Tanzania Health Sector Wide Approach (SWAp)
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Transcript of Tanzania Health Sector Wide Approach (SWAp)
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Tanzania Health Sector Wide Approach (SWAp)
Rob CunnaneHealth and Population Officer
USAID Tanzania
Prepared for SOTA, June 2002
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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!
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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
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Key components
Government Leadership
Phase-out of “projects”
Reducing transaction costs
Sustainable results
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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
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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%
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Health Expenditures (millions)
Total expenditures: 178 million
66.5
10.5
101Donor Spending
Pooled
Government
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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
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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
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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
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Serious concerns
Support to NGOs, faith-based groups is declining
Social marketing of critical RH products is at risk
Building public-private partnerships
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For USAID: Consultation is Critical
Joint Health Sector Review
SWAp meeting
Basket group