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

在塞内加尔的研究.激励：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(DAH)。与此同时，LMIC政府每年向高收入国家(HIC)债权人偿还近3000亿美元的公共债务。对低收入中等收入国家的这些正、负资金流如何影响各国自身的公共卫生投资，人们知之甚少。此外，这些流动如何影响低收入中等收入国家卫生筹资的构成，即对公共卫生筹资与私人卫生筹资的依赖，这几乎是一个未被探索的问题。为了使英国和其他经合组织国家的国际发展政策实现其目标，即通过强大的国内卫生系统应对全球卫生威胁和挑战，并促进世界上最贫困人口的健康和福祉，需要对这些资金流动的卫生筹资影响有更深入的了解。目的：目的1：探讨DAH和公共外债对低收入中等收入国家国内政府卫生支出(S)的影响。目的：探讨DAH和公共外债对低收入中等收入国家自付医疗服务(OOP)和自愿医疗保健计划(VHPS)支出的影响。目标3：探讨国际官方捐助者和债权人以及接受和支付给他们的资金对塞内加尔国内卫生筹资的影响。方法：我对上述问题的方法论方法将是定量和定性的。我将结合一些公开提供的多国大型数据集，并使用先进的计量经济学方法进行分析，包括在STATA中进行的面板数据分析。为了向这一分析提供信息并探索潜在的潜在原因机制，我还将与利益相关者进行访谈，并在塞内加尔的利益相关者机构进行文件审查。预期影响：通过这项研究，我旨在增加我们对国际官方资金流动如何影响低收入中等收入国家国内卫生融资的理解。我的目标是能够就如何避免或减轻可能阻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确定的影响提出基于证据的建议。这将是朝着实现卫生可持续发展目标(SDGs)、全民健康覆盖(UHC)和捐助国的发展目标迈出的关键一步：为所有人建立一个更健康、更安全和更繁荣的世界。在学习期间获得的技能：-我在伦敦政治经济学院(LSE)完成了一个为期三周的高级计量经济学全日制课程。这使我掌握了分析大型国家级数据集的最先进技术。-我已经完成了一个为期一天的半结构化面试课程。-我对LSHTM为期8周的定性方法课程进行了审计。-我在网上复习了为期10周的ESRC DTP《博士研究人员的核心技能》课程材料。-在我整个学生生涯中学习的主题领域将主要涵盖卫生和发展经济学，主要是宏观经济层面，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。-我已经评估了我的研究的伦理方面，并获得了伦理批准。-我已经获得了关键的数据收集和管理技能。-在塞内加尔进行的案例研究增进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技能，这使我能够更好地为公共卫生和国际发展事业(包括法语技能)做准备。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.