Sector programs or sector-wide approaches in health: some early lessons

AusAID is committed to helping developing countries lead their own health reforms; to deliver quality health services and ultimately achieve health outcomes to those in most need over the long term. Central to this aim is our support for health sector wide approaches (SWAp) in which:

"… all significant funding for the sector supports a single 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 all funds."¹

Not many countries have well-developed versions of this challenging approach, so the evidence base is not strong. However, we have already learned some lessons.

The approach requires commitment to shared goals, a good macroeconomic basis and sound overall public spending.
Mapping government and external financial inputs against a common medium-term expenditure framework has proven useful in directing funds to priorities, identifying gaps and ensuring accountability.
There is no single blueprint.
The approach requires new skills for donors in policy dialogue, and a changed relationship among participants at a high level of engagement. These changes can take time.
Policy dialogue can facilitate a focus on pro-poor policy in delivering health services.
Involving non-government organisations can be advantageous; they have felt marginalised in some contexts.
The contribution of global health initiatives needs to be coordinated within a program approach.
Sector-wide approaches to delivering services need to avoid too much focus at the central level to the exclusion of the district level and moves to decentralise delivery.
The development of joint policy, monitoring and management frameworks may be as important as, or even more important than, pooled funding.²
Dialogue may need to include government agencies other than health, particularly the central agencies for finance, planning, labour and education.
Participants in sector-wide approaches should continue to share experiences with other countries to learn from each other.

¹ M Foster et al., Findings, issues and recommendations from the experiences of implementing SWAps in six countries, Overseas Development Institute, London, 2000.

² WHO, Health and the Millennium Development Goals, World Health Organization, Geneva, 2005, p. 48.

Last reviewed: 16 July, 2010