云南省2000～2005年艾滋病防治经费投入及流向分析

对云南省2000～2005年中央财政转移支付的艾滋病防治专项经费、云南省省级财政用于艾滋病防治的专项经费、中英项目投入经费及经费使用情况、23个中英项目县各级政府艾滋病防治专项经费投入及使用情况进行综合分析。结果表明,各级政府高度重视我省的艾滋病防治工作,投入经费逐年递增;中英项目经费的投入弥补了我省艾滋病防治经费的不足,中英项目投入经费的使用方向与政府艾滋病防治专项投入经费的使用方向有很好的互补作用。     

艾滋病防制措施效果的经济学评价

艾滋病已成为迫切需要解决的重大公共卫生问题,目前国家出台了一系列艾滋病防治的政策和实施计划,国家专项经费投入逐年增多,各级地方政府安排的艾滋病防治经费也有较多增加,同时国际社会对中国艾滋病的投入明显增多。但由于缺乏必要的评估,尤其是经济学评价,存在着实施计划落实不力、现有资金的分配和使用不够合理的现象,未能使各级政府投入、国际组织投入等有限的卫生资源获得最大的效果。     

基层疾病预防控制机构艾滋病防治经费的使用管理

当前,在认真落实重点传染病的预防控制业务工作中,怎样加强对艾滋病防治经费的科学规范管理,提高资金的使用效率,保证艾滋病防治事业的健康发展,是一项复杂而具有挑战性的系统工程。笔者认为,艾滋病防治经费管理可按资金的运作过程分为资金筹集、分配、拨付使用及监督评估等环节。基层区县疾控机构日常艾滋病防治工作经费管理应重点掌握以下环节：协调机制、持续投入、保障重点、规范管理、提高效率。     

大区域控制血吸虫病经费的使用和管理

一、科学考查、作出计划在专项经费分配下达前,县血地办组织人员进行了大量的调查摸底工作,根据我县防治工作,机构建设的实际需要拟订了初步计划,并积极向上反映情况,争取上级支持。专项经费和防治任务确定以后,又组织有关人员对限定经费内的计划安排进行科学考查,预测、论证,把需要和现实结合起来,分清主次与轻重缓急,使计划要办的事情件件得到落实。县大区域控制血吸虫病办公室根据以上原则对分配我县的专项经费制定了详细的安排计划和实施意     

山西省某县基本公共卫生服务专项经费管理的调查与思考

目的研究山西省某县基本公共卫生服务专项经费的拨付、补偿和使用情况,为县域内该专项经费的管理提供理论支持和实践经验。方法采用半结构式访谈法,并查阅相关机构数据和文献,以定性研究为主,分析该县基本公共卫生服务专项经费管理的优势和弊端,并提出改进的建议。结果该县基本公共卫生服务专项经费拨付和成本测算较科学合理,但经费支出中人员补助和耗材费用比例失调,补偿机制不利于调动各参与方的积极性,经费使用细节上也存在改善空间。结论调整专项经费的拨付制度和拨付标准,合理分配经费,有效激励各参与方,并规范服务成本的测算,进而提高基本公共卫生服务质量。     

艾滋病防治经费管理研究:现状、问题及成因

艾滋病防治经费管理,可按资金运动过程分为资金筹集、分配、拨付与使用,以及监督与评估等环节.通过现状分析,我们认为,我国艾滋病防治经费管理正在不断规范,管理水平明显提高,但同时也存在一些不可忽视的问题.通过发现问题,寻找问题的成因,为研究解决问题的对策创造条件.     

民主党派在艾滋病防治中的作用探讨

目的在长沙市市委、市政府领导下,在卫生部门的具体组织下,积极调动民主党派等社会力量参与艾滋病综合防治工作,减缓甚至阻断艾滋病的迅速蔓延。方法组织医疗卫生机构专家中的民主党派调研艾滋病防治工作,撰写并通过市政协会议提交提案,引起市委、市政府主要领导的高度重视,根据市领导的重要批示,及时进行多部门协调、制定政策文件、有效解决艾滋病防治工作中存在的部门协作、政策不全、资金不足等问题。结果通过民主党派积极建言,政府对艾滋病防治工作更加重视,一系列艾滋病预防控制、职业暴露防护、经费保障等政策文件陆续出台,确保了艾滋病防治工作有章可循、经费到位、措施落实。全市各级政府艾滋病防治专项经费预算从2006年的326.81万元,增加至2009年的575.89万元,增长76.22%;艾滋病疫情从2006年前的年增长翻倍,下降至2009年的年增长仅20.51%,增长速度明显趋缓。结论要做好艾滋病防治工作,关键在于领导层的开发,在于领导的重视和支持,利用民主党派进言能达到事半功倍的效果。     

凉山州四地区多部门开展艾滋病防治工作的策略研究

目的全面了解凉山州政府多部门开展艾滋病防治工作的现状,分析其面临的主要挑战,为推进政府多部门开展艾滋病防治工作提供决策依据。方法采用个人深入访谈法、非概率抽样的方法对凉山州四地区政府多部门开展艾滋病防治工作的28名分管领导、业务骨干进行定性访谈,利用MAXQDA 10进行资料整理,建立主题框架法进行资料分析。结果目前,各地区政府部门多结合日常工作开展艾滋病防治工作,普遍存在多部门合作机制不完善、专项经费分配机制不健全、人力资源缺乏等问题。结论凉山州在艾滋病防治工作中取得了一定的成绩,多部门应制定相应规章制度、加强各部门协调合作机制、统筹专项经费安排、提升艾防人员的数量与质量。     

加强艾滋病防治经费管理的思路和对策

一、思路 加强对艾滋病防治经费的管理，提高资金的使用效率，保证艾滋病防治事业的健康发展，是一个极其复杂而艰巨的系统工程。系统的有序运行依赖于科学的系统目标，艾滋病防治经费管理的目标可以简单地概括为：协调机制、持续投入、保障重点、规范管理、提高效率。协调机制主要是指筹资计划与资金需求的协调，工作任务与物资、货币资源的协调，工作流程与资源流程的时间协调、各部门之间经费安排的协调等。持续投入主要包括防治资金总量的持续稳定和对防治资金在特定项目上的持续性两方面的内容。在对艾滋病防治短期和长期的资源总体需求预测基础上广开筹资渠道，保证资金来源的持续性，以资金来源的持续性保证艾滋病防治工作的持续性。保障重点是指在经费管理中要依据疫情的发展变化，恰当确定投入的工作重点，依据各地的财力状况恰当确定中央专项资金投入的地区重点，依据管理工作的实际情况恰当确定艾滋病防治经费监管的重点等。规范管理是指艾滋病防治经费的管理应当具有科学规范的制度，并保证这些制度能得到切实的执行，对不规范的行为能够追究明确的责任。提高效率是指在总结我国艾滋病防治经费管理经验的基础上，借鉴国际先进经验，不断提高资金筹集、分配拨付以及使用的效率。上述目标的实现有赖于管理能力的提高、管理制度的完善和管理方法的改进，因此，加强艾滋病防治经费管理必须以培养管理能力、完善管理制度和创新管理方法作为突破口。     

中央年投入防艾专款增至8亿多

从11月28日召开的全国防治艾滋病电视电话会议上了解到,近年来,中央财政逐年加大艾滋病防治专项经费投入,2005年,专项投入已增加到8·01亿元,其中7·01亿元为中央转移地方支付经费。中央财政艾滋病防治专项经费2002年为1亿元,2003年为3·9亿元。同时,地方财政也加大了投入力度,     

A model for allocating CDC’s HIV prevention resources in the United States

The Division of HIV/AIDS Prevention (DHAP) at the Centers for Disease Control and Prevention has an annual budget of approximately $325 million for funding HIV prevention programs in the U.S. The purpose of this paper is to thoroughly describe the methods used to develop a national HIV resource allocation model intended to inform DHAP on allocation strategies that might improve the overall effectiveness of HIV prevention efforts. The HIV prevention resource allocation problem consists of choosing how to apportion prevention resources among interventions and populations so that HIV incidence is minimized, given a budget constraint. We developed an epidemic model that projects HIV infections over time given a specific allocation scenario. The epidemic model is then embedded in a nonlinear mathematical optimization program to determine the allocation scenario that minimizes HIV incidence over a 5-year horizon. In our model, we consider the general U.S. population and specific at-risk populations. The at-risk populations include 15 subgroups structured by gender, race/ethnicity and HIV transmission risk group. HIV transmission risk groups include high-risk heterosexuals, men who have sex with men and injection drug users. We consider HIV screening interventions and interventions to reduce HIV-related risk behaviors. The output of the model is the optimal funding scenario indicating the amounts to be allocated to all combinations of populations and interventions. For illustrative purposes only, we provide a sample application of the model. In this example, the optimal allocation scenario is compared to the current baseline funding scenario to highlight how the current allocation of funds could be improved. In the baseline allocation, 29% of the annual budget is aimed at the general population, while the model recommends targeting 100% of the budget to the at-risk populations with no allocation targeted to the general population. Within the allocation to behavioral interventions the model recommends an increase in targeting diagnosed positives. Also, the model allocation suggests a greater focus on MSM and IDUs with a 72% of the annual budget allocated to them, while the baseline allocation for MSM and IDUs totals 37%. Incorporating future epidemic trends in the decision-making process informs the selection of populations and interventions that should be targeted. Improving the use of funds by targeting the interventions and population subgroups at greatest risk may lead to improved HIV outcomes. These models can also direct research by pointing to areas where the development of cost-effective interventions can have the most impact on the epidemic.     

Optimal incentives for allocating HIV/AIDS prevention resources among multiple populations

Many agencies, such as the United Nations Program on HIV/AIDS (UNAIDS), the World Health Organization (WHO), the World Bank, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), and the Global Fund to Fight AIDS, Tuberculosis and Malaria, provide funding to prevent HIV/AIDS infections worldwide. These funds are allocated at multiple levels, resulting in a highly complicated distribution process. An oversight agency allocates funds to various national-level decision-makers who then allocate funds to regional-level decision-makers who in turn distribute the monies to local organizations, programs, or risk groups. Simple allocation techniques are often preferred by the decision-makers at each administrative level, but such methods can lead to sub-optimal allocation of funds. Thus, incentives could be provided to decisionmakers in order to encourage optimal allocation of HIV/AIDS prevention resources. We formulate an incentive-based resource allocation model that takes into consideration strategic interactions between decision-makers in a multiple-level resource-allocation process. We analyze each decision-maker's behavior at the equilibrium and summarize the results that characterize the optimal solution to the resource-allocation problem. Our intended audiences are technical experts, decision-makers, and policy-makers in governments who can make use of incentives to encourage effective decisions regarding HIV/AIDS policy modeling and budget allocation at local levels.     

S4HARA: System for HIV/AIDS resource allocation

Background

HIV/AIDS resource allocation decisions are influenced by political, social, ethical and other factors that are difficult to quantify. Consequently, quantitative models of HIV/AIDS resource allocation have had limited impact on actual spending decisions. We propose a decision-support System for HIV/AIDS Resource Allocation (S4HARA) that takes into consideration both principles of efficient resource allocation and the role of non-quantifiable influences on the decision-making process for resource allocation.

Methods

S4HARA is a four-step spreadsheet-based model. The first step serves to identify the factors currently influencing HIV/AIDS allocation decisions. The second step consists of prioritizing HIV/AIDS interventions. The third step involves allocating the budget to the HIV/AIDS interventions using a rational approach. Decision-makers can select from several rational models of resource allocation depending on availability of data and level of complexity. The last step combines the results of the first and third steps to highlight the influencing factors that act as barriers or facilitators to the results suggested by the rational resource allocation approach. Actionable recommendations are then made to improve the allocation. We illustrate S4HARA in the context of a primary healthcare clinic in South Africa.

Results

The clinic offers six types of HIV/AIDS interventions and spends US$750,000 annually on these programs. Current allocation decisions are influenced by donors, NGOs and the government as well as by ethical and religious factors. Without additional funding, an optimal allocation of the total budget suggests that the portion allotted to condom distribution be increased from 1% to 15% and the portion allotted to prevention and treatment of opportunistic infections be increased from 43% to 71%, while allocation to other interventions should decrease.

Conclusion

Condom uptake at the clinic should be increased by changing the condom distribution policy from a pull system to a push system. NGOs and donors promoting antiretroviral programs at the clinic should be sensitized to the results of the model and urged to invest in wellness programs aimed at the prevention and treatment of opportunistic infections. S4HARA differentiates itself from other decision support tools by providing rational HIV/AIDS resource allocation capabilities as well as consideration of the realities facing authorities in their decision-making process.     

Current approaches to prevention of HIV infections.

The HIV education and prevention strategy of the Centers for Disease Control has three principal components: (a) public information and education, (b) education for school-aged populations, and (c) risk reduction education and individual counseling and testing services for people at increased risk of HIV infection. The most visible components of the public information and education programs are the National Public Information Campaign ("America Responds to AIDS"), the National AIDS Hotline system, and the National AIDS Information Clearinghouse. Components of the youth education program consist of funding for national health and education organizations, funding for State and local education departments, training, surveillance of education efforts, and evaluation. Counseling and testing has entailed performance of approximately 2,500,000 HIV antibody tests with pre- and post-test counseling, notification and counseling of sexual and needle-sharing partners of those infected with HIV, and targeted risk reduction education through community-based organizations. Over time, these activities will continue to evolve and become more effective.     

From brothel to boardroom: prospects for community leadership of HIV interventions in the context of global funding practices

The empowerment of marginalised communities to lead local responses to HIV/AIDS is a key strategy of funding agencies' globalised HIV/AIDS policies, given evidence that disempowerment is a root source of vulnerability to HIV. We report on two multi-level ethnographies at the interface between HIV prevention projects for sex workers in India and their funding environment, examining the extent to which the funding environment itself promotes or undermines sex worker empowerment. We show how the 'new managerialism' characteristic of the funding system undermines sex worker leadership of HIV interventions. By requiring local projects to conform to global management standards, funding agencies risk undermining the very localism and empowerment that their intervention policies espouse.     

Prioritization of prevention activities to combat the spread of HIV/AIDS in resource constrained settings: a cost-effectiveness analysis from Chad,Central Africa

In Chad, as in most sub-Saharan Africa countries, HIV/AIDS poses a massive public health threat as well as an economic burden, with prevalence rates estimated at 9% of the adult population. In defining and readjusting the scope and content of the national HIV/AIDS control activities, policy makers sought to identify the most cost-effective options for HIV/AIDS control. The cost-effectiveness analysis reported in this paper uses a mixture of local and international information sources combined with appropriate assumptions to model the cost-effectiveness of feasible HIV prevention options in Chad, with estimates of the budget impact. The most cost-effective options at under US$100 per infection prevented were peer group education of sex workers and screening of blood donors to identify infected blood before transfusion. These options were followed by mass media and peer group education of high risk men and young people, at around US$500 per infection prevented. Anti-retroviral therapy for HIV infected pregnant women and voluntary counselling and testing were in the order of US$1000 per infection prevented. The paper concludes with recommendations for which activities should be given priority in the next phase of the national HIV/AIDS control programme in Chad.     

President seeks 4 percent increase in funding for 2000

President Clinton has proposed a 4 percent increase of $162 million in discretionary funding for HIV-specific programs for the fiscal year 2000 budget. The budget calls for a 7 percent increase for the Ryan White CARE Act funds and a similar increase for the Housing Opportunities for People with AIDS program. AIDS drug assistance programs would receive $35 million, or an 8 percent increase in funding. In 4 of the past 5 years, Congress has appropriated more funds to HIV programs than the President requested. A chart shows current funding levels and proposed increases for key HIV/AIDS programs.     

AIDS advisors say administration has grown complacent

President Clinton's AIDS advisors charge that the current administration's interest in and support of HIV and AIDS programs is diminishing. While AIDS advisors and advocates within the Presidential Advisory Council on HIV/AIDS acknowledge that President Clinton is the first U.S. president to take significant actions to address the epidemic, the nation is still without a consistent strategy for prevention, research, and eradication. Advisors cite lack of funding, outdated restrictions, and a continued refusal on the part of the President to authorize Federal funding of needle exchange programs as evidence that AIDS issues are a low priority for this administration. The absence of an initiative to provide current HIV and AIDS drug therapies to low income people and those without health insurance is also cited as evidence. AIDS advocates express strong reservations over proposals to create a national name-based HIV surveillance system.     

艾滋病防治国际合作项目资源配置分析

目的 了解中国艾滋病防治国际合作项目投入状况以及影响因素,为国际合作项目资源分配提供决策依据.方法 收集中央和各省2000-2006年国际合作项目资源与分配相关数据,选择各省GDP、艾滋病病毒感染者和艾滋病患者(HIV/AIDS)数作为影响国际合作项目投入的因素,通过多因素回归分析计算他们与国际合作项目投入经费数量的相关性,在此基础上计算了各省需求Z值并与国际合作项目投入状况进行了比较.通过卡方检验计算艾滋病防治国际合作项目与中央经费在不同防治领域投入的一致性.结果 2000-2006年国际合作项目投入地方的资金分别为489.30、2466.91、5056.65、5294.96、11 214.31、36 339.63和24 704.53万元;投入中央的资金分别为300.65、1972.56、2903.52、3753.00、7749.99、10 578.62和7703.54万元.各省国际合作项目的投入情况与HIV/AIDS数(R=0.56,P＜0.01)及艾滋病患者数(R=0.69,P＜0.01)的相关系数差异有统计学意义,但是与GDP之间差异无统计学意义(R=0.066,P=0.725).各省的国际合作项目投入与需求并不完全对应,广东、山东、江苏的Z值排名分别为3、5、6,而国际合作项目的经费投入排名仅为18、13、28.在监测(检测)、宣传教育干预、治疗关怀和其他领域的经费投入比例2005年中央经费分别为22.4%、19.7%、36.8%和21.1%,国际合作项目分别为11.5%、20.8%、10.4%和57.4%,2者比较差异有统计学意义(x2=35.09,P＜0.001);2006年中央经费分别为18.6%、23.8%、32.6%和25.0%,国际合作项目分别为14.0%、34.3%、17.1%和34.6%,2者比较差异有统计学意义(x2=9.26.P=0.026).说明国际合作项目与中央项目投入的侧重点不同.结论 国际合作项目应该纳入国家和项目地区的整体防治工作,结合各地的疫情流行严重程度和各地的经济发展水平确定投入的数量和领域,同时要强调国际合作项目的技术优势.     

Despite deadline, Congress not finished with AIDS funding bills

As the Federal budget deadline nears, it appears that many of the appropriations measures affecting AIDS programs will not be completed on time. Among items slated for reauthorization are the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, at a slightly higher funding level; and the Housing Opportunities for People with AIDS (HOPWA) program, at a slightly lower level. Prevention funding for the Centers for Disease Control and Prevention (CDC) remains unchanged, and Medicaid has been drastically cut. Key differences are still being resolved by House and Senate conference committees on several issues. A House proposal would eliminate specific allocations for research and pass funding decisions to the director of the National Institutes of Health (NIH). The Senate favors specific appropriations for AIDS and a $53.3 million increase in funding. The House voted for mandatory HIV testing of newborns, and the Senate voted to create a program encouraging health-care professionals to counsel pregnant women about HIV and offer voluntary testing. The House wants to eliminate AIDS education and training centers, while a Senate committee recommends continuing the programs and halving funding to $8 million. The Senate has adopted an amendment that prohibits agencies receiving Ryan White funds from performing activities promoting homosexuality; the House's Ryan White bill does not have such a restriction.