Strategies for promoting equity: experience with community financing in three African countries
Strategies for promoting equity: experience with community financing in three African countries
复制标题
DOI：
10.1016/s0168-8510(01)00153-1
复制
发表时间：
2001-10-01
期刊：
影响因子：
3.3
通讯作者：
Ouendo, M
中科院分区：
文献类型：
--
作者：
Gilson, L;Kalyalya, D;Ouendo, M
虽然在低收入和中等收入国家制定有利于穷人的卫生保健改革议程的必要性日益明显，但实施这种政策变革总是困难的。本文件旨在通过对儿童基金会/卫生组织巴马科倡议的社区筹资活动的思考，帮助思考如何推进这一议程。报告介绍了1994/95年在贝宁、肯尼亚和赞比亚进行的一项三国研究的结果，这项研究的目的是更好地了解社区筹资活动对公平的影响的性质以及造成这种影响的因素。在贝宁取得的持续的相对可负担性收益突出表明，必须确保将筹资变化用作加强保健服务管理的政策杠杆，以支持提高护理质量。然而，所有国家都未能保护最贫穷者免受支付负担，优先惠及这一群体，并确保在决策过程中听取他们的意见。解决这些问题，除其他外，需要在中央和地方一级的决策之间取得适当的平衡，并需要建立地方决策结构，其中有民间社会团体的代表，能够表达最贫穷者的需要。领导力、战略和战术在确保任何形式的公平收益方面也总是很重要的，比如建立公平目标以推动实施。在所审查的经验中，财务可持续性目标占主导地位促成了它们的股权失败。需要进一步研究，以了解社区本身希望以何种公平目标来指导筹资政策。(C)2001爱思唯尔科学爱尔兰有限公司保留所有权利。
Although the need for a pro-poor health reform agenda in low and middle income countries is increasingly clear, implementing such policy change is always difficult. This paper seeks to contribute to thinking about how to take forward such an agenda by reflection on the community financing activities of the UNICEF/WHO Bamako Initiative. It presents findings from a three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, which was initiated in order to better understand the nature of the equity impact of community financing activities as well as the factors underlying this impact. The sustained relative affordability gains achieved in Benin emphasise the importance of ensuring that financing change is used as a policy lever for strengthening health service management in support of quality of care improvements. All countries, however, failed in protecting the most poor from the burden of payment, benefiting this group preferentially and ensuring that their views were heard in decision-making. Tackling these problems requires, amongst other things, an appropriate balance between central and local-level decision-making as well as the creation of local decision-making structures which have representation from civil society groups that can voice the needs of the most poor. Leadership, strategy and tactics are also always important in securing any kind of equity gain-such as establishing equity goals to drive implementation. In the experiences examined, the dominance of the goal of financial sustainability contributed to their equity failures. Further research is required to understand what equity goals communities themselves would prefer to guide financing policy. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.