SECTOR-WIDE APPROACHES
IN THE HEALTH SECTOR
(IN UGANDA)
KEY CHARACTERISTICS
&
CHALLENGES
Dr. Martinus Desmet,
MPN, WHO Country Office - Uganda
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Content
Common definitions of SWAp
What SWAp really is (should be)
Challenges
Belgian contribution to SWAp
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1. COMMON DEFINITIONS
- from policy to policy
- a process
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SWAp’s - DEFINITIONS
“All significant funding for the sector supports:
- a single sector policy and expenditure programme
- government leadership
- adopting common approaches across the sector
- progress towards relying on government procedures to
disburse and account for all funds.”
WHO (2000) “Sector-wide Approaches for Health Development”
SWAp = a process:
-broadening & deapening policy dialogue
- more sector funds into co-ordinated arrangements
- developing common procedures based on those of government
------> focus on the intended direction of change
rather than just the level of attainment
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2. WHAT SWAp REALLY IS
(or should be)
- not only funding
- efficiency / effectiveness
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ULTIMATE GOAL OF A
Health SWAp ?
“NOT ONLY A PROCESS”
ULTIMATE PURPOSE ?
INCREASE EFFICIENCY =
INCREASED AND IMPROVED OUTPUT
AT THE SAME COST
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So: What are the keys in a
Health SWAp to increase efficiency ?
GOVT USE PARTNERSHIP FOR
CONSENSUS BUILDING AROUND:
1) “SOLID PIECE” of POLICY
- Evidence-based; based on ORGANISATIONAL
PRINCIPLES for SERVICE DELIVERY
2) Common PLANNING devices
- activity packages by level; 5-yr/1yr, incl. COSTING &
FINANCING
3) ‘Adapted’ FUNDING arrangements
(not only ‘common basket’)
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Health SWAp keys for
increased efficiency (Cont’d)
4) Reliable MONITORING
- on input, process & output
5) Continuous EVALUATION mechanisms
- at “Health District” & national level; regular meetings
with all involved
6) Accountable resources MANAGEMENT &
ACCOUNTING procedures.
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3.CHALLENGES
- Donors & Govt
- Link with national budget
frame & PRSP/PRSC
- Decentralisation
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1) GOVT & DONORS
 GOVERNMENT
POLICY, STRUCTURES & SYSTEMS NOT YET FULLY IN PLACE
ACCOUNTABILITY !
LINKS WITH BROADER GOVT POLICIES, GOVT BUDGET PROCESS
 DONORS
RELUCTANT TO GO INTO BUDGET SUPPORT
 (funding is not the only point)
‘MANAGERS’ MORE THAN HEALTH PROFESSIONALS
 DONORS + GOVERNMENT
NEW CONCEPT, NEEDS INTERNALIZATION
TOO MUCH ‘PROCESS-ORIENTED’ AT NATIONAL (DISTRICT ?) LEVEL
NO KNOWLEDGE OF DONOR DEPENDENCY RATIO
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2) LINK WITH NATIONAL BUDGET
FRAME & PRSP/PRSC
 TRENDS IN HEALTH FINANCING MECHANISMS
 PROJECT VS SECTOR SUPPORT; OTHER SOURCES ?
 OVER TIME: ‘REMAINING’ % OF TOTAL BUDGET FROM PROJECTS
 ‘EXTRA-BUDGETARY’ / FUNDS UNACCOUNTED FOR.
 TENSION ‘SECTOR’ - ‘TOTAL’ GOVT BUDGET
 TOTAL GOVT BUDGET = OWN RESOURCES + HIPC I/II + OVERALL BUDGET
SUPPORT + SECTOR-SPECIFIC BUDGET SUPPORT
 BUDGET ALLOCATION PROCESS: PARTICIPATORY GOVT / CIVIL SOC /
DONORS / PARLIAMENT
 FUNGIBILITY OF DONOR FUNDS/ ROLE NATIONAL BANK
 DONOR DEPENDENCY RATIO ???
 ESTABLISHMENT ‘POVERTY ACTION FUND’ = SPECIFIC
ACTIVITIES IN DEFINED SECTORS FUNDED BY HIPC RETURNS + SPECIFIC
DONOR CONTRIBITIONS (fungibility !).
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2) LINK WITH NATIONAL BUDGET
FRAME & PEAP PRSP/PRSC (2)
 IMPACT GLOBAL INITIATIVES
 NON-ADDITIONAL TO SECTOR BUDGET CEILING / “DISRUPTIVE”
 EXCHANGED AGAINST LESS TIGHT BUDGET COMPONENTS
 SWAp STRUCTURES:
 Mid-Term Review, Health Policy Advisory Committee, Health Development
Partners Group
 NEED FOR CLOSE COLLABORATION BETWEEN
TECHNICAL EXPERTISE, AND
 ‘POLITICAL/ DIPLOMATIC’ LEVELS OF
REPRESENTATION’ OF DONOR COUNTRY
E.g. Presidential proposal for budget cuts so as to cover extraordinary defense expenditure. / Presidential proposal to increase
with 25% the No. Of districts.
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2) LINK WITH NATIONAL BUDGET
FRAME & PEAP PRSP/PRSC (3)
 PEAP / PRSP VERY BROAD !
 Macro-economic; Governance; Income of the Poor; Quality of Life of the Poor
 Poor vs Non-poor ?
 FROM NATIONAL PLAN ----> PRSP ----> PRSC
 HEALTH SECTOR WITHIN “PILAR 4” OF POVERTY ERADICATION ACTION
PLAN (“PEAP”)
 PEAP = PRSP
 PRSP AS THE BASIS FOR PRSC.
 OUTCOME OF HEALTH SWAp in PRSC PROCESS
 HSSP TARGETS AND MTR ‘UNDERTAKINGS’ USED AS BENCHMARKS IN THE
POLICY MATRIX OF PRSC TO MONITOR PROGRESS MADE
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4. CONTRIBUTION OF
BELGIUM ?
- NATIONAL
- DISTRICT
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Contribution of Belgium
National level
GOAL ?? (linked to sectors in Country Strategy
Paper, Indicative Country Programme)
Participation in SWAp structures (HAPC, HDP
group, MTR, Working Groups, ICCs):
WHO ?
HOW ?
Participation in PRSC process ?
WHO ?
HOW ?
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Contribution of Belgium (2)
District level
GOAL ??
In district coordination structures (esp. When
decentralised governments)
WHO ?
HOW ?
In operational activities.
WHO ?
HOW ?
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THANK YOU
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