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Sector-wide approaches for health develpment : a review of experience

FOSTER, M
BROWN, A
CONWAY, T
2000

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[Publisher's abstract:] Summarizes lessons learned in five countries which are attempting to implement a sector-wide approach to health development. The sector-wide approach is a comparatively recent mechanism for coordinating the roles of governments and donors. A significant characteristic of this approach is the use of all significant funding to support a single sector policy and expenditure programme, under government leadership, with eventual reliance on the government to disburse and account for all funds. The approach also involves a transition of donor contributions away from project-funded vertical programmes and towards a single budget administered by the government. Case studies of the successes and failures of this approach were conducted in Cambodia, Mozambique, Tanzania, Uganda, and Viet Nam. Although these countries represent a range of different stages of implementing the approach, the review reached a number of conclusions about shared problems and impediments to progress. These include weaknesses in government monitoring procedures and a corresponding reluctance of donors to relinquish control, increased demands on staff within ministries of health, and a management complexity that can overwhelm government capacity. On the positive side, the review found evidence of greater agreement on a more restricted range of priorities, better integration of individual programmes within the budget planning process, better links between policy and implementation, and improved understanding of barriers to service utilization, including the role of corruption and incentive problems. On the basis of this assessment, the review issues six key recommendations for improved sector-wide management of projects and resources

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