This article from the World Health Organisation discusses a new strategy for the joint involvement of governments and development agencies in the area of healthcare provision. The idea is to move agencies away from individual responsibility for isolated projects within the health sector, to a ‘sector-wide’ approach (SWAp) whereby every agency shares responsibility for the entire health sector with the government, having more control of overall health policy and less devotion to specific projects. A partnership is developed between national governments and development agencies, the public and private sectors, and NGOs and civil society so as to better use available funds from all sources, attend to the needs of the poor, and improve health and human development.
Sustained improvements in health and welfare require long-term partnerships in which development assistance is used to support national policy. SWAps are more likely to succeed than individual responsibility for discrete projects. Other important findings in this article include:
- The key assumption underlying SWAps is that governments will be better placed to achieve sectoral goals (i.e. improve people’s health) if development assistance is used to support nationally defined policies rather than specific projects.
- SWAps will only succeed if there is sufficient commitment to shared goals, a good macro-economic basis and sound overall public spending.
- Donors face a choice between a project focus which ensures that their contribution reaches those in most need, or a sector-wide focus by which they shape policy and attempt to influence the allocation of resources to help the poor across the board.
- Policy documents often fail to address issues: Whereas long-term plans are common, policy frameworks which link strategic analysis and decisions about resource allocation are rare, and yet essential.
Donors and governments must take collective responsibility for sectoral achievements, and therefore donors must judge their success not by the success of an individual project but by success in the sector overall. In fact, as a result of a SWAp, some donors will be obliged to give up the right to select which projects they finance, in exchange for influence in the development of strategy and resource allocation. Furthermore:
- Government ownership is absolutely essential to the success of SWAps, but this must not result in donors urging ill-equipped and incapable governments to take the lead.
- Policy development is not a one-off exercise, but an integral and continuous part of the programme which should define roles for each player, identify policy instruments, set the agenda, and provide guidance for expenditure priorities.
- Targets should be set for a range of programmes, the success of which will indicate sectoral performance overall.
- Because external agencies are involved in policy making and strategy, frictions will arise between them and also with government. It is therefore essential that mechanisms are in place to deal with this.
