目的:国际援助的主要目的是促进世界各地的经济和社会发展。国际援助在阿富汗的医疗体系中发挥着重要作用。本研究的目的是从国家和国际管理者的角度调查2022年阿富汗卫生部门的国际援助管理,并为改进提供建议。
方法:该研究采用横断面设计。通过随机抽样选择研究参与者。样本量是根据亚曼公式在110确定的。数据收集工具是国际卫生伙伴关系和相关倡议提供的问卷。以两种描述性(平均值和百分比)和分析格式分析数据。独立t检验,Mann-Whitney,使用Kolmogorov-Smirnov检验和方差分析来检查人口统计学变量与每个维度得分之间的关系。
结果:对援助管理的不同维度的平均得分如下:1)捐助者对国家卫生战略的支持:48/68±16.14(49%),2)可预测融资:50/23±16.02(50%),3)预算外援:55/39±20.15(55%),4)加强公共财政管理体制:38/35±19.06(38%),5)加强供应和采购体系:40.97±19.55(41%),6)相互问责:46.50±19.26(46%),7)技术支持和培训:50.24±17.33(50%),8)民间社会参与:35.24±18.61(35%),9)私营部门参与:36±17.55(36%),总分平均为44.52±13.27(44%)。两组管理者给出的得分差异不显著。在总分和任何人口统计学变量之间没有观察到有意义的关系,但是工作和管理经验与总分之间的关系较弱。相关系数显示问卷不同维度之间的关系具有统计学意义。总而言之,援助管理各方面的绩效几乎没有达到50%。捐助者对国家卫生战略的支持不够。基于证据的决策存在挑战,制定国家卫生战略,控制和评估,采购系统的资源分配和使用。捐助者和政府的优先事项并不总是相似的,缺乏共同责任。技术援助和支持多边合作是必要的。
结论:大多数关于外国援助的研究集中在其对经济增长的影响上,贫困和投资,而不是援助管理过程。没有适当的援助管理,部分资源被浪费,援助计划的目标无法实现。本研究从两个主要利益相关者的角度调查了发展中国家的援助管理,国际和国家经理。
■数据收集恰逢阿富汗政府更迭。现在情况可能不同了。尽管如此,这项研究为被研究国家的援助管理提供了改进的领域。未来的研究可以基于这项研究的结果,并对援助有效性领域进行深入的探索,并设计详细的改进方案。
结论:需要遵循《援助实效巴黎宣言》的指示。特别是,民间社会的参与和私营部门的参与应受到关注。需要制定一项联合计划,以改善不同利益相关者的合作。
OBJECTIVE: The primary purpose of international aid is to promote economic and social development around the world. International aid plays an important role in Afghanistan\'s healthcare system. The purpose of this study is to investigate international aid management in Afghanistan\'s health sector from the perspectives of national and international managers in 2022 and to provide recommendations for the improvement.
METHODS: The study has a cross-sectional design. The study participants were chosen by random sampling. The sample size was determined based on Yaman\'s formula at 110. The data collection tool was the questionnaire provided by International Health Partnership and Related Initiatives. The data were analyzed in two descriptive (mean and percentage) and analytical formats. Independent t-test, Mann-Whitney, Kolmogorov-Smirnov tests and Variance analysis were used to examine the relationships between demographic variables and the scores of each dimension.
RESULTS: The average scores given to different dimensions of aid management were as following: 1) the donners\' support of the national health strategy: 48/68 ± 16.14 (49%), 2) the predictable financing: 50/23 ± 16.02 (50%), 3) foreign aid on budget: 55/39 ± 20.15 (55%), 4) strengthening public financial management system: 38/35 ± 19.06 (38%), 5) strengthening the supply and procurement system: 40.97 ± 19.55 (41%), 6) mutual accountability: 46.50 ± 19.26 (46%), 7) technical support and training: 50.24 ± 17.33 (50%), 8) civil society involvement: 35.24 ± 18.61(35%), 9) private sector participation: 36 ± 17.55 (36%), and in total the average score was 44.52 ± 13.27 (44%). The difference between the scores given by two groups of managers was not significant. No meaningful relationship was observed between the total score and any of the demographic variables, but there was a weak relationship between work and management experience and total score. The correlation coefficient showed a statistically significant relationship between the different dimensions of the questionnaire. To sum up, the performance in all dimensions of aid management hardly reached 50%. Donors\' support for the national health strategy was not adequate. There were challenges in evidence-based decision-making, developing national health strategies, control and evaluation, the allocation of resources and use of procurement system. The priorities of donors and government were not always similar and mutual responsibility was lacking. Technical assistance and supporting multilateral cooperation are necessary.
CONCLUSIONS: Most studies on foreign aid focused on its effects on economic growth, poverty and investment and not aid management processes. Without proper aid management, parts of resources are wasted and aims of aid programs cannot be achieved. This study investigates aid management in a developing country from the perspectives of two main stakeholders, international and national managers.
UNASSIGNED: Data collection coincided with the change of government in Afghanistan. The situation might be different now. Still, this study provides areas for the improvement of aid management in the studied country. Future studies can build upon the findings of this research and conduct in-depth exploration of areas of aid effectiveness and designing detailed programs of improvement.
CONCLUSIONS: Instructions of the Paris Declaration on Aid Effectiveness need to be followed. Particularly, civil society involvement and private sector participation should receive attention. A joint plan for improvement and collaboration of different stakeholders is needed.