sector wide approach (swap)

1. Sector-wide Approach (SWAp)
10 June 2016

2. SWAp
• SWAp is a planning tool
• Project approach is the dominating form of planning:
MOHFW had 128 projects prior to 1st
SWAp, HPSP
• SWAp is considered as programmatic approach
against project approach
• It is practiced in health sector since 1998 and
Bangladesh Health SWAp is the largest in World
• Primary Education also practice SWAp – PEDP
(Primary Education Development Programme)

3. SWAp
• Government follow Five-year Development Plans: with a two-
year approach plan; Poverty Reduction Strategy (PRSP)
followed in two cycles; On-going is 6th
Five Year Plan up to
June 2016
• Characteristics of SWAp
1. Government ownership and leadership
2. Partnership with development partners
3. Agreed sector policy framework and strategies based on
shared vision and priorities
4. Common sector programme/expenditure framework
5. Coordination/alignment of resources
6. Harmonized implementation mechanism and use of local
systems and procedures

4. Difficulties in SWAp
• Against existing mainstream – odd person,
out?
• Against the benefits of existing machineries
• Difficult to find out champion
– Planning Commission
– Planning Wing of the Ministry of Health and
Family Welfare
– Development Partners
• Not the best planning tool, but best among
the currently available

5. Health SWAps in Bangladesh
Since 1998 till now Bangladesh has 3
successive SWAps in health sector as follows:
1.Health and Population Sector Programme
(HPSP) July 1998 – June 2003
2.Health, Nutrition and Population Sector
Programme (HNPSP) July 2003 – June 2011
3.Health, Population and Nutrition Sector
Development Programme (HPNSDP) July 2011
– December 2016

6. Budget of Health SWAps
SWAps Total Budget
in US $
GOB
Contribution
HPSP 2.2 billion 62%
HNPSP 5.4 billion 67%
HPNSDP 7.7 billion 76%

7. HPSP
• Health and Population Sector Strategy (HPSS)
• GOB health expenditures to Essential Service Package (ESP):
over 65%
• Two poorest quantities comprise more than half of those
using facilities at Upazila & below
• Unification of Health & Family Planning at upazila and below
• Powerful unsatisfied stakeholders
• Procurement problems
• Boundary of the sector – N & HIV/AIDS not included, Urban
health
• Change in government in 2001
• Reforms reverted : Community Clinics and unification of
health and family planning
• Credit suspended by World Bank

8. HNPSP
• Conceptual framework for the HNP sector (2003 -
2006)
• HNPSP initially for July 2003 – June 2006
• Strategic Investment Plan in Nov. 2004
• HNP Programme Proposal in Jan. 2005
• Project Appraisal Document - PAD : 28 March 2005
• Development Credit Agreement – DCA: 17 May 2005
• HNPSP Duration
 Original: July 2003 – June 2006 [ECNEC approved on 17 March 2004]
 1st revised: July 2003 – June 2010 [ECNEC approved on 31 January 2006]
 2nd revised: July 2003 – June 2011 [ECNEC approved on 28 August 2008]

9. HPNSDP
VISION: The vision is to see the people
healthier, happier and economically
productive to make Bangladesh a middle
income country by 2021
MISSION: The mission is to create conditions
whereby the people of Bangladesh have the
opportunity to reach and maintain the highest
attainable level of health.

10. Goal of HPNSDP
The goal is to ensure quality and equitable
health care for all citizens in Bangladesh by
improving access to and utilization of health,
population and nutrition services. A number
of development activities in other key sectors
implemented throughout Bangladesh will
contribute to achievement of this goal along
with HPNSDP

11. Operational Plans of HPNSDP:
DGHS
1. Maternal, Neonatal, Child and Adolescent
Health (MNCAH)
2. Essential Services Delivery (ESD)
3. Community Based Health Care (CBHC)
4. TB and Leprosy Control (TB-LC)
5. National AIDS And STD Program (NASP)
6. Communicable Diseases Control (CDC)

12. OPs of HPNSDP: DGHS contd.
7. Non-Communicable Diseases (NCD)
8. National Eye Care (NEC)
9. Hospital Services Management (HSM)
10. Alternate Medical Care (AMC)
11. In-Service Training (IST)
12. Pre-Service Education (PSE)
13. Planning, Monitoring and Research (PMR-
DGHS)

13. OPs of HPNSDP: DGHS contd.
14. Health Information Systems and
E-Health (HIS-EH)
15. Health Education and Promotion (HEP)
16. Procurement, Logistics and Supplies
Management (PLSMCMSD)
17. National Nutrition Services (NNS)
DGHS = 56.23% of budget

14. OPs of HPNSDP: DGFP
18. Maternal, Child, Reproductive and
Adolescent Health (MCRAH)
19. Clinical Contraception Services Delivery
(CCSD)
20. Family Planning Field Services Delivery
(FPFSD)
21. Planning, Monitoring and Evaluation of
Family Planning (PME-FP)

15. OPs of HPNSDP: DGFP contd.
22. Management Information Systems (MIS)
23. Information, Education and Communication
(IEC)
24. Procurement, Storage and Supplies
Management (PSSM-FP)
DGFP = 18.64% of budget

16. OPs of HPNSDP: Others
24. Training, Research and Development (TRD)
25. Nursing Education and Services (NES)
26. Strengthening of Drug Administration and
Management (SDAM)
Others: 2% of budget

17. OPs of HPNSDP: MOHFW
28. Physical Facilities Development (PFD)
29. Human Resources Management (HRM)
30. Sector-Wide Program Management and
Monitoring (SWPMM)
31. Improved Financial Management (IFM)
32. Health Economics and Financing (HEF)
MOHFW = 23.12% of budget

18. Monitoring of HPNSDP
• Thematic Tasks groups with members from
government and donors
Monitoring and Evaluation
Financial Management
Procurement
Nutrition
Human Resource for Health
Gender, Equity, Voice and Accountability
Health Financing
MNCHFP
Sector Management

19. Monitoring of HPNSDP contd.
• LCG – Health Sub working Group
Government, from other ministries and donors –
meets quarterly
• Annual/Mid Term Programme Review – APR/MTR
APIR – Annual Programme Implementation Report
Pool of International and National Consultants
review for 2 weeks – IRT
Prioritized Joint Action Plan
Policy Dialogue

20. SWAp Experience from Bangladesh
• Business as usual – improved in service
delivery
• No Reforms
• Odd Timing of SWAps
• No Political Appetite for reforms
• Donors are in delicate dilemma
• No involvement of others – Civil Society