Transcript The Sector Wide Approach and its application in the

Consequences of donor aid not
Channelled through the Govt
System: the case of Global
Fund
Emily Nyanzi K.(Mrs)
Economist/TA
Ministry of Health - UGANDA
Presentaion to HEPNEt- Zambia 29th
May 2008
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Outline of Presentation
Background
 Donor Funding
 Uganda experience (Global fund)

Benefits
 Consequences
 Way forward

Presentaion to HEPNEt- Zambia 29th
May 2008
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Background-1
In The late 80’s Uganda’s health
system, had literally collapsed after
many years of civil strife and was
characterized by heavy donor support
and multiple projects;
 This support however did not
translate into significant
improvements in health outputs and
outcomes – thus no improvements in
peoples health;

Presentaion to HEPNEt- Zambia 29th
May 2008
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Background -2
In Year 2000, GoU and partners
noted a lot of shortcomings Donor
support and Multiple projects &
agreed to introduce Sector-Wide
Approaches (SWAP).
 This was further strengthened by the
Paris Declaration 2005 on aid
effectiveness.

Presentaion to HEPNEt- Zambia 29th
May 2008
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Paris Declaration 2005
Endorsed on 2 nd March 2005, an
international agreement to which over
one hundred Ministers & Heads of
Agencies committed their countries
and organizations to:
1. Increase efforts in AID
harmonisation,
2.Align and manage aid for results with
a set of monitorable actions and
indicators

Presentaion to HEPNEt- Zambia 29th
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% of Donor funding to TT
Sector Funding
FY
2002/03
03/04
04/05
05/06
06/07
07/08
Total
337.9
375.06
432.018
510.25
381.8
428.2
%
42
41.6
45.1
52.5
36.3
35
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% of Donor Funding
 2006/07
– 36.4%
 2007/08-
35.2 %
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% donor funding from 2002
to 2008
% Grow th of Donor Funding from 2002 to date
2002/03
2003 04
2004/ 05
2005 /06
2006/07
2007/08
Presentaion to HEPNEt- Zambia 29th
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Donor Funding Components
1. PAF –Poverty Action Fund

General PAF
 Earmarked PAF
2.Budget Support also called SWAp (
Sector Wide Approach)
3. Project Support- Funding for specific
projects in the country at central and
district level e.g DANIDA. Global
Fund, etc.
Presentaion to HEPNEt- Zambia 29th
May 2008
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Donor funding from FY 2002/03
to 2007/05 Excluding ( PAF
Funding)
2002/
03
03/04
04/05
05/06
06/
07
141.96
156.22
195.105
268.38
139.22 150.9
Presentaion to HEPNEt- Zambia 29th
May 2008
07/08
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Global Fund Uganda (GFTAM)
Started Operation in FY 2004/05 this was the first
phase of funding by GFTAM in Uganda
1.Disagreement between MOH & Global Fund
Secretariat regarding Budget Support Viz. Project
Support
2. GFTAM opted for project model and
eventually got into trouble.
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1.Funding was project mode outside
the SWAp mainly to specific central
level projects and projects at districts
& different Ministries and NGOs)
2.Funding was for Drugs ARVs for
HIV/AIDS control, TB and ACT for
Malaria control programmes & LINS
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May 2008
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Funding- GFTAM 2004/05
1.
There was a Project management
Unit (PMU) Premised outside MOH
Headquarters
2. Characterized by Third Party
Procurements and high admin costs.
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May 2008
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GFTAM-2005/06
2005/06 there was suspension of
funding and Global fund activities in
Uganda due to.
 Misappropriation of funds and
improper condition of project
activities.
 Many NGOs most of them new in the
country, district level activities and
govt programs had not accounted for
funds.

Presentaion to HEPNEt- Zambia 29th
May 2008
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GFTAM-2005/06
Conditionality for lifting the
suspension was to have all
programs/NGOs account for funds
received.
 GOU and Global fund had to agree to
conditions of funding modalities, M&E
and accountability of funds.

Presentaion to HEPNEt- Zambia 29th
May 2008
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GFTAM 2007/08 -1



Funding streamlined with clear and
stipulated roles for all Ministries/NGOs
MFPED is the Principal recipient of funds
and realizes them to different
Ministries/NGOs.
Earnest and Young a private company
oversees MGT of funds at a cost of
US.Dollars 1m every year.
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GFTAM 2007/08 - 2
MOH Coordinating role
 M&E by UAC etc
 Funds are realized in rounds after
Malaria, TB and HIV/AIDs
programmes producing and sending
acceptable proposals which are sent
to Geneva.

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Benefits - (GFATM)- 1
GFATM focuses on the
implementation of interventions
related to particular diseases:- Mainly
Malaria, HIV/AIDs and Tuberculosis.
 Free Antimalarial, TB and ARVs
although too much concentration in
specific geographical esp urban
areas.
 Are characterized by a vertical or
categorical mode of delivery

Presentaion to HEPNEt- Zambia 29th
May 2008
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Benefits of Project Mode of
Funding (GFATM)

At project level the focus of attention
lies on a relatively narrow range of
issues.

Essential approach to flexibility and
quick response in health systems

Ownership of project activities
Presentaion to HEPNEt- Zambia 29th
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Benefits - (GFATM)- 2
Demonstrates results in key priority
health concerns
 Easy and Focused M&E
 Fragmentation of the health system
into several sub systems enables
deliveries of different interventions to
different beneficiaries

Presentaion to HEPNEt- Zambia 29th
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Consequences -1


High admin costs due to third party
procurrements
Difficulties in financial flows from the
central government to the districts

Limited human resource capabilities at
health facilities and beneficiaries
centres/NGOs

Generally large system constraints within
the project framework
Presentaion to HEPNEt- Zambia 29th
May 2008
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Consequences -2

Proliferation of projects, multiple reporting
requirements, lack of coherence in donor
support

Distortion of spending priorities and leading
to problems of sustainability, with limited
scope for preparing comprehensive sectoral
budgets;

Creation of parallel systems undermining
organizational capacity building
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May 2008
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Consequences -3

Such international initiatives have a strong
political dimension and;

decisions (taken outside the country) no
longer lie at technical level where emphasis
is on harmonization with the health
system.
General lack of knowledge of local realities
and ; not in line with locally agreed
policies.

Presentaion to HEPNEt- Zambia 29th
May 2008
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GFTAM- Way Forward

All in all GFATAM is considering joining the
SWAP- budget support mode of funding.

Long Term Institutional Arrangement
(LTIA) that HPAC are working on as a
future framework for handling
Global Fund, GAVI, etc.

Generally SWAp reduces administrative
costs for government
Presentaion to HEPNEt- Zambia 29th
May 2008
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SWAp- Budget Support
Essentially SWAp was established to
enable governments to:
 Own and coordinate development
assistance in any given sector
 Policy design
 Strategic and operational
management
 Financial pooling, Resource allocation
and common arrangements for M&E
Presentaion to HEPNEt- Zambia 29th
May 2008
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Core elements
of Budget Support






Government in “driver’s seat”
Sector-wide in scope
Agreed policy framework & strategy
All/most donors sign on
Common/joint work program
Common management arrangements:
1. disbursement and accounting of
funds
2.reviewing performance

Move to streamline govt. procedures
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May 2008
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Further readings

Oliveira Cruz. V, et al 2005. sing
agency theory to analyse
relationships between recipient
governments and international
development partners.

Ministry of health ,Uganda
2006.Health systems reforms in
Uganda: Processes and Out puts
Presentaion to HEPNEt- Zambia 29th
May 2008
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Thank you for Your Audience
Presentaion to HEPNEt- Zambia 29th
May 2008
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