全民健康覆盖(UHC)最近变得e very popular in international forums: the 2016-approved WHO development agenda consecrated UHC asSustainable Development subgoal 3.8。因此，许多“旧”卫生融资政策都以UHC的语言重新构成。可能出现的一个问题是，国家政府是否真的接受了这一概念并决定实现（几乎是神圣）目标的策略。

As I started my career as a junior professional in global health in West Africa, something caught my attention: the relationship between foreign donors and African governments. In many situations, my assessment was that there was something problematic with this relationship, something that somehow impeded the success of interventions.

我亲眼目睹了国际项目的实施，几乎没有考虑到适当的公共系统或人民的需求。我目睹了外国捐助者（非政府组织，私人基金会，国际组织和双边捐助者）的贡献之间的不足，而在现场实际上有意义的是什么。

有一次，我看到一个著名的国际非政府组织招募社区卫生工作者，然后将他们送往农村和偏远村庄。但是，这些CHW最初不是来自这些地区：它们来自城市。最有可能的是，他们在社区中融入并做好工作的能力将受到这个简单的事实的破坏。我没有判断 - 这种明显的不匹配背后有很好的意图 - 但仅仅意识到值得进一步调查。因此，我开始了卫生系统融资领域的博士冒险。

政府在驾驶座位上？

One of the reasons I chose to specialize in this domain was that I thought this would be an area where governments would definitely have a say. Governments had to be in the driver’s seat because they would certainly care what sort of financial model would better provide healthcare in the whole country.

We chose to do a rapid review of what ownership actually implied for countries when decisions were made.

They would care because: 1) their budget is always tight (yes, tighter than ours) and 2) their popularity partly depends on the health status of their population. Idealists – myself included – would add to these self-regarding motives a genuine will to provide better and more accessible healthcare to populations. And this would, in turn, contribute to legitimize their power (some readers will probably think ofFoucault在这个非常时刻）。

So I started investigating ownership of the policy making process in health financing. The problem was that, I was not at all convinced by the word “ownership”, which to me perpetuated – again – therepresentation systems of external donors。在本文的介绍中，我们试图解释为什么与其他单词（国家，国家等）配对的术语是有问题的。

To depoliticize the word, we chose to do a rapid review of what ownership actually implied for countries when decisions were made. We came up with the following indicators of government ownership: political commitment by demonstrating leadership at the highest levels of government, effective engagement of technical levels of government, ability to coordinate international donors and partners’ support within public bodies, and national mobilization of domestic resources to finance the policy in the long term.

UHC涉及许多方面（例如，健康的人力资源，医疗保健质量），但我们决定专注于旨在实现非洲UHC的政策。势头是正确的，因为几个非洲国家刚刚进行major health financing reforms。我们审查了三个主要健康融资保单的政策制定流程所有权：用户豁免，健康保险和基于结果的融资。我们的审查检索了35篇论文，其中24篇显示政府所有权混合（即在某些政策制定阶段有所有权的指标，但不是全部）。

我们还发现证据表明政府所有权和捐助者的影响力都可以成功共存。

Interestingly, when results demonstrated some lack of government ownership, we noticed that donors did not necessarily play a role: other actors’ involvement was contributing to undermining government-owned decision-making, such as the private sector. We also found evidence that both government ownership and donors’ influence can successfully coexist.

The results of our review show that, instead of pushing for new financing policies, donors should shift to strengthening the State’s coordination and domestic funding mobilization roles, together with securing a higher involvement of governmental (both political and technical) actors.

Short bio: Lara is a global health researcher currently enrolled as PhD student at School of Public Health (ESPUM) and Public Health Research Institute (IRSPUM) at Université de Montréal, and Paris Diderot University’s Centre d’Etudes en Sciences Sociales sur les Mondes Africains, Américains et Asiatiques (CESSMA). She coordinates the现实主义研究论文collection.