Official Development Assistance, External Public Debt and Domestic Health Financing in Low- and Middle-Income Countries: Panel Data Analysis and Case

在塞内加尔学习。动机：每年向低收入和中等收入国家支付近400亿美元作为卫生发展援助。与此同时，中低收入国家政府每年向高收入国家债权人偿还近3000亿美元公共债务。人们对中低收入国家的这些正面和负面资金流动如何影响国家自身的公共卫生投资知之甚少。此外，这些资金流动如何影响中低收入国家卫生筹资的构成，即对公共和私人卫生筹资的依赖，这几乎是一个尚未探讨的问题。为了使英国和其他经合组织国家的国际发展政策在应对全球健康威胁和挑战以及通过强大的国内卫生系统促进世界上最贫困人口的健康和福祉方面实现其目标，需要更深入地了解这些资金流的卫生筹资效果。目的：目的1：探讨发展中国家医疗保健和公共外债对国内政府卫生支出的影响。目的2：探讨DAH和公共外债对中低收入国家卫生服务自费支付（OOP）和自愿卫生保健支付计划（VHPS）支出的影响。目标3：探讨国际官方捐助者和债权人以及从他们那里收到和支付给他们的资金如何影响塞内加尔国内卫生筹资。方法：我对上述问题的方法论方法将是定量和定性的。我将结合一些大型公开可用的多国数据集，并使用先进的计量经济学方法分析它们，包括在STATA中执行的面板数据分析。为了为这一分析提供信息并探索潜在的潜在病因机制，我还将与利益攸关方进行面谈，并在塞内加尔的利益攸关方机构进行文件审查。预期影响：通过这项研究，我旨在增进我们对国际官方资金流如何影响中低收入国家国内卫生筹资的理解。我的目标是能够就如何避免或减轻可能妨碍发展中经济体向加强、公平的国内卫生筹资过渡的任何已查明的影响提出循证建议。这将是朝着实现卫生可持续发展目标、全民健康覆盖和捐助国发展目标迈出的关键一步：为所有人创造一个更健康、更安全、更繁荣的世界。在校期间获得的技能：我在伦敦政治经济学院（LSE）完成了为期三周的高级计量经济学全日制课程。这使我具备了分析大型国家级数据集的最先进技术。我已经完成了为期一天的半结构化面试课程。-我旁听了LSHTM为期8周的定性方法论课程。-我已经在线阅读了为期10周的ESRC DTP“博士研究人员核心技能”课程材料。-在我的学生学习期间，我将主要研究宏观经济层面的健康和发展经济学、计量经济学、全球治理、卫生系统和政策、统计、访谈和文件审查方法。我已经对我的研究进行了伦理方面的评估，并获得了伦理方面的批准。—具备关键数据收集和管理技能。-在塞内加尔进行的案例研究提高了我对这些国家的公共卫生和发展政策机制的了解，并培养了我的沟通和跨文化能力，这为我从事公共卫生和国际发展的职业生涯（包括法语技能）做好了更好的准备。我将在学术期刊和国际会议上传播我的研究成果。

Study in Senegal.Motivation: Nearly US$ 40 billion are disbursed annually as Development Assistance for Health (DAH) to Low- and Middle-Income Countries (LMICs). At the same time, LMIC governments repay nearly US$ 300 billion of public debt annually to High-Income Country (HIC) creditors. It is poorly understood how these positive and negative funding flows in LMICs affect countries' own public health investments. It is further nearly an unexplored question, how these flows affect the composition of health financing in LMICs, i.e. the reliance on public vs. private health financing. In order for the UK's and other OECD countries' international development policies to achieve their objectives in tackling global health threats and challenges and promoting the health and wellbeing of the world's poorest through strong domestic health systems, a deeper understanding of the health financing effects of these funding flows is needed. Objectives: Objective 1: To explore the effects of DAH and public external debt on domestic government health expenditure (GHE-S) in LMICs. Objective 2: To explore the effects of DAH and public external debt on out-of-pocket payments (OOP) for health services and voluntary health care payment scheme (VHPS) expenditures in LMICs. Objective 3: To explore how international official donors and creditors, and the funds received from and paid to them, have influenced domestic health financing in Senegal. Methods: My methodological approach to the above questions will be both quantitative and qualitative. I will combine a number of large publicly available multi-country datasets and analyse them using advanced econometric methods including panel data analysis performed in STATA. To inform this analysis and explore potential underlying causative mechanisms, I will also conduct interviews with stakeholders and perform a document review at stakeholder institutions in Senegal.Expected Impact: With this research I aim to increase our understanding of how international official funding flows affect domestic health financing in LMICs. I aim to be able to propose evidence-based suggestions for how to avoid or mitigate any identified effects that may hamper the transition of developing economies towards strengthened, equitable domestic health financing. This will be a key step towards achieving the health Sustainable Development Goals (SDGs), Universal Health Coverage (UHC) and the development objectives of donor countries: A healthier, safer and more prosperous world for all. Skills gained during studentship: -I have completed a three-week full-time course in advanced econometrics at the London School of Economics and Political Science (LSE). This has equipped me with state-of-the-art techniques for analysing large country-level datasets. -I have completed a one-day course in semi-structured interviews. -I have audited the 8-week course in qualitative methodologies at LSHTM. - I have reviewed the 10-week ESRC DTP "Core Skills for Doctoral Researchers" course material online. -The topic areas studied throughout my studentship will span health and development economics predominantly at the macroeconomic level, econometrics, global governance, health systems and -policy, statistics, interview- and document review methodology. -I have assessed the ethical aspects of my research and been granted ethics approval. - I have obtained key data collection and management skills. -The case study conducted in Senegal has improved my understanding of public health and development policy mechanisms in these countries, and it has develop my communication and intercultural skills, which has better equipped me for a career in public health and international development (including French language skills). I will disseminate the results of my research in academic journals and at international conferences.