sharenet NETHERLANDS NETWORK ON SEXUAL

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share-netNETHERLANDS NETWORK ON SEXUAL
REPRODUCTIVE HEALTH AND AIDS

• Summary of the SWAp Seminar (Adam, Sep 2002)
• for EuroNGOs/Rome, 25 October 2002

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share-net SWAp Seminar

• 1 of 6 regular seminars in 2002
• Organised by Working Group on SWAp (gtgtnow WG on
  Health System Devel.)
• Keynote speakers
• Rene Dubbeldam, ETC Crystal, NL
• Helen Elsey, DFID/Liverpool School TM, UK
• Susannah Mayhew, London School HTM, UK
• NOW Summary (not own work)

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(1)SWAps in HealthGeneral Key Issues
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SWAp Goal

• Increase sustainable, efficient and equitable use
  of ALL available (national and external)
  resources

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SWAp Characteristics

• SWAp is an APPROACH, alternative for
  project/vertical approach
• Identifies all sector funding
• Supports single sector programme
• Led by government
• Adopts common approach
• Aiming at single set of procedures

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SWAp Central assumption

• Stakeholders can and will pool their interests
  and resources, and collaborate towards common
  agenda of health development

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SWAp SW A

• SECTOR-WIDE
• Funders
• Owners
• Providers

• APPROACHES
• Vision
• Policies
• Strategies
• ME
• Checksbalances

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SWAp Performance criteria

• Multi-sectoral!
• Poverty, gender,
• Sector/system focus
• Equity, efficiency
• Consumer satisfaction
• Procurement
• HRD

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SWAp Opportunities

• Strengthening district health care
• Equitable resource allocation
• Resource mobilisation
• Stakeholder involvement in policy dialogue
• Sector-wide info for evidence-based planning
  budgeting

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SWAp Limitations

• MoH mostly lead agency, but capacity?
• Health sector health development or health
  services?
• Cure vs. care/prevention/CBS
• SWAps under decentralisation?? (deconcentration
  vs. devolution/local government)

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SWAp Risks

• Too ambitious
• Focus on efficiency/streamlining, not on equity
  and quality/client perspective
• No CSO involvement ownership?
• Sector-wide turns out to be sector narrow no
  attention for multi-sectoral issues
• Donors do not give up own interests
• If major donors not involved?

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SWAp Discussion issues

• Old way of earmarking donor funds for
  NGOs/vertical progr. do not solve basic health
  sector problems gtgt alt.
• SWAps necessarybut not sufficient
• SWAp OK as policy framework, but NOT to use to
  channel funds
• SWAp is nonsense, too complex, unclear, not major
  issue in many countries, big out-of-pocket

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(2)SWAps and SRH, HIV/AIDSOpportunities and
Pitfalls
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Opportunities

• SWAp-goal is essential for improving basic health
  services, this is crucial for SRH and HIV/AIDS
  activities
• Opportunity to mainstream SRH in whole sector,
  IF stakeholders agree on importance
• Also CSO-opportunities
• On local level, if devolution/Local Govt.
  planning
• In principle resource mobilisation and equity,
  also important
• for SRH

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Pitfalls

• Risk of sector-narrow How to organise
  intersectoral collaboration re. SRH/AIDS? Whom?
  What level?
• SRH is not a priority, unaddressed
• Capacity health sector remains too limited to
  adeq. address wide range of SRH/AIDS issues
• Emphasis on cure vs. prevention

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Discussion issues (1)

• CSO-input essential for SRH/AIDS, this is
  problematic in SWAps
• OR NGOs involved, but dependent on Government
• Donors should still fund CSO as advocates
• Attn. for quality/client persp. is essential,
  also problematic

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Discussion issues (2)

• Global Fund is threat to SWAps
• SWAp and AIDS sustainability vs. speedy action?
• SRH and HIV/AIDS still separate circuits, this
  weakens influence!