SECTOR-WIDE APPROACHES IN THE HEALTH SECTOR (IN UGANDA)

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SECTOR-WIDE APPROACHESIN THE HEALTH SECTOR(IN
UGANDA)

• KEY CHARACTERISTICS
• CHALLENGES
• Dr. Martinus Desmet,
• MPN, WHO Country Office - Uganda

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Content

• Common definitions of SWAp
• What SWAp really is (should be)
• Challenges
• Belgian contribution to SWAp

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1. COMMON DEFINITIONS

• - from policy to policy
• - a process

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SWAps - DEFINITIONS

• All significant funding for the sector supports
• - a single sector policy and expenditure
  programme
• - government leadership
• - adopting common approaches across the sector
• - progress towards relying on government
  procedures to disburse and account for all
  funds.
• WHO (2000) Sector-wide Approaches for Health
  Development
• SWAp a process
• -broadening deapening policy dialogue
• - more sector funds into co-ordinated
  arrangements
• - developing common procedures based on those of
  government
• ------gt focus on the intended direction of change
  
• rather than just the level of attainment

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2. WHAT SWAp REALLY IS(or should be)

• - not only funding
• - efficiency / effectiveness

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ULTIMATE GOAL OF AHealth SWAp ?

• NOT ONLY A PROCESS
• ULTIMATE PURPOSE ?
• INCREASE EFFICIENCY
• INCREASED AND IMPROVED OUTPUT
• AT THE SAME COST

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So What are the keys in aHealth SWAp to
increase efficiency ?

• GOVT USE PARTNERSHIP FOR
• CONSENSUS BUILDING AROUND
• 1) SOLID PIECE of POLICY
• - Evidence-based based on ORGANISATIONAL
  PRINCIPLES for SERVICE DELIVERY
• 2) Common PLANNING devices
• - activity packages by level 5-yr/1yr, incl.
  COSTING FINANCING
• 3) Adapted FUNDING arrangements
• (not only common basket)

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Health SWAp keys for increased efficiency (Contd)

• 4) Reliable MONITORING
• - on input, process output
• 5) Continuous EVALUATION mechanisms
• - at Health District national level regular
  meetings with all involved
• 6) Accountable resources MANAGEMENT ACCOUNTING
  procedures.

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3.CHALLENGES

• - Donors Govt
• - Link with national budget frame PRSP/PRSC
• - Decentralisation

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1) GOVT DONORS

• GOVERNMENT
• POLICY, STRUCTURES SYSTEMS NOT YET FULLY IN
  PLACE
• ACCOUNTABILITY !
• LINKS WITH BROADER GOVT POLICIES, GOVT BUDGET
  PROCESS
• DONORS
• RELUCTANT TO GO INTO BUDGET SUPPORT
• (funding is not the only point)
• MANAGERS MORE THAN HEALTH PROFESSIONALS
• DONORS GOVERNMENT
• NEW CONCEPT, NEEDS INTERNALIZATION
• TOO MUCH PROCESS-ORIENTED AT NATIONAL (DISTRICT
  ?) LEVEL
• NO KNOWLEDGE OF DONOR DEPENDENCY RATIO

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2) LINK WITH NATIONAL BUDGET FRAME PRSP/PRSC

• TRENDS IN HEALTH FINANCING MECHANISMS
• PROJECT VS SECTOR SUPPORT OTHER SOURCES ?
• OVER TIME REMAINING OF TOTAL BUDGET FROM
  PROJECTS
• EXTRA-BUDGETARY / FUNDS UNACCOUNTED FOR.
• TENSION SECTOR - TOTAL GOVT BUDGET
• TOTAL GOVT BUDGET OWN RESOURCES HIPC I/II
  OVERALL BUDGET SUPPORT SECTOR-SPECIFIC BUDGET
  SUPPORT
• BUDGET ALLOCATION PROCESS PARTICIPATORY GOVT /
  CIVIL SOC / DONORS / PARLIAMENT
• FUNGIBILITY OF DONOR FUNDS/ ROLE NATIONAL BANK
• DONOR DEPENDENCY RATIO ???
• ESTABLISHMENT POVERTY ACTION FUND SPECIFIC
  ACTIVITIES IN DEFINED SECTORS FUNDED BY HIPC
  RETURNS SPECIFIC DONOR CONTRIBITIONS
  (fungibility !).

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2) LINK WITH NATIONAL BUDGET FRAME PEAP
PRSP/PRSC (2)

• IMPACT GLOBAL INITIATIVES
• NON-ADDITIONAL TO SECTOR BUDGET CEILING /
  DISRUPTIVE
• EXCHANGED AGAINST LESS TIGHT BUDGET COMPONENTS
• SWAp STRUCTURES
• Mid-Term Review, Health Policy Advisory
  Committee, Health Development Partners Group
• NEED FOR CLOSE COLLABORATION BETWEEN
• TECHNICAL EXPERTISE, AND
• POLITICAL/ DIPLOMATIC LEVELS OF
• REPRESENTATION OF DONOR COUNTRY
• E.g. Presidential proposal for budget cuts so as
  to cover extra-ordinary defense expenditure. /
  Presidential proposal to increase with 25 the
  No. Of districts.

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2) LINK WITH NATIONAL BUDGET FRAME PEAP
PRSP/PRSC (3)

• PEAP / PRSP VERY BROAD !
• Macro-economic Governance Income of the Poor
  Quality of Life of the Poor
• Poor vs Non-poor ?
• FROM NATIONAL PLAN ----gt PRSP ----gt PRSC
• HEALTH SECTOR WITHIN PILAR 4 OF POVERTY
  ERADICATION ACTION PLAN (PEAP)
• PEAP PRSP
• PRSP AS THE BASIS FOR PRSC.
• OUTCOME OF HEALTH SWAp in PRSC PROCESS
• HSSP TARGETS AND MTR UNDERTAKINGS USED AS
  BENCHMARKS IN THE POLICY MATRIX OF PRSC TO
  MONITOR PROGRESS MADE

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4. CONTRIBUTION OF BELGIUM ?

• - NATIONAL
• - DISTRICT

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Contribution of BelgiumNational level

• GOAL ?? (linked to sectors in Country Strategy
  Paper, Indicative Country Programme)
• Participation in SWAp structures (HAPC, HDP
  group, MTR, Working Groups, ICCs)
• WHO ?
• HOW ?
• Participation in PRSC process ?
• WHO ?
• HOW ?

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Contribution of Belgium (2)District level

• GOAL ??
• In district coordination structures (esp. When
  decentralised governments)
• WHO ?
• HOW ?
• In operational activities.
• WHO ?
• HOW ?

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THANK YOU