GCRF:Thanzi la Onse (Health of All): Frameworks and analysis to ensure value for money health care - developing theory, changing practice

在所有国家，都需要就如何资助、组织和提供卫生保健以造福民众作出艰难的决定。决定包括如何确定和确保适当的保健筹资水平；资助哪些干预措施；如何在地理位置之间集中和分配资源；以及何时投资资源以加强保健系统的关键组成部分，以提高现有干预措施的质量和覆盖面，而不是引入新的有效干预措施。所有保健系统都面临这样一个现实，即增加福利的现有机会的成本总是超过可用的资金。所做的决定影响到所提供的干预措施的种类、谁接受卫生保健、谁不受影响，并最终影响人口受益的大小。在低收入国家，资源尤其稀缺。例如，马拉维的人均卫生保健总支出为39美元，这也是一个高度依赖援助的国家，约占资金的62%，这导致当地对如何使用资源的偏好必须与捐助者的优先事项相平衡。在撒哈拉以南的非洲国家(如马拉维)，改善人口福利的机会很大，但错误的决定可能会造成严重的损失。Thanzi la onse(TLO)提供了一个多学科研究的综合方案，为低收入环境下的卫生保健资源分配决策提供信息。这一具有挑战性的政策领域位于卫生、经济和政治的交汇点。这项拟议研究的结构反映了这一现实。“物有所值”在决定国内和国际发展活动方面的中心地位现在已被广泛接受，特别是在低收入国家，但鉴于贫穷国家卫生保健系统面临的证据和体制限制，解决政策制定和资源分配决策方面的挑战仍然是一项紧迫的研究优先事项。这项工作将建立研究能力，通过评估通过替代支出承诺实现的当地实现的健康惠益的替代政策选择来满足这一需求。这需要评估任何承诺的好处，以及由于卫生保健系统普遍存在的资源限制而放弃的好处。了解这些结果的大小和分布是确保卫生支出物有所值的关键。具体干预措施的价值需要在提供具体干预措施的卫生保健系统的背景下理解。TLO将研究不同干预措施和政策对人口福利的影响与该系统在如何为保健提供资金和提供保健方面的一系列特点、其弱点和制约因素之间的相互关系。支持决策的研究还需要认识到接受和实施决策的潜在障碍，这需要与政策制定者保持密切联系。流行病学和卫生经济学的研究主题将得到政治和治理的第三个主题的补充；实现迄今尚未得到充分利用的跨学科互补性。TLO的最初重点将是与政策制定者合作，并为马拉维和乌干达的资源分配决定提供信息。这将包括对马拉维的整个卫生系统进行建模，以充分反映其有限的资源、人口的需求和特征以及相互竞争的资源索取权的价值。活动将受到国际关注，并为国际组织的优先事项提供信息。从长远来看，该方案预计将与东部、南部非洲地区和其他地区的政策制定者密切合作，以确保通过领先的研究方法尽可能充分地了解卫生保健的提供。

In all countries, difficult decisions are needed on how health care is financed, organised and provided for the benefit of populations. Decisions include how to determine and to secure appropriate levels of funding for health care; which interventions to fund; how to pool and distribute resources between geographical localities; and when to invest resources in strengthening key components of the health care system to improve the quality and coverage of existing interventions versus introducing new effective interventions. All health care systems face the reality that the cost of the available opportunities to enhance benefits always exceeds the available funding. The decisions made affect the kinds of interventions provided, who receives health care, who goes without and, ultimately, the magnitude of benefits to populations. Resources are particularly scarce in low-income countries.For example, total health care spending is US$39 per capita in Malawi, a country that is also highly dependent on aid, representing about 62% of that funding, resulting in local preferences regarding how resources are used having to be balanced against donors' priorities. In sub-Saharan African countries (such as Malawi), the opportunities for improving population benefits are great, but the consequences of getting these decisions wrong are potentially severe in terms of forgone benefits. Thanzi la Onse (TLO) provides an integrated programme of multi-disciplinary research to inform decisions in low-income settings on health care resource allocation. This challenging policy area lies at the intersection of health, economics and politics. The structure of this proposed research reflects that reality. The centrality of 'value for money' in determining domestic and international development activities is now widely accepted, particularly so in low-income countries, but tackling the challenges of policy formulation and resource allocation decisions, given the evidential and institutional constraints faced by health care systems in poor countries, remains an urgent research priority. This work will build research capability to address this need by evaluating alternative policy options in terms of locally-realised health benefits achieved through alternative spending commitments. This requires evaluating the benefits of any commitments and also what is foregone as a result of resource constraints prevailing in health care systems. Understanding the magnitude and distribution of such outcomes is key to ensuring value for money for spending on health.The value of specific interventions needs to be understood within the context of the health care system in which it is delivered. TLO will study the inter-relationships between the impact of different interventions and policies on population benefits and the range of characteristics of the system in terms of how it funds and delivers care, its weakness and constraints. Research to support decision-making also needs to recognise the potential barriers to its acceptance and implementation, requiring close links with policy-makers. Themes of research in epidemiology and health economics will be complemented by a third theme on politics and governance; realising inter-disciplinary complementarities which hitherto have not been fully exploited.The initial focus of TLO will be working with policy-makers and informing resource allocation decisions in Malawi and Uganda. This will include modelling the whole health system in Malawi to fully reflect its limited resources, the needs and characteristics of the population and the value of competing claims upon resources. Activities will receive international attention and inform the priorities of international organizations. Over the longer term, the programme is expected to work closely with policy-makers across the east, southern Africa region and beyond to ensure health care delivery is as fully informed as possible by leading research methods.