SECTOR-WIDE APPROACHES IN THE HEALTH SECTOR (IN
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Transcript SECTOR-WIDE APPROACHES IN THE HEALTH SECTOR (IN
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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