Transcript Tanzania Health Sector Wide Approach (SWAP)

Tanzania Health Sector Wide
Approach (SWAp)
Rob Cunnane
Health and Population Officer
USAID Tanzania
Prepared for SOTA, June 2002
Definition of a SWAp:
 What it is NOT:
Pooled Funds
 What it IS:
An approach of working
between government and
donors. It is a long-term
work in progress!
SWAp Goal:
 Support for a single health sector policy and
expenditure program, under government
leadership, adopting common approaches
across the sector, and progressing towards
relying on government procedures to
disburse and account for funds.
 Contributes to poverty reduction
Key components
 Government Leadership
 Phase-out of “projects”
 Reducing transaction costs
 Sustainable results
Key Objective in Tanzania
 Improve GOT budget process


Capture all funding sources and expenditures
Decentralization has driven earmarked grants to districts
 Improve GOT health planning process

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Incorporate in rolling medium-term budget where overall
allocation decisions reflect national priorities
Key processes: Public Expenditure Review, MTEF,
Annual Budget, Joint Review
Tanzania Expenditure Data
 45% increase in health expenditures
 Decline in proportion of donor funding from
53-43%
 Increased funding to district based health
services
 Decline in hospital spending from 60-50%
Health Expenditures (millions)
101
66.5
Donor Spending
Pooled
10.5
Total expenditures: 178 million
Government
Donor Commitments to Pool
Funding
Dfid
16.2
DANIDA
Ireland AID
Swiss Development
Cooperation
KFW
World Bank
Others (GTZ, RNE)
Total Commitments/Pooled
6
3.1
2.5
2.3
10
1.5
41.7 million
Carpe (Per) Diem
(Seize the…Day??!)
 38% of funds spent on per
diem and training
 21% spent on essential
medical supplies
 Weak capacity at district
level to account for and
spend funds
 Weak priority setting
within budget process
 MOH not accountable for
RESULTS
Issues coming to light under
SWAp/the Pool
 Targeted TA is critical!!


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Logistics and supply #1
priority
Quality Improvement
Parliament (budget,
accountability)
Monitoring health impact
Serious concerns
 Support to NGOs,
faith-based groups is
declining
 Social marketing of
critical RH products
is at risk
 Building publicprivate partnerships
For USAID:
Consultation is Critical
 Joint Health Sector Review
 SWAp meeting
 Basket group