Sector-Wide Approaches

Over the past one-and-a-half decade, many developing countries faced the challenge to force a breakthrough in the stalling rates of improvement in the performance of the national health sectors. Since the mid-90s the development of a comprehensive and integrated approach to health care – Sector-Wide Approaches (SWAps) – is the basic strategy for the improvement of effectiveness and efficiency of health sectors. A leading principle in these health sector reforms is to move away from isolated projects and programmes within the health sector.

Among the core elements of SWAps is the host country’s ownership of the process and the management of a pooled fund that is established by donors and the local government. This implies that the visibility of donors’ contributions to specific priority areas in the health sector diminishes significantly and that tracking of resources to specific health categories becomes more difficult. Although this is inherently bound to the change in focus from vertical programmes and projects to sector programmes, it also relates to the limited accounting capacity in developing countries.

The problem of tracking resources in countries with SWAp-like approaches is increasingly encountered by the RF project, which monitors resource flows on the following four population and AIDS categories: (1) family planning services; (2) basic reproductive health services; (3) STDs and HIV/AIDS activities; and (4) basic research, data and population and development policy analysis. In the past, respondents to the RF mail questionnaires reported on funds disbursed to specific programmes and projects that could be classified in one of these categories. Since more and more donor resources are transferred to SWAp basket funds, it is usually not possible to identify the share of population and AIDS categories within this finance pool in the absence of well-developed accounting mechanisms.

In March 2005, the RF project presented a paper entitled “Donor contributions to population and AIDS activities in health sector-wide approaches”. The purpose of this paper is to develop an allocation principle for the four RF categories within pooled donor and government basket funds for the health sector. Besides a brief history on the emergence of SWAps and elaboration of methodology the report also contains a case study, which applies the method to the case of Ghana. The report is available in PDF format and can be found here.

Future activities

The RF project intends to provide selected donors and developing country and country in transition governments involved in SWAps with estimates of pooled basket funds shares spent on population and AIDS activities.