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Sector Programs or Sector-Wide Approaches in Health: Some Early Lessons

A sector-wide approach is one 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*.

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.**
• 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.

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

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

2007

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