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Tanzania Health Sector Wide Approach (SWAp)

Tanzania Health Sector Wide Approach (SWAp). Rob Cunnane Health and Population Officer USAID Tanzania Prepared for SOTA, June 2002. Definition of a SWAp:. What it is NOT: Pooled Funds

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Tanzania Health Sector Wide Approach (SWAp)

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  1. Tanzania Health Sector Wide Approach (SWAp) Rob Cunnane Health and Population Officer USAID Tanzania Prepared for SOTA, June 2002

  2. Definition of a SWAp: • What it is NOT: Pooled Funds • What it IS: An approach of working between government and donors. It is a long-term work in progress!

  3. SWAp Goal: • Support for a single health 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 funds. • Contributes to poverty reduction

  4. Key components • Government Leadership • Phase-out of “projects” • Reducing transaction costs • Sustainable results

  5. Key Objective in Tanzania • Improve GOT budget process • Capture all funding sources and expenditures • Decentralization has driven earmarked grants to districts • Improve GOT health planning process • Incorporate in rolling medium-term budget where overall allocation decisions reflect national priorities • Key processes: Public Expenditure Review, MTEF, Annual Budget, Joint Review

  6. Tanzania Expenditure Data • 45% increase in health expenditures • Decline in proportion of donor funding from 53-43% • Increased funding to district based health services • Decline in hospital spending from 60-50%

  7. Health Expenditures (millions)

  8. Donor Commitments to Pool Funding

  9. Carpe (Per) Diem (Seize the…Day??!) • 38% of funds spent on per diem and training • 21% spent on essential medical supplies • Weak capacity at district level to account for and spend funds • Weak priority setting within budget process • MOH not accountable for RESULTS

  10. Issues coming to light under SWAp/the Pool • Targeted TA is critical!! • Logistics and supply #1 priority • Quality Improvement • Parliament (budget, accountability) • Monitoring health impact

  11. Serious concerns • Support to NGOs, faith-based groups is declining • Social marketing of critical RH products is at risk • Building public-private partnerships

  12. For USAID: Consultation is Critical • Joint Health Sector Review • SWAp meeting • Basket group

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