Are current debt relief initiatives an option for scaling up health financing in beneficiary countries?
Are current debt relief initiatives an option for scaling up health financing in beneficiary countries?
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DOI：
10.2471/blt.08.053686
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发表时间：
2008-11-01
期刊：
影响因子：
--
通讯作者：
Furrer, E
中科院分区：
文献类型：
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作者：
Kaddar, M;Furrer, E
加强的重债穷国倡议（重债穷国倡议）和最近的多边减债倡议（多边减债倡议）的一个中心目标是腾出更多资源用于减少贫困的公共支出。预计卫生部门将从这些资金中获得相当大的份额。在某些国家，释放的资源数量非常重要，足以对迄今资金不足的优先方案产生影响。然而，这些举措在增加保健支出方面的相关性在全球一级主要取决于捐助者遵守其援助承诺，而在国内一级则取决于卫生官员能否成功地倡导适当分享额外的财政空间。宣传工作往往受到信息不对称状况的限制，因此一些部委并不十分了解债务减免对公共财政的经济影响，也不了解处理债务减免节省的管理制度。对这些问题的透彻理解似乎对健康倡导者提高他们的议价能力至关重要，对更广泛的公众重新调整对债务减免可以实际实现的目标和可以衡量的目标的期望至关重要。本文旨在通过对实践中观察到的债务减免储蓄管理制度进行分类来缩小信息差距。我们说明了一些主要的优点和缺点，并概述了在有关国家开展工作的卫生官员的政策影响。应当仔细监测可替代性（即无法追踪的资金有替代风险）和附加性（即在国家和国际一级新投入对现有投入的增加程度）。
One central goal of the enhanced Heavily Indebted Poor Countries (HIPC) Initiative and the more recent Multilateral Debt Relief Initiative (MDRI) is to free up additional resources for public spending on poverty reduction. The health sector was expected to benefit from a considerable share of these funds. The volume of released resources is important enough in certain countries to make a difference for priority programmes that have been underfunded so far. However, the relevance of these initiatives in terms of boosting health expenditure depends essentially, at the global level, on the compliance of donors with their aid commitments and, at the domestic level, on the success of health officials in advocating for an adequate share of the additional fiscal space. Advocacy efforts are often limited by a state of asymmetric information whereby some ministries are not well aware of the economic consequences of debt relief on public finances and of the management systems in place to deal with savings from debt relief. A thorough comprehension of these issues seems essential for health advocates to increase their bargaining power and for a wider public to readjust expectations of what debt relief can realistically achieve and of what can be measured. This paper intends to narrow the information gap by classifying debt relief savings management systems observed in practice. We illustrate some of the major advantages and stated drawbacks and outline the policy implications for health officials operating in the countries concerned. There should be careful monitoring of fungibility (i.e. where untraceable funds risk substitution) and additionality (i.e. the extent to which new inputs add to existing inputs at national and international level).