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，都需要就如何为人民的利益筹资、组织和提供卫生保健作出艰难的决定。决策包括如何确定和确保适当水平的卫生保健资金;哪些干预措施的资金;如何汇集和分配资源之间的地理位置;以及何时投资资源，以加强卫生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。所有卫生保健系统都面临这样一个现实，即提高福利的现有机会的成本总是超过现有资金。所作的决定影响到所提供的干预措施的种类，谁得到保健，谁得不到保健，并最终影响到人口受益的程度。低收入国家的资源尤其稀缺，例如，马拉维的医疗保健总支出为人均39美元，而马拉维也高度依赖援助，约占援助资金的62%，这导致当地在如何使用资源方面的偏好必须与捐助者的优先事项相平衡。在撒哈拉以南非洲国家（如马拉维），改善人口福利的机会很大，但就放弃的福利而言，这些决策失误的后果可能很严重。Thanzi la Onse（TLO）提供了一个多学科研究的综合方案，为低收入环境中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处于卫生、经济和政治的交叉点。本研究报告的结构反映了这一现实。“物有所值”在确定国内和国际发展活动中的中心地位现在已被广泛接受，特别是在低收入国家，但鉴于穷国保健系统面临的证据和体制限制，应对政策制定和资源分配决定的挑战仍然是一个紧迫的研究优先事项。这项工作将建立研究能力，以满足这一需要，通过评估替代政策选择，通过替代支出承诺实现当地实现的健康效益。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东西。了解这些结果的规模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这些措施的卫生保健系统的背景下加以理解。TLO将研究不同干预措施和政策对人口福利的影响之间的相互关系，以及该系统在如何资助和提供护理方面的一系列特点，其弱点和限制因素。支持决策的研究还需要认识到其接受和执行的潜在障碍，需要与决策者密切联系。流行病学和卫生经济学的研究主题将由关于政治和治理的第三个主题补充;实现迄今尚未充分利用的跨学科互补性。TLO的最初重点将是与马拉维和乌干达的政策制定者合作，并为资源分配决策提供信息。这将包括建立马拉维整个卫生系统的模型，以充分反映其有限的资源、人口的需要和特点以及对资源的竞争要求的价值。这些活动将得到国际关注，并为国际组织的优先事项提供信息。从长远来看，该计划预计将与东部，南部非洲地区及其他地区的政策制定者密切合作，以确保医疗保健服务尽可能充分了解领先的研究方法。

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.