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

SECTOR-WIDE APPROACHES IN THE HEALTH SECTOR (IN UGANDA). KEY CHARACTERISTICS & CHALLENGES Dr. Martinus Desmet, MPN, WHO Country Office - Uganda. Content. Common definitions of SWAp What SWAp really is (should be) Challenges Belgian contribution to SWAp. 1. COMMON DEFINITIONS.

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

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  1. SECTOR-WIDE APPROACHESIN THE HEALTH SECTOR(IN UGANDA) KEY CHARACTERISTICS & CHALLENGES Dr. Martinus Desmet, MPN, WHO Country Office - Uganda

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

  3. 1. COMMON DEFINITIONS - from policy to policy - a process

  4. SWAp’s - 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 ------> focus on the intended direction of change rather than just the level of attainment

  5. 2. WHAT SWAp REALLY IS(or should be) - not only funding - efficiency / effectiveness

  6. ULTIMATE GOAL OF AHealth SWAp ? “NOT ONLY A PROCESS” ULTIMATE PURPOSE ? INCREASE EFFICIENCY = INCREASED AND IMPROVED OUTPUT AT THE SAME COST

  7. 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’)

  8. Health SWAp keys for increased efficiency (Cont’d) 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.

  9. 3.CHALLENGES - Donors & Govt - Link with national budget frame & PRSP/PRSC - Decentralisation

  10. 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

  11. 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 !).

  12. 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.

  13. 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 ----> PRSP ----> 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

  14. 4. CONTRIBUTION OF BELGIUM ? - NATIONAL - DISTRICT

  15. 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 ?

  16. Contribution of Belgium (2)District level • GOAL ?? • In district coordination structures (esp. When decentralised governments) • WHO ? • HOW ? • In operational activities. • WHO ? • HOW ?

  17. THANK YOU

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