Background: Since 2009, China has implemented a chronic disease management program within primary healthcare (PHC) institutions in response to challenges posed by an aging population. However, the effectiveness of the program has been reported as mixed, likely due to variations in PHC physicians' efforts and the support they received from the health system and community. This multi-sector engagement was conceptualized as management intensity in this study, and its impact on the program's effectiveness was evaluated. Methods: This study analyzed 60 885 patients under the chronic disease management program in Yuhuan, Zhejiang province, as of 2023. Management intensity, the primary predictor, was quantified by township-level residual measured based on patients' length of follow-up after eliminating patient demographics. This approach removed the portion of follow-up length attributable to individual characteristics, leaving the residual serving as a purified exposure variable for management intensity. The outcome measures included outpatient visits, inpatient admissions, outpatient and inpatient expenses, and glycemic and blood pressure (BP) control status. Data sources included chronic disease management registration records, service records of follow-up, and electronic medical records. A two-level mixed-effects regression model was then used to examine how management intensity affected the outcomes. Results: Each unit increase in management intensity corresponded to 0.21 more PHC outpatient visits and 0.15 fewer hospital outpatient visits. Meanwhile, higher management intensity was also associated with increased utilization of PHC inpatient services (odds ratio [OR]: 0.98, 95% CI: 0.97-0.98) and decreased utilization of hospital inpatient services (OR: 1.24, 95% CI: 1.18-1.29). Conclusion: Greater management intensity correlated with better health outcomes and higher utilization of PHC services. Since multi-sector engagement strongly affected how intensively chronic diseases were managed, it was imperative for health systems and communities to actively participate in and strengthen the program by supporting physicians.

BackgroundPhysical activity is generally associated with improved adolescent mental health, yet its dose–response relationship remains unclear. This study examined how physical activity relates to stress perception, psychological resilience, and self-efficacy among adolescents.MethodsA cross-sectional survey was conducted in September 2024 among 2,270 students aged 12–15 years from 4 middle schools in Shanghai, China. Multivariable linear regression and restricted cubic spline (RCS) models were used to examine association and dose–response relationships, adjusting for demographic and academic covariates.ResultsHigher physical activity was significantly associated with lower stress perception (B = −0.13, p < 0.001), higher psychological resilience (B = 0.33, p < 0.001), and higher self-efficacy (B = 0.25, p < 0.001). RCS analyses revealed dose–response relationships. At lower physical activity levels, the slopes were −5.65 for stress perception, 8.59 for psychological resilience, and 12.10 for self-efficacy (all p < 0.001), while at higher physical activity levels, the associations were substantially attenuated. Gender-stratified analyses indicated stronger associations in males than in females.ConclusionPhysical activity is associated with better mental health in adolescents, particularly among those with lower activity levels. The findings highlight the importance of targeting less active adolescents in school-based interventions.

Despite the high prevalence of mental disorders in China, most patients do not utilize mental health services. Digital mental health services offer a potential solution, but their full potential remains untapped. Understanding consumer preferences is key to tailoring these services and boosting acceptance and adoption. This study aims to elicit preferences for digital mental health services in urban China. A discrete choice experiment was conducted with 867 participants, including both current and potential consumers of mental health services, recruited from urban areas in China. Under the guidance of the Theory of Planned Behavior, attributes relevant to digital mental health services were identified through a multi-stage process including a literature review and in-depth semi-structured interviews with 30 consumers and potential consumers of mental health services, and five professionals from Internet-based healthcare and online psychological counseling fields. Six attributes were identified: (1) professional engagement; (2) intervention type; (3) endorser/recommender; (4) mode of content delivery; (5) monthly costs; and (6) privacy policy. Recruited via a market research company, participants completed a discrete choice experiment survey with 11 option sets online. Participants’ choices were analyzed with a mixed logit model and further stratified by experience with mental health services, sex, education, income, age, and risk for mental health conditions. The relative importance score was calculated to interpret the results of the discrete choice experiment. Additionally, the willingness-to-pay approach was used to estimate the monetary value of each attribute level. The most important influence on the choice of digital mental health services was the level of professional engagement (β = 2.470, β = 1.011), followed by the customized and adaptive intervention (β = 0.508) and data usage solely used for iterative product upgrades (β = 0.492). The relative importance score also revealed the most important attributes for consumers were professional engagement, intervention type, and privacy policy. Considering the professional engagement attribute, consumers were willing to pay an additional ¥3916.5 per month for services provided by mental health professionals throughout. Preferences diverged based on participant characteristics including experience with mental health services, sex, and education. Our results indicated a consistent preference for services provided by mental health professionals across demographics and regardless of previous mental health service experience. We also found a preference for personalized services, highlighting a shift towards customization in healthcare and emphasizing the need to customize digital mental health services.

PurposeThis study aimed to identify long-term trends in continuity of care (COC) among hypertensive patients using group-based trajectory modeling (GBTM) and evaluate their association with medical expenses, thereby providing evidence for chronic disease management.MethodsWe analyzed 6-year (2016–2021) reimbursement data of the social health insurance from Yuhuan City, China, including 30,545 hypertensive adults. Continuity of Care Index (COCI) was calculated annually. GBTM was employed to classify patients into trajectory subgroups based on COCI trends, with the best-fitting model selection guided by Bayesian information criterion (BIC), average posterior probability (AvePP). Multiple linear regression assessed the relationship between trajectory groups and annual medical expenses, adjusting for age, gender, insurance type, and Charlson Comorbidity Index (CCI).ResultsFour COCI trajectories were identified: low-level maintenance (52.06%), low-level increase (17.14%), high-level decrease (18.94%), and high-level maintenance (11.87%). Patients in the high-level maintenance group incurred the lowest annual medical expenses (mean range: ¥3,786–¥5,088), while the low-level maintenance group exhibited the highest (mean range: ¥6,450–¥10,321). After adjustment, the low-level maintenance group had significantly higher expenses than the high-level maintenance group (β = 3,049.44 CNY, p < 0.001). Older age, employee insurance coverage, and higher CCI were also associated with increased medical expenses (p < 0.001).ConclusionSustained high continuity of care correlates with reduced medical expenses in hypertensive patients. Long-term COC maintenance should be prioritized in chronic disease management to mitigate healthcare costs. Policymakers should incentivize care continuity through integrated health systems and targeted patient interventions.

PurposeThe purpose of this study is to present the findings of a cross-sectional survey on health state utility (HSU) values, a crucial metric for economic evaluations, and to analyze the primary factors influencing the HSU values of individuals with normal cognition (NC) or mild cognitive impairment (MCI).MethodsA community-based survey was conducted in Haikou City, China, employing cluster random sampling to select participants. The presence of NC and MCI was determined through the administration of the Chinese version of the Mini-Mental State Examination (MMSE). The assessment of HSU was conducted using the Chinese version of the Short Form Six Dimensions version 2 (SF-6Dv2), in conjunction with a questionnaire that collected data on socio-demographic characteristics, health-related behaviors, and health conditions. The HSU values were calculated using the SF-6Dv2 value set, which was developed for the Chinese population. A multiple linear regression model was constructed to identify the factors influencing HSU values.ResultsThe survey indicated that 536 older individuals were identified with NC (mean age 70.7, SD 7.1, 51.4% females), 245 were identified with MCI (mean age 73.0, SD 7.8, 67.4% females). The mean HSU values in NC group and MCI group were 0.792 (SD: 0.174) and 0.720 (SD: 0.199), respectively. The optimal multiple regression model for the MCI group demonstrated a linear relationship between age, depression symptomatology, and MMSE score with HSU, with coefficients of −0.009 (p < 0.001) for age and −0.132 (p < 0.001) for depression symptomatology. And for NC group, the optimal multiple linear regression model included five variables: age, sex, monthly personal income, depression symptomatology, and number of comorbidities.ConclusionThis study presented findings on HSU and its influencing factors in both the NC and MCI groups. The older adult individuals with MCI demonstrated lower HSU compared to their cognitively normal counterparts. The results of the factor analysis indicated that intervention programs designed to enhance the health-related quality of life for older adult individuals with MCI should include strategies to address depression.

The 686 Program in China primarily aims to provide certain health and policy services to individuals with severe mental disorders within the community. As of 2020, a total of 6.43 million patients were registered nationwide under this program. However, there remains a disparity between the actual number of patients covered by the program and the total number of individuals with mental disorders. Factors influencing the engagement in 686 Program among individuals with severe mental disorders remain underexplored in current research.This study aims to understand the barriers and facilitators to program contact, offers implications for the development of targeted interventions for people with severe mental disorders, enabling the creation of more tailored and impactful strategies to enhance the 686 Program’s effectiveness and reach. We aimed to explore the influencing factors associated with the registration and management of the 686 Program in a clinical sample of inpatients with severe mental disorders. This study employed a cross-sectional study design. Demographic information, behavioral characteristics, and clinical information of inpatients firstly diagnosed with severe mental disorders from 2018 to 2022 were retrieved from the Hainan Provincial Anning Hospital information system, subsequently, registration and management data were matched using resident ID numbers within the 686 Program information system to effectively align independent and dependent variables. Binary logistic regression analysis was utilized to investigate the factors influencing the registration and management of the 686 Program among the first confirmed patients with severe mental disorders. Between 2018 and 2022, Hainan Provincial Anning Hospital had 3,008 individuals who were first diagnosed with severe mental disorders. Among them, 1135 (37.73

Background:Universal health coverage (UHC) and global health security (GHS) should be pursued synergistically to strengthen health systems. However, existing studies found that the efforts toward the two agendas were divergent worldwide. We reviewed the synergy status between UHC and GHS in the Western Pacific Region (WPR) to provide evidence for decision-makers to promote synergy. Methods:We collected the UHC service coverage index (UHC SCI) and the GHS index (GHSI) scores. We created a four-quadrant diagram to discover the gap in UHC and GHS capacities within WPR and divide WPR countries into four groups based on the global mean scores. Further, we adopted global spatial autocorrelation analysis to discover spatial aggregations of high and low scores by calculating Moran's I. In addition, we conducted a correlation analysis to assess the synergy level in WPR and reveal the gap between Pacific Island countries or territories (PICTs) and non-PICTs. We conducted key informant interviews to uncover actual scenarios and address gaps in the quantitative evidence. Results:Compared to the global mean UHC SCI and GHSI scores, nine out of 13 non-PICTs had higher scores, while all 14 of the PICTs had lower scores for both indexes. The Moran's I for WPR countries' UHC SCI and GHSI scores in 2021 were 0.20 and 0.23, respectively (Z-score >2.58; P < 0.01). The correlation coefficients between the two index scores were 0.722 (P < 0.001) at the global level and 0.869 (P < 0.001) at WPR. Within the WPR, the correlation coefficients were 0.859 (P < 0.001) in the non-PICTs and -0.026 (P > 0.05) in the PICTs. Conclusions:The synergy level between UHC and GHS was high in the WPR, but this mainly came from the synergy in the non-PICTs. The two agendas have barely synergised the PICTs. To build a safer and healthier WPR, it is important to pay more attention to the countries that have weaker health capacities in the region and narrow the gap.

Perinatal depression (PND) has emerged as a significant public health concern. There is no consensus among countries or organizations on whether to screen for PND. Despite the growing body of evidence regarding the economic value of PND screening, its cost-effectiveness remains inadequately understood due to the heterogeneity of existing studies. This study aims to synthesize the available global evidence on the cost-effectiveness of PND screening compared to routine or usual care to provide a clearer understanding of its economic value. A detailed search strategy was predetermined to identify peer-reviewed publications that evaluated the cost-effectiveness of PND screening. We designed a scoping literature review protocol and searched electronic databases, including MEDLINE, EMBASE, and Web of Science, for studies published from inception to 10 December 2023. We included studies that conducted full economic evaluations comparing PND screening with usual care or other comparators and excluded studies that were not in English or lacked full texts. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to evaluate the reporting quality of the studies. Then, the data regarding costs and effectiveness were extracted and summarized narratively. A total of ten eligible studies were included, all of which were evaluated as being of high reporting quality. Nine of these studies compared the economic value of PND screening with usual care without screening, with eight finding that PND screening was generally more cost-effective. The remaining study evaluated the cost-effectiveness of two psychosocial assessment models and indicated that both effectively identified women “at risk”. Across studies, PND screening ranged from being dominant (cheaper and more effective than usual care without screening) to costing USD 17,644 per quality adjusted life year (QALY) gained. Most included studies used decision trees or Markov models to test if PND screening was cost-effective. Although current economic evaluation studies have mostly suggested PND screening could be more cost-effective than usual care without screening, there is high heterogeneity in terms of participants, screening strategies, screening settings, and perspectives across studies. Despite varied settings and designs, most studies consistently indicate PND screening as cost-effective. Further evidence is also required from low- and middle-income countries (LMIC), non-Western countries, and randomized controlled trials (RCTs) to draw a more robust conclusion.

Background Malaria infection during pregnancy is associated with an increased risk of maternal death, as well as adverse birth outcomes. Intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) is known to improve pregnancy outcomes. However, the coverage of IPTp-SP in antenatal care (ANC) in sub-Saharan Africa remains well below the target. This study aims to estimate to what extent malaria service readiness affects the uptake of IPTp-SP during ANC visits in sub-Saharan African countries. Methods This study included 3267 pregnant women attending ANC for the first time and 2797 pregnant women who had attended ANC more than a month ago in six sub -Sahara n African countries. The readiness of malaria services at each institution includes four indicators: the presence of IPTp-SP guidelines, SP availability, integration of IPTp-SP service into ANC, and provider training on IPTp-SP. The outcome variable indicates whether a pregnant woman received IPTp-SP at her current ANC visit. A modified Poisson regression model estimated the associations between malaria service readiness and IPTp-SP uptake for women eligible for the first and subsequent doses. Results For women eligible for their first dose, visiting an institution with available SP was associated with an increased probability of receiving IPTp-SP (risk ratio (RR) = 1.43; 95% confidence interval (CI) = 1.22 to 1.67, P < 0.001). For women who were eligible for their next dose, the availability of SP (RR = 1.17; 95% CI = 1.04 to 1.32, P = 0.008) and integration of IPTp-SP service into ANC (RR = 1.82; 95% CI = 1.21 to 2.74, P = 0.004) in the institution were associated with increased likelihood of IPTp-SP uptake. Counterfactual predictions indicated that enhanced provider training could boost IPTp-SP uptake in high-uptake countries, while better SP availability and IPTp-SP integration into ANC would significantly impact low-uptake countries. Conclusions For better IPTp-SP coverage, strategies should be customized. High uptake countries should focus on provider training, while low uptake ones should ensure IPTp-SP availability and service integration.

Background: The coverage of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) in antenatal care (ANC) in sub-Saharan Africa, remains well below the target. This study examined the impact of the availability and readiness of malaria services on the uptake of IPTp-SP provided during ANC visits in sub-Saharan countries.

Background The majority of patients with perinatal depression (PND) in China do not receive adequate treatment. As forming a therapeutic alliance with patients is crucial for depression treatment, shared decision-making (SDM) shows promise in promoting patients’ uptake of evidence-based mental health services, but its impact on patient outcomes and implementation in real-world maternal care remain uncertain. Therefore, this study aims to develop and evaluate an interprofessional shared decision-making (IP-SDM) model for PND to enhance maternal mental health services. Methods This study contains four research phases: feasibility testing (Phase 1), toolkit development (Phase 2), usability evaluation (Phase 3), and effectiveness evaluation (Phase 4). During the development stage, focus group interviews will be conducted with expectant and new mothers, as well as maternal care providers for feasibility testing. A toolkit, including a patient decision aid along with its user guide and training materials, will be developed based on the findings of Phase 1 and syntheses of up-to-date evidence and appraised by the Delphi method. Additionally, a cognitive task analysis will be used for assessing the usability of the toolkit. During the evaluation stage, a prospective randomized controlled trial embedded in a mixed methods design will be used to evaluate the effectiveness and cost-effectiveness of the IP-SDM care model. The study targets to recruit 410 expectant and new mothers who screen positive for depression. They will be randomly assigned to either an intervention group or a control group in a 1:1 ratio. Participants in the intervention group will receive decision aid, decision coaching, and clinical consultation, in addition to usual services, while the control group will receive usual services. The primary outcome is the quality of decision-making process, and the secondary outcomes include SDM, mental health service utilization and costs, depressive symptoms, and health-related quality of life. In-depth interviews will be used to explore the facilitating and hindering factors of SDM. Discussion This study will develop an IP-SDM care model for PND that can be implemented in maternal care settings in China. This study will contribute to the understanding of how SDM impacts mental health outcomes and facilitate the integration of mental health services into maternal care. Trial registration ChiCTR2300072559. Registered on 16 June 2023.

自中美贸易战后,尽管中美关系处于战略竞争乃至对抗的局面,备受学术界和社会各界人士关注,但在公共卫生等非传统安全领域仍然有较为广阔的合作空间和前景.中美政府间的公共卫生合作主要体现在两国疾病预防控制中心之间的技术合作.自改革开放以来,合作历程可以划分为合作发展阶段(1979-2002 年),合作深入阶段(2003-2016 年),以及合作倒退阶段(2017-2020 年).通过文献和相关资料的梳理和整合,可以发现既往的合作主要呈现三大特点:合作内容以传染病防治为主线,合作形式从技术援助逐渐转向平等共建,合作机制从双边合作逐步转向多边合作.在新型冠状病毒感染疫情趋于平缓的背景下,两国为了应对未来的突发性公共卫生危机,可继续以传染病防控为重点,将维护卫生安全作为开展公共卫生合作的主要驱动力,同时拓展在全球卫生领域的合作.未来两国能否开启新的公共卫生合作阶段,或对两国乃至全球公共卫生安全产生深远影响.

目的:分析基本医疗保险类型对糖尿病患者的就医行为和健康状况产生的影响.方法:统计浙江省玉环市的全体糖尿病患者在2020 年9 月-2021 年 8 月间因糖尿病就诊的行为和就诊倾向,并使用患者在之后4 个月的血压、空腹血糖和体重指数来评价其健康状况.采用logistic回归探讨影响患者就诊倾向和健康状况的因素.结果:共纳入了14110 名患者.与参加城乡居民基本医疗保险的患者相比,参加城镇职工基本医疗保险的患者更少去基层医疗机构就诊[OR为 0.46,95％CI为(0.41,0.51)],且健康状况更好.与经常去二级及以上医院的患者相比,经常去基层医疗机构就诊的患者健康状况相对更差.结论:城镇职工基本医疗保险现有的差异化报销政策不足以引导患者去基层医疗机构就诊.此外,基层医疗机构为患者提供糖尿病管理的能力尚有不足,应通过县域医共体加强基层医疗机构的服务能力,并提升患者对基层医疗机构的信心.

随着各国人民对健康关注度的提高和公共卫生学科在全球的发展,公共卫生教育在教育体系中的地位越来越重要.以巴基斯坦、坦桑尼亚为代表的部分"一带一路"沿线国家,由于教育资源缺乏,公共卫生教育体系尚不完善,存在着教育机构规模较小、师资力量较为薄弱,当地学生学费负担较重等问题.我国与两国长期保持着良好的教育合作关系.建议我国应从"一带一路"沿线国家的教育体系特点和教育合作需求出发,从提高公共卫生教育体系适配度、完善课程设置、提升师资力量、增加学生交流等方面展开公共卫生教育合作,在促进各国公共卫生教育发展的同时提升大国形象,实现共赢.

目的 分析广西紧密型县城医疗共同体(以下简称"医共体")试点县前后患者对居民就医体验和服务质量的满意度变化,评价紧密型县域医共体建设的实施成效.方法 在2020年与2022年,分别对试点县和非试点县的医共体门诊患者、住院患者进行满意度基线调查和终末调查,采用描述性分析、双重差分法比较前后满意度差异.结果 2022年的患者满意度较2020年有不同程度的提升(P<0.05).试点县住院患者的总体满意度、就医环境、等候时间、服务态度、技术水平、医疗费用满意度与非试点县相比,分别提升了0.306分、0.361分、0.462分、0.377分、0.273分、0.404分(P<0.05),但医共体建设对门诊患者满意度影响不大.结论 广西"三二"医联体(三级公立医院与县级二级医疗机构组成的医疗联合体)取得了一定成效,牵头医院住院患者就医体验不断改善.应促进"三二"医联体和县域医共体有机衔接和融合,提高县域整体医疗服务能力.

Background: Universal health coverage (UHC) and global health security (GHS) should be pursued synergistically, but fragmentations have occurred worldwide. To promote the synergies in the Western Pacific Region (WPR), this study aimed to review the current status of fragmentations.Methods: The Universal Health Coverage-Service Coverage Index (UHC-SCI) and the Global Health Security Index (GHSI) scores of WPR countries were collected from the World Health Organization(WHO) database and the GHSI official website, respectively. The scores were analyzed through descriptive, correlation, and global spatial autocorrelation analyses between June and September 2023. Due to limited available data, 27 out of 37 countries or territories were included in the study.Findings: Most WPR countries had stronger UHC capacity but weaker GHS capacity than the global median. The UHC-SCI and GHSI were strongly correlated. Besides, both indexes showed spatial aggregation, and high scores tended to appear in non-Pacific Island countries while low scores were mainly in Pacific Island countries or territories (PICTs).Interpretation: The efforts in the UHC and GHS in the WPR were fragmented. However, the UHC and GHS in this region were much more interdependent than the global average, meaning that promoting the synergies is extremely important for WPR countries. In addition, the gap within the WPR mainly existed between PICTs and non-PICTs; therefore, the PICTs’ capacities should be strengthened.Funding: This study is supported by Grants from the WHO < Promoting Global Health Partnership in the Western Pacific Region (#2023/1373961-0).Declaration of Interest: We declare no competing interests.

目的:分析美国实施对外卫生援助的特点,为我国开展对外卫生援助提供参考.方法:本研究基于美国国际开发署的对外援助数据库,从实施部门(横向)和实施时间(纵向)两个维度,定量分析美国实施的卫生援助,分别比较不同维度内的援助渠道、受援地区和健康领域的异同点.结果:2001—2020年,美国实施卫生援助的主要渠道是政府机构、非政府组织、多边组织以及企业渠道.美国本土机构是构成非政府组织和企业渠道的主体.主要援助地区是撒哈拉以南的非洲,主要援助的健康领域是艾滋病防控.美国国务院、国际开发署、卫生与公众服务部是三大出资机构.近三届总统任期内的卫生援助在地区(国家)、健康领域的分布上表现出了一定的一致性.结论:顶层设计上,建议我国继续强化卫生援助在对外政策中的战略定位.实施层面上,建议我国积极动员包括非政府组织、私人企业、科研机构等在内的非国家行为体参与卫生援助,同时强化卫生援助的评估与监管体系.

针对COVID-19期间上海市应急医疗资源配置进行建模与仿真化模拟.基于传染病SEIR susceptible-exposed-infected-removed)模型,结合患者门诊就诊和住院治疗过程,构建了医疗资源需要量测算的SEIOWHR(susceptible-exposed-infected-outpatients-waiting to hospitalized-hospitalized-removed)系统动力学模型.仿真模拟武汉疫情若发生在上海,需要的应急医疗资源量和不同医疗资源供给水平下的缺口发生时间及待住院患者疾病转归结局,探索传染病疫情下医疗资源配置的关键因素.建议应结合疫情发展趋势和患者疾病转归结局,加强医疗资源的早期规划和动态调整,并努力提高确诊率,有效应对传染病疫情.

目的:分析"一带一路"沿线国家卫生资源配置状况,总结卫生资源配置空间分布情况及特征.方法:选取卫生费用、卫生人力与设施、海外卫生援助3个方面的指标,对"一带一路"沿线的64个国家的卫生资源配置状况进行空间分布分析、全局空间自相关分析以及热点分析.结果:卫生资源的空间分布方面,总体呈现由北至南逐渐降低的趋势.空间自相关分析结果显示6个指标存在显著的空间正相关性,其中每千人口拥有医院床位数的Moran's I为0.445(Z=10.988,P<0.01),空间聚集性最强.热点分析结果显示卫生资源分布的热点区域主要集中在中东欧地区,冷点区域主要集中在南亚与东南亚地区.结论:"一带一路"沿线国家的卫生资源配置状况呈现空间分布上的不均衡,南亚地区资源投入尤其不足;相邻国家的卫生资源配置存在明显的空间聚集性;南亚与东南亚地区对海外卫生援助的依赖性较强.

抗击艾滋病、结核病和疟疾的全球基金是一个旨在通过公私合作伙伴关系,加速终结艾滋病、结核病和疟疾等传染病流行的国际融资机构.全球基金成立20年以来,为艾滋病、结核病和疟疾流行的控制做出了重要贡献,影响力日益扩大.本文详细介绍了全球基金的治理结构以及筹资与分配模式,比较分析了主要捐赠国家与全球基金的合作方式,以及中国与全球基金的关系,并为中国参与全球基金等全球卫生多边平台提出了相应的政策建议.