Health and 'Sector Wide Approach'- How Realistic? (1)

Dr Aminu Magashi
At a health stakeholders' meeting that was held in Bauchi State Government House on Sunday, 2nd October 2011, the Minister of State for Health, Dr Ali Muhammaed Pate proposed that the state consider sector wide approach in an attempt to ensure proper coordination of donor funded projects.

It was a unique meeting for the state and 'the 1st of its kind' according to a senior and retired colleague. All those that matters in health sector especially indigenes of the state as well as those in public and private sector, international development partners and friends of Bauchi State were in attendance to brainstorm on how to improve maternal and child health services in the state.

It will be good to properly understand 'sector wide approach' as one of the panacea that improves coordination among international partners as well as helping not only Bauchi but other states that has an avalanche of international donor organizations in the health sector and doing almost the same thing but with different approach and strategies.

In an article 'the sector-wide approach: a blessing for public health? Written by Guy Hutton and co published by WHO (http://www.who.int/bulletin/volumes/82/12/editorial21204html/en/), the authors observed that there is compelling evidence that improved health system performance is key to improved health, and necessary to meeting health-related international development targets such as the Millennium Development Goals .

In contrast, the strategies on how this is achieved are still open to debate. Since the mid-1990s, a new approach to health sector development has taken hold in a number of developing countries: the sector-wide approach.

The paper argued that 'there are persuasive arguments for supporting a sector-wide approach (SWAP) as opposed to the traditional project approach: increased health sector coordination, stronger national leadership and ownership, and strengthened countrywide management and delivery systems.

These are variously claimed to reduce duplication, lower transaction costs, increase equity and sustainability, and improve aid effectiveness and health sector efficiency. Furthermore, the SWAP has become an integral part of poverty reduction strategies, and its ideology has enjoyed a growing acceptance from donor agencies as well as aid recipients.'

To understand the potential impact of this approach on population health, four key areas are strengthened which indirectly, but importantly, have implications for public health: country leadership and ownership, institutional and management capacity, flow of resources, and monitoring and evaluation.

First and foremost, a SWAP explicitly mandates the ministry of health with the leadership. However, this role has been partly problematic owing to limited leadership capacity (e.g. Rwanda), poor relationship with the ministry of finance (e.g. Mozambique), slow shift of ownership (e.g. Cambodia), change of senior management (e.g. Zambia), little ministry of health leverage to secure additional funds (e.g. the United Republic of Tanzania), and low priority of cross-sectoral collaboration.

As the paper put it succinctly the SWAP emphasizes strengthened health sector management through the development or adaptation of management tools, combined with strengthening of implementation capacity. For example, under SWAP greater attention is given to health sector planning, financial management, and improved health information systems. SWAps also tend to emphasize strengthening district level management capability within existing decentralization policies (e.g. Ghana, Uganda and the United Republic of Tanzania).

Another dimension is that under a SWAp, 'recipient governments and donors only fund activities in the national health sector plan. Donor funds are pooled and earmarked for high priority activities, such as essential health package (e.g. Uganda, Tanzania).

Importantly, pooled donor funding supports government budgets, giving a much needed boost to recurrent expenditures. Lastly emphasis on monitoring and evaluation of the health sector is very key and need to be institutionalized under a SWAp.

The "one voice" of donors has strengthened their position to create conditions. The once or twice yearly joint review meeting is an important instrument providing an open forum to review the progress and performance of the health sector. These large meetings are complemented by more frequent meetings with key development partners. The success of these processes depends mainly on the people involved and their experience, expertise and sensitivity to developing partnerships.'

Another technical approach paper written by HLSP, a UK based institute titled 'Implementing a sector wide approach in health: the case of Mozambique has emphasized that 'In the year 2000 the Government of Mozambique and its development partners made the strategic decision to establish a Sector Wide Approach to Programming (SWAP) in health. The Mozambique health SWAP soon became widely cited in international health policy circles, particularly as the agreements and processes linked to it - the partner code of conduct, sector strategy, and coordination and review mechanisms - were developed and implemented fairly rapidly.

To many external observers, the health SWAP in Mozambique epitomized all the advantages of working sector wide: improved government leadership, greater sector policy and strategic focus, more effective use of aid to the health sector and lower transaction costs.'

In the part 2 of this article, I will elaborate more on the Mozambique experience vis-a- vis the practicability of implementing SWAP in Bauchi as well as the states across the federation.

http://allafrica.com/stories/201110110599.html