中国全球基金项目结核病防治资源配置分析

Resource allocation analysis of China Global Fund TB Program for Tuberculosis prevention and control

目的了解中国全球基金结核病项目投入状况、分配原则、有关影响因素，为2014年项目停止后以国家财政经费支持为主的资源分配提供科学依据。方法收集2003-2013年全球基金结核病项目各级资源配置相关信息，选择全国31省（直辖市、自治区；我国香港、澳门、台湾地区除外）人均国内生产总值（GDP）、结核病患者登记数、登记率作为影响全球基金项目投入的因素，检验其与全球基金项目投入的相关性。在此基础上，分析各省需求指数Z值与全球基金人均实际投入情况进行比较。分析近年防治经费与全球基金经费投入的一致性。采用SPSS18．0统计软件进行统计学分析，用Pearson相关分析对中国全球基金结核病项目投入与相关指标的相关性进行分析，以P〈0．05为差异具有统计学意义。结果2003--2013年全球基金结核病项目总计支出经费2．38亿美元，其中1．62亿美元即67．68％由地方结核病防治机构支出；全球基金项目中结核病防治经费与Z值排名前十的省（自治区）（广东、新疆、河南、湖南、贵州、浙江、湖北、四川、江苏、内蒙古）结核病防治需求指数Z总值依次为（2．73、1．97、1.77、1．74、1．44、1．19、1．18、1．13、0．99、0．60）（r=0．626，P=0．000）、各省（自治区）（广东、新疆、河南、湖南、贵州、浙江、湖北、四川、江苏、内蒙古）结核病患者登记数（71988、29793、70595、58485、42374、35777、47407、60339、38784、18236例）（r=0．765，P=0．000）呈正相关；与各省（自治区）（广东、新疆、河南、湖南、贵州、浙江、湖北、四川、江苏、内蒙古）的人均GDP情况（57067、7505、29599、22154、6852、34665、22250、23872、54058、15880亿元）没有相关性（r=0．039，P=0．833）；与结核病患者登记率（广东、新疆、河南、湖南、贵州、浙江、湖北、四川、江苏、内蒙古分别为68．53／10万、134．89／10万、75．20／10万、88．67／10万、122：16／10万、65．49／10万、82．34／10万、74．96／10万、49．10／10万、73．48／10万）呈负相关（r=-0．18，P=0．924）。某些省（自治区）全球基金资助经费与实际需求不相应，新疆的实际需求位于第2位，而全球基金投入经费则处于第16位。结论尽管与中央转移支付经费覆盖工作内容的占比不同，全球基金项目的结核病防治经费分配总体公平。

Objective To understand the funding input, distribution, and related factors of China Global Fund （GF）TB Program, in order to provide basis for Government funding allocation after the closure of China GF TB Program in middle of 2014. Methods National and 31 provincial （prefectural and county, except for Hong Kong, Macao and Taiwan）GF TB program investment and allocation data from 2003 to 2013 were collected. Several factors in each province were analyzed through Pearson correlation analysis in order to determine whether they had a statistical correlation to the distribution of GF TB program resources in China,including： the Per Capital Gross Domestic Product （GDP）, the number of TB registration, and TB registration rate were calculated at each provincial level and compared with related GF investment. The Z values were calculated at each provincial level and compared with the per capita of GF investment. The resource allocation in different program areas were compared with the level of resource input by GF and the central transfer payments. SPSS 18.0 software was adopted to carry out the data processing and analysis, and the correlation between the resource input of China GF TB Program and related indicators was analyzed by Pearson correlation. P〈0. 05 was considered a significant difference Results The total expenditure for China TB prevention and control by GF reached US 238 million from 2003 to 2013, 67.68% corresponding to US162 million was funded TB dispensaries under the central. Positive correlation （r is 0. 626 and 0. 765 and P%0.01 both） was identified between GF resource input and the ＂TB resource needs combined index＂, the number of TB registration. However, there was no statistical correlation （r is 0. 039 and P=0. 833） between GF resource input and the GDP. There was negative correlation （r is =0.18 and P=0. 924） between GF resource input and TB registration rate of each province. The GF TB program investment and need in different province could not meet completely. The rank of Z value in Xiniiang Uygur Autonomous Region were 8 ,but the rank of GF TB program in same province was 16. Conclusion Though in comparison with the central transfer payment, the global fund funding covered different working content, the overall allocation of funds was fair.