Public health seminar

1. By
Nisha Thapa Magar
2015-1-37-0021
SWAp in health? What is it? Where we are?
Ways forward
Seminar on
Under cordial guidance of
Hari Prasad Kaphle
Assistant. Proffessor (Public Health)
PU, SHAS

2. Outline
• Background
• Introduction
• Global context
• Nepal context
• Policy
• References
2

3. Background
• Developed in early 1990s.
• adopted by wide group of development agencies at meeting held in
Copenhagen in February 1997.
• In 1998, Peter published the first analysis in the peer-reviewed
literature on the design and experience in SWAp.
3
David H. Peters, Ligia Paina, Schlemann F. Sector-wide approaches (SWAps) in health: what have we learned? Health
policy and planning. 2012;28:884-90.

4. Introduction
A SWAp (Sector Wide Approach) is-
• an approach involving different type of relationship between
government and development partners,
• a mechanism through which supports to public expenditure program
for better coordination,
• a means of improving aid effectiveness-by improving the efficiency
and effectiveness with which all resources are used, and accounted for,
in the sector.
4
Sector Wide Approaches: A Resource Document for UNFPA Staffs. 2005

5. Components of SWAp
There are four key components of SWAp-
• A clear nationally-owned sector policy and strategy;
• A medium term expenditure framework that reflects the sector
strategy;
• Systematic arrangements of programming resources that supports the
sector;
• A performance monitoring system that measures progress and
strengthens accountability.
Sector Wide Approaches: A Resource Document for UNFPA Staffs. 2005 5

6. Approaches
1. Building individual human and institutional capacity.
2. Promoting dialogue and advocacy, establishment of equitable
partnership and improve donor coordination.
3. Efficiency of policy advisory services and improving sector
stewardship, national ownership and financial management.
4. Promoting knowledge production and support national health
information systems.
5. Supporting Health SWAps to improve population health.
6. Supporting Health SWAps to improve health system functioning.
Elis Borde, Publica ENdS. Sector-wide approaches (SWAps) in health. Gederal Ministry for Econimic Cooperation and
Development 6

7. Global context
• SWAp is known as development sector across many countries around
the world.
• The World Bank regard SWAp as integral to its strategy in Africa.
• It is the most appropriate step for effective aid management and health
sector development.
• SWAp modality came into practice in Bangladesh in 1998 when
MOHFW realized the need to refine its project implementation design.
(MOHFW= Ministry of Health and Family Welfare)
7
Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the Health and Education Sectors of Nepal.
Government of Nepal,Ministry of Finance,International Economic Cooperation Coordination
Division(IECCD)Kathmandu,Nepal. 2018

8. Cont…
SWAp follow five basic principles of Paris Declaration.
1. Ownership
2. Alignment
3. Harmonisation
4. Managing for results
5. Mutual accountability
8
Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the Health and Education Sectors of Nepal. Government
of Nepal,Ministry of Finance,International Economic Cooperation Coordination Division(IECCD)Kathmandu,Nepal. 2018

9. Nepal Context
• MoF is responsible for monitoring and evaluation of aid effectiveness
in Nepal as it is involved in Joint Annual Review (JAR) for discussing
the progress made in SWAp.
• In health sector, the Nepal Health Sector Strategy (NHSS),2015-2020
guide the decision across different sector including public and private
services and partnership with external donors.
• In education, the School Sector Reform Plan (SSRP) 2004-2015 is a
long term strategic plan for achieving basic and secondary education.
9
Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the Health and Education Sectors of Nepal.
Government of Nepal,Ministry of Finance,International Economic Cooperation Coordination
Division(IECCD)Kathmandu,Nepal. 2018

10. Evolution of SWAp in health sector in Nepal
• December 2003: ‘The Health Sector Strategy (HSS): An agenda for
reform was endorsed against the backdrop of Nepal’s commitments on
delivering Poverty Reduction Strategy (PRS) and the MDGs.
• February 2004: Signing of ‘Statement of intent to guide the
partnership in health sector in Nepal by GoN and 11 External
Development Partners (EDPs).
• July 2004: ‘Letter of sector development policy’ was drafted by the
then Deputy Prime Minister and Finance Minister.
Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the Health and Education Sectors of Nepal. Government of Nepal,Ministry of
Finance,International Economic Cooperation Coordination Division(IECCD)Kathmandu,Nepal. 2018
10

11. Cont..
• August 2004: The Nepal Health Sector Implementation Plan 2004-
2009 was formulated.
• March 2005: Signing of JFA (Joint Financing Arrangement) between
GoN, Department for international Development (DFID) and the
World Bank.
• June 2009: Signing of JFA with Aus-Aid as third partner to provide
health sector budget supports.
• 2009: Signing of National Health Sector Development compact
between MoHP and Development Partners (DPs).
Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the Health and Education Sectors of Nepal. Government of Nepal,Ministry of
Finance,International Economic Cooperation Coordination Division(IECCD)Kathmandu,Nepal. 2018
11

12. Policy Context of SWAp
Major policy
1. Foreign Aid Policy (FAP), 2002
2. Development Cooperation Policy (DCP), 2014
Education sector policies and program
1. School Sector Reform Plan, 2009-2015
2. School Sector Development Plan, 2016-2023
12
Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the Health and Education Sectors of Nepal. Government
of Nepal,Ministry of Finance,International Economic Cooperation Coordination Division(IECCD)Kathmandu,Nepal. 2018

13. Cont..
Health sector policies and program
1. Health Sector Strategy, 2003-2015
2. Nepal Health Sector Programme I, 2004-2009
3. Nepal Health Sector Programme II, 2010-2015
4. National Health Policy, 2014
5. Nepal Health Sector Strategy, 2015-2020
13

14. Challenges of SWAps
The top 10 challenges of implementing sector wide approaches are-
• Not easy to decide on how wide to define the sector
• Core issues affecting the sector, decided outside the sector
• Few institutional incentives to cooperate
• Shifting of political focus from basic service delivery to a growth
agenda
• Focus on short-term results, not sustainable service delivery
14Study of Sector Wide Approach in the water sector. European Commission. 2011

15. Cont..
• Past reforms not consolidated, roles and responsibility are unclear
• National systems too weak to carry out core tasks
• Lack of resources and energy to coordinate and implement reform
• The sector approach concept is not country led
• Support from donor is inconsistent and unpredictable
Study of Sector Wide Approach in the water sector. European Commission. 2011
15

16. Opportunities for SWAp
• Reinforce decentralization
• Shift sector objectives from short-term coverage targets to long-term
sustainable service delivery
• Respond to challenging and persistent constraints
• Bring synergies with administration reform
16Study of Sector Wide Approach in the water sector. European Commission. 2011

17. Cont..
• Complement new planning and financial tools
• Use information as an agent of cooperation and change
• Support a focus on environment and climate change
• Offer new prospects for international cooperation and partnerships.
Study of Sector Wide Approach in the water sector. European Commission. 2011
17

18. Recommendation
• Design and implement SWAp awareness program for local level staff.
• Capacitate the existing system for SWAp implementation in terms of
logistics, human resources and policy instruments.
• Design and implement Leadership Development Programmes for
senior policy makers working in SWAp.
• Provide capacity development and other incentives for focal person
and other staff working in SWAp Unit and/or Planning
Divisions/Sections.
18
Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the Health and Education Sectors of Nepal.
Government of Nepal,Ministry of Finance,International Economic Cooperation Coordination
Division(IECCD)Kathmandu,Nepal. 2018

19. References
1. David H. Peters, Ligia Paina, Schlemann F. Sector-wide approaches
(SWAps) in health: what have we learned? Health policy and planning.
2012;28:884-90.
2. Finance Mo. An Assessmemt of Sector Wide Approach (SWAp) in the
Health and Education Sectors of Nepal. Government of Nepal,Ministry of
Finance,International Economic Cooperation Coordination
Division(IECCD)Kathmandu,Nepal. 2018.
3. Elis Borde, Publica ENdS. Sector-wide approaches (SWAps) in health.
Gederal Ministry for Econimic Cooperation and Development.
4.. Sector Wide Approaches: A Resource Document for UNFPA Staffs. 2005.
5. Study of Sector Wide Approach in the water sector. European Commission.
2011.
19

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