In many African countries, hundreds of health-related NGOs are fed by a chaotic tangle of donor funding streams. The case of Mozambique illustrates how this NGO model impedes Universal Health Coverage. In the 1990s, NGOs multiplied across post-war Mozambique: the country's structural adjustment program constrained public and foreign aid expenditures on the public health system, while donors favored private contractors and NGOs. In the 2000s, funding for HIV/AIDS and other vertical aid from many donors increased dramatically. In 2004, the United States introduced PEPFAR in Mozambique at nearly 500 million USD per year, roughly equivalent to the entire budget of the Ministry of Health. To be sure, PEPFAR funding has helped thousands access antiretroviral treatment, but over 90% of resources flow "off-budget" to NGO "implementing partners," with little left for the public health system. After a decade of this major donor funding to NGOs, public sector health system coverage had barely changed. In 2014, the workforce/ population ratio was still among the five worst in the world at 71/10000; the health facility/per capita ratio worsened since 2009 to only 1 per 16,795. Achieving UHC will require rejection of austerity constraints on public sector health systems, and rechanneling of aid to public systems building rather than to NGOs.

中文翻译：

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莫桑比克的非政府组织，紧缩政策和全民健康覆盖。

在许多非洲国家，成百上千个与健康相关的非政府组织被捐助者资金流的混乱缠住。莫桑比克的案例说明了这种非政府组织模式如何阻碍全民健康覆盖。在1990年代，非政府组织在战后莫桑比克的数量成倍增加：该国的结构调整计划限制了公共卫生系统的公共和外国援助支出，而捐助者则偏爱私人承包商和非政府组织。在2000年代，许多捐助者为艾滋病毒/艾滋病和其他垂直援助提供的资金急剧增加。2004年，美国以每年近5亿美元的价格在莫桑比克引入了PEPFAR，大致相当于卫生部的全部预算。可以肯定的是，PEPFAR的资金已帮助成千上万的人获得了抗逆转录病毒治疗，但超过90％的资源“预算外”流向了非政府组织“ 自2009年以来，医疗机构/人均比例恶化至每16795人中只有1人。要实现超高效率，将需要拒绝对公共部门卫生系统的紧缩限制，并需要将援助重新分配给公共系统建设而不是非政府组织。自2009年以来，医疗机构/人均比例恶化至每16795人中只有1人。要实现超高效率，将需要拒绝对公共部门卫生系统的紧缩限制，并需要将援助重新分配给公共系统建设而不是非政府组织。