Tanzania Health Sector Wide Approach (SWAp)

Rob CunnaneHealth and Population Officer

USAID Tanzania

Prepared for SOTA, June 2002

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!

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

Key components

Government Leadership

Phase-out of “projects”

Reducing transaction costs

Sustainable results

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

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%

Health Expenditures (millions)

Total expenditures: 178 million

66.5

10.5

101Donor Spending

Pooled

Government

Donor Commitments to Pool Funding

Dfid 16.2

DANIDA 6Ireland AID 3.1Swiss Development Cooperation

2.5

KFW 2.3World Bank 10Others (GTZ, RNE) 1.5Total Commitments/Pooled 41.7 million

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

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

Serious concerns

Support to NGOs, faith-based groups is declining

Social marketing of critical RH products is at risk

Building public-private partnerships

For USAID: Consultation is Critical

Joint Health Sector Review

SWAp meeting

Basket group