group participation. In this sample (N=18), 67% of participants were female of various ethnicities. The participants'' mean age was 62.2 (SD =14.3) years. Questions asked by the moderator were based on the American College of Providers'' Patient-Centered Medical Home Assessment Tool.The three universal themes generated by the focus groups included quality care, provider and health services accessibility, and communication and coordination. Health information technology was a topic that was explored in the focus groups, and encompasses all three themes. Communication is regarded as a key to receiving quality care. Participants suggested having a rotation of specialists flown-in regularly from O‘ahu to improve care quality. Technology is appreciated as it can streamline the information exchange process, and increase the patient''s access to health services. There is unanimous concern regarding confidentiality and privacy. It is imperative that the health centers keep patients informed as they make their transition.     

中国对外援助医疗卫生机构的历史、现状与发展趋势

本研究估算中国政府每年在医疗卫生机构援助项目上的投入约2.67亿美元,接近双边卫生援助排名第五的德国的水平。援助的医疗卫生机构多为综合医院或卫生中心,地理分布上非洲最多,规模较为统一,并采用"交钥匙"的援建方式。这些项目一定程度上缓解了当地医疗卫生资源稀缺和居民就医可及性问题,并促进当地人就业与生活水平提高,但由于援助缺乏总体战略和规划的指导与统筹,缺乏对受援国卫生体系的知识经验积累,强调"需求牵引"却忽视需求评估,立项管理"重工程建设可行性、轻项目功能可行性"等问题,难以实现精准援助。未来医疗卫生机构援助应实现三个转变,即从以交付基础设施为导向的"实物援助"向"功能性援助"转变,从项目援助向方案援助转变,从单一的政府官方援助向投援结合转变。     

Latin American health policy and additive reform: the case of Guatemala

Until the mid-1960s, the market-based, dependent-development-conditioned structure of Latin American health systems reflected the skewed distribution of wealth in the region: most (including government) health resources were found in curative care medicine and were concentrated in the capital cities, where they primarily served the needs of the elite. But for many countries of the area, the 1964 PAHO-led efforts to introduce health planning, intended as a first step in rationalizing the health sector, marked a fundamental turning point in the structural development of their delivery systems. Since then, this commitment has been reaffirmed in the Latin American Ministers of Health's 1973 adoption of the primary care approach as the cornerstone of their national health plans, and their ongoing endorsement and pursuit of "Health For All by 2000." Guatemala, however, was and remains an exception. Guatemalan technocrats have proven unable to plan effectively. But, far more fundamentally, the Guatemalan oligarchy has proven unwilling to appropriate the resources necessary to effect change. The reforms that have been made have been the products of bilateral and multilateral agencies, which have conceptualized, promoted, designed, built, and underwritten them. Those changes have not altered the fundamental structure of the system, but instead have been tacked onto it, and exemplify what may be termed "additive reform." Evidence suggests that without the continued sponsorship, support, and guidance of the bilateral and multilateral agencies, even these "reforms" will prove evanescent.