BACKGROUND Addressing the social and other non-biological determinants of health largely depends on policies and programmes implemented outside the health sector. While there is growing evidence on the effectiveness of interventions that tackle these upstream determinants, the health sector does not typically prioritise them. From a health perspective, they may not be cost-effective because their non-health outcomes tend to be ignored. Non-health sectors may, in turn, undervalue interventions with important co-benefits for population health, given their focus on their own sectoral objectives. The societal value of win-win interventions with impacts on multiple development goals may, therefore, be under-valued and under-resourced, as a result of siloed resource allocation mechanisms. Pooling budgets across sectors could ensure the total multi-sectoral value of these interventions is captured, and sectors' shared goals are achieved more efficiently. Under such a co-financing approach, the cost of interventions with multi-sectoral outcomes would be shared by benefiting sectors, stimulating mutually beneficial cross-sectoral investments. Leveraging funding in other sectors could off-set flat-lining global development assistance for health and optimise public spending. Although there have been experiments with such cross-sectoral co-financing in several settings, there has been limited analysis to examine these models, their performance and their institutional feasibility. AIM This study aimed to identify and characterise cross-sectoral co-financing models, their operational modalities, effectiveness, and institutional enablers and barriers. METHODS We conducted a systematic review of peer-reviewed and grey literature, following PRISMA guidelines. Studies were included if data was provided on interventions funded across two or more sectors, or multiple budgets. Extracted data were categorised and qualitatively coded. RESULTS Of 2751 publications screened, 81 cases of co-financing were identified. Most were from high-income countries (93%), but six innovative models were found in Uganda, Brazil, El Salvador, Mozambique, Zambia, and Kenya that also included non-public and international payers. The highest number of cases involved the health (93%), social care (64%) and education (22%) sectors. Co-financing models were most often implemented with the intention of integrating services across sectors for defined target populations, although models were also found aimed at health promotion activities outside the health sector and cross-sectoral financial rewards. Interventions were either implemented and governed by a single sector or delivered in an integrated manner with cross-sectoral accountability. Resource constraints and political relevance emerged as key enablers of co-financing, while lack of clarity around the roles of different sectoral players and the objectives of the pooling were found to be barriers to success. Although rigorous impact or economic evaluations were scarce, positive process measures were frequently reported with some evidence suggesting co-financing contributed to improved outcomes. CONCLUSION Co-financing remains in an exploratory phase, with diverse models having been implemented across sectors and settings. By incentivising intersectoral action on structural inequities and barriers to health interventions, such a novel financing mechanism could contribute to more effective engagement of non-health sectors; to efficiency gains in the financing of universal health coverage; and to simultaneously achieving health and other well-being related sustainable development goals.

中文翻译：

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为卫生部门间行动筹资：共同筹资模式的系统审查。

背景技术解决健康的社会和其他非生物决定因素在很大程度上取决于在卫生部门之外实施的政策和计划。尽管有越来越多的证据表明解决这些上游决定因素的干预措施的有效性，但卫生部门通常不会将其作为优先事项。从健康的角度来看，它们可能不具有成本效益，因为它们的非健康结果往往被忽略。由于非卫生部门将重点放在自己的部门目标上，因此它们可能会低估干预措施，从而对人口健康产生重要的共同好处。因此，由于孤立的资源分配机制，对多个发展目标产生影响的双赢干预措施的社会价值可能被低估且资源不足。跨部门汇总预算可以确保捕获这些干预措施的多部门总价值，并更有效地实现部门的共同目标。在这种共同供资方法下，具有多部门成果的干预措施的成本将由受益部门分摊，从而刺激互利的跨部门投资。利用其他部门的资金可能抵消对健康的全球统一发展援助，并优化公共支出。尽管已经在多个环境中进行了此类跨部门联合融资的实验，但对于分析这些模型，其绩效和机构可行性的分析仍然有限。目的本研究旨在确定并描述跨部门联合融资模式，其运作方式，有效性，以及机构的推动者和障碍。方法我们按照PRISMA指南对同行评审的灰色文献进行了系统的综述。如果提供的数据涉及跨两个或多个部门或多个预算的干预措施，则包括在内的研究。对提取的数据进行分类和定性编码。结果在筛选的2751种出版物中，鉴定出81个共同出资的案例。大多数来自高收入国家（93％），但在乌干达，巴西，萨尔瓦多，莫桑比克，赞比亚和肯尼亚发现了六种创新模式，其中也包括非公共和国际支付者。病例数最多的是卫生部门（93％），社会护理部门（64％）和教育部门（22％）。共同筹资模式最常被采用，目的是为确定的目标人群整合跨部门的服务，尽管还发现了针对卫生部门以外的卫生促进活动和跨部门财务奖励的模型。干预措施可以由一个部门实施和管理，也可以采用跨部门问责制的综合方式进行。资源约束和政治相关性成为共同筹资的主要推动力，而围绕不同部门参与者的角色和集合目标缺乏清晰性被发现是成功的障碍。尽管缺乏严格的影响或缺乏经济评估，但经常报告采取积极的过程措施，并有一些证据表明共同筹资有助于改善成果。结论共同供资仍处于探索阶段，跨部门和环境实施了多种模式。通过鼓励就结构性不平等和卫生干预措施的障碍采取部门间行动，这种新颖的筹资机制可以促进非卫生部门的更有效参与；提高全民健康覆盖筹资的效率；并同时实现健康和其他与福祉相关的可持续发展目标。