Abstract:
Although not reliant on donor funding for health, the external assistance that Sri Lanka receives contributes to the improvement of the health system and health outcomes. In this study, we evaluated transition experiences of the expanded programme on immunization (EPI) that received Gavi funding to expand the vaccine portfolio and the Anti-Malaria Campaign (AMC) that received funding from the Global Fund for AIDS, Tuberculosis and Malaria to scale-up interventions to target and achieve malaria elimination. We assessed if EPI and AMC programmes were able to sustain coverage of previously donor-funded interventions post-transition and explain the facilitators and barriers that contribute to this. We used a mixed methods approach using quantitative data to assess coverage indicators and the financing mix of the health programmes and qualitative analysis guided by a framework informed by the Walt and Gilson policy triangle that brought together document review and in-depth interviews to identify facilitators and barriers to transition success. The EPI programme showed sustained coverage of Gavi-funded vaccines post-transition and the funding gap was bridged by mobilizing domestic financing facilitated by the Gavi co-financing mechanism, full integration within existing service delivery structures, well-established and favourable pharmaceutical procurement processes for the public sector and stewardship and financial advocacy by technically competent managers. Although the absence of indigenous cases of malaria since 2012 suggests overall programme success, the AMC showed mixed transition success in relation to its different programme components. Donor-supported programme components requiring mobilization of operational expenses, facilitated by early financial planning, were successfully transitioned (e.g. entomological and parasitological surveillance) given COVID-19-related constraints. Other key programme components, such as research, training, education and awareness that are dependent on non-operational expenses are lagging behind. Additionally, concerns of AMC\'s future financial sustainability within the current structure remain in the context of low malaria burden.
摘要:
尽管不依赖捐助者的卫生资金,斯里兰卡获得的外部援助有助于改善卫生系统和卫生成果。在这项研究中,我们评估了扩大免疫计划(EPI)的过渡经验,该计划获得了Gavi资金以扩大疫苗组合,以及从全球艾滋病基金获得资金的抗疟疾运动(AMC),结核病和疟疾将扩大干预措施,以达到消除疟疾的目标。我们评估了EPI和AMC计划是否能够维持过渡后以前由捐助者资助的干预措施的覆盖范围,并解释了促成这一目标的促进因素和障碍。我们使用混合方法方法,使用定量数据来评估覆盖范围指标和卫生计划的融资组合,并在Walt和Gilson政策三角框架的指导下进行定性分析,该框架将文件审查和深入访谈结合在一起,以确定促进者和障碍过渡成功。扩大免疫方案显示,过渡后全球疫苗和免疫接种基金资助的疫苗得到持续覆盖,通过全球疫苗和免疫接种共同供资机制调动国内资金,弥补了资金缺口,与现有服务交付结构完全集成,为公共部门建立完善和有利的药品采购流程,并由技术胜任的管理人员进行管理和财务宣传。尽管自2012年以来没有土著疟疾病例,这表明总体方案取得了成功,AMC在其不同的计划组成部分方面表现出不同的过渡成功。需要调动业务费用的捐助者支持的方案构成部分,在早期财务规划的推动下,在考虑到COVID-19相关限制的情况下,成功过渡(例如昆虫学和寄生虫学监测)。其他关键方案构成部分,比如研究,培训,依赖于非运营支出的教育和意识落后。此外,在低疟疾负担的背景下,对AMC在当前结构内未来财务可持续性的担忧仍然存在。