The Role of Development Assistance for Health in Reducing Child Mortality

说明(由申请人提供)：拟议的五年培训和研究计划项目将使一名已经在全球卫生筹资方面取得成就的初级学者掌握人口学和人口研究的理论、方法和技术，并探索经济和人口方法的整合，以通过一项跨国比较研究和卢旺达的一项国家案例研究，研究卫生发展援助(DAH)在降低儿童死亡率方面的作用。拟议的职业发展计划设定了四个培训目标：(1)发展人口统计学和人口学方面的专门知识，以衡量儿童死亡率和建立儿童死亡率变化原因的理论和模型；(2)获得流行病学背景知识，以便了解发展中国家不同年龄组五岁以下儿童的疾病概况；(3)提高时间序列和多水平研究的统计技能；(4)获得研究伦理方面的培训，并制定赠款申请的概念和技能。这四个目标将通过以下四项发展活动来实现：(1)人口学和人口学、流行病学、统计学方法和研究伦理方面的课程工作和指导阅读；(2)人口学(Kenneth Hill和Samuel Preston)、流行病学(Megan Murray)、卫生政策(Agnes Binagwaho)和卫生经济学(Peter Smith)的领先专家的指导；(3)参与人口研究和健康的研讨会、研讨会和学术会议并在其上展示研究；以及(4)开发一项赠款，以支持一项关于医疗保健资金和人口健康结果的独立研究计划。研究的具体目标有三：(1)通过人口与健康调查，对国家新生儿、婴儿和儿童死亡率水平的年度差异进行具体国家的时间序列估计，并为1996年至2011年期间总的DAH、儿童健康的DAH和传染病项目的DAH生成完整的时间序列国家具体支出数据集；(2)系统评估1996年至2011年卫生部国家的总DAH、儿童健康DAH和抗击传染病的DAH对儿童死亡率的影响；以及(3)通过使用“国家平台方法”增加儿童保健服务，了解DAH在改善卢旺达儿童健康和降低儿童死亡率方面的作用。K-01奖将在人口学和人口研究以及流行病学和定性方法方面为我提供强有力的指导和专门培训，这将使我能够实现我的长期职业目标，即通过跨学科方法为设计卫生保健筹资战略提供严格的科学证据，从而有效地改善弱势群体的健康结果。 公共卫生相关性：降低儿童死亡率和改善儿童健康是卫生方面的千年发展目标之一。在降低儿童死亡率方面进展缓慢，迫切需要以证据为基础的指导，以便最有效地利用现有资源。拟议的研究将解决这一知识差距，并为了解低收入国家卫生发展援助与降低儿童死亡率之间的关系作出重要贡献。

DESCRIPTION (provided by applicant): The proposed five-year project of training and research plans will enable a junior scholar already accomplished in global health financing to master theories, methodologies, and techniques in demography and population studies and explore the integration of economic and demographic methods for studying the role of Development Assistance for Health (DAH) in reducing child mortality through a cross-country comparative study and a country case-study in Rwanda. The proposed career development plan sets four training goals: (1) to develop expertise in demography and population science concerning the measurement of child mortality and theories and models on the causes of child mortality change; (2) to obtain background knowledge of epidemiology so as to understand the disease profiles of under-five children of different age groups in developing countries; (3) to advance statistical skills for time-series and multilevel studies; and (4) to obtain training in research ethics and develop concepts and skills for grant writing. These four goals will be met with the following four development activities: (1) course work and directed reading in demography and population studies, epidemiology, statistical methods, and research ethics; (2) mentorship from leading experts in demography (Kenneth Hill and Samuel Preston), epidemiology (Megan Murray), health policy (Agnes Binagwaho) and health economics (Peter Smith); (3) participating and presenting research in workshops, seminars, and academic conferences for population studies and health; and (4) developing a grant to support an independent research program on health care financing and population health outcomes. There are three research specific aims: (1) to produce time-series country-specific estimates for the annual difference in the level of neonatal, infant and child mortality rates for the 64 countries with Demographic and Health Surveys and to generate complete time-series country-specific disbursement datasets for overall DAH, DAH for child health, and DAH for infectious disease programs from 1996 to 2011; (2) to systematically assess the effects of total DAH, DAH for child health, and DAH for combating infectious diseases on child mortality rates for the 64 DHS countries between 1996 and 2011; and (3) to understand the role of DAH in improving child health and reducing child mortality in Rwanda through increasing child health care provision using a "national platform approach." The K-01 award will provide me with strong mentorship and specialized training in demography and population studies as well as epidemiology and qualitative methods, which will enable me to carry out my long- term career goal of providing rigorous scientific evidence through an interdisciplinary approach for designing health care financing strategies that will effectively improve health outcomes for disadvantaged populations. PUBLIC HEALTH RELEVANCE: Reducing child mortality and improving child health is one of the health Millennium Development Goals (MDGs). The slow progress in reducing child mortality makes urgent the need for evidence-based guidance for achieving the most efficient use of existing resources. The proposed research will address this gap of knowledge and make an important contribution to understanding the relationship between the development assistance for health and child mortality reduction in low-income countries.