Programme Building under SWAp: Some experiences from Tanzania Technical Co-operation in Health in a...
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![Page 1: Programme Building under SWAp: Some experiences from Tanzania Technical Co-operation in Health in a Changing Context.](https://reader035.fdocuments.net/reader035/viewer/2022081603/56649f345503460f94c51c1c/html5/thumbnails/1.jpg)
Programme Building under SWAp:
Some experiences from Tanzania
Technical Co-operation in Health in a Changing Context
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Sector Wide Approach
in Tanzania
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Definition of SWAp
All significant funding for the sector supports a single sector policy and
expenditure programme, under government leadership, adopting common approaches across the sector, and progressing towards
relying on government procedures to disburse and account for all funds
Source:
WHO: Sector-Wide Approaches for Health Development – A Review of Experience
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First steps toward SWAp and Basket Funding 1999
• GOT and donors agreed on a SWAP implementation plan for 1999 – 02
• Elaboration of a a collaborative framework
– Programme of Work (POW)
– Plan of Action (POA)
• Memorandum of Understanding
• Six main donors contribute to holding account for joint funding (basket)
March 1998
June 1999
October 1999
December 1999
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Points of interest:
• Contributing to one sector is not as easy at is sounds when there is an interplay of reforms to contend with.
• In Tanzania the Health Sector Reform and the introduction of the SWAp has been strongly impacted upon by the parallel Local Government Reform process.
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What does SWAp/Basket mean for the districts?
• Considerable augmentation of the annual budget (0,5$ per capita)
• Significant improvement of planning
• Districts can implement their plans because money is available
• Reporting, monitoring, auditing have become routine tools
• Progress in decentralisation
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Monitoring of the SWAp Process
• Joint review of the sector by SWAp partners:
Rationale?– Sector-wide snapshot of progress– Avoid multiple assessment missions– Conclude with key agreements
If we would take this seriously, no individual appraisal for German TC would be needed
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Problems encountered with reviews
• Suitability of large forum?• Insufficient debate, premature conclusions,
decisions made at the lowest level of consensus• Limitations of technical work• Limited linkage with other reforms/ Ministries• Competing missions (!) – despite everything.
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Problems encountered with reviews (2)
• Tendency to review everything (later growing focus on priorities)
• Too many external consultants, available expertise in country not sufficiently used
• Mostly a snapshot which was backward-looking• Donor driven and dominated by Basket Partners• Little owned by GoT/MoH (absence of top
management from MoH)
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Improvements:
• Small technical committee to do thorough preparation• Inclusive process (MOH, PORALG, Basket/non-
Basket partners, CSO)• More forward-looking, less judgemental• Discussion of forward budget / strategic planning• More focus on results (State of Health) and health
issues (HIV, malaria) rather than SWAp mechanics• Development of new Strategic Plan in Partnership
(not without its problems)
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Way forward….
• Basket funding becoming out of “fashion”
• DFID (a main basketier) will withdraw from the basket and will assist the sector by budget support
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Rationale of DFID
– MOH gets what the donors decide, not what it argues the case for: earmarked funding undermines integrity of GOT budget process
– GOT funds still largely used for “core” costs, Basket fund as an “extra” for discretionary items: encourages frivolous expenditure
– Encourages MOH to look to donors rather than MOF for budget justification, performance appraisal: externalises accountability of MOH
– Increase in basket total but fixed district basket => ever-increasing central funding: how much more can MOH effectively absorb? Do we undermine decentralisation?
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Key questions?
Basket versus Budget support•What is our position?
•What is the position of the BMZ?
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Programme Building:
Tanzanian German Programme to Support Health
(TGPSH)
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First steps to build a German TC Programme 2001
Start of the process :Sector Strategy Paper for Tanzanian-German
Co-operation in the priority area of Health through a thorough process of consultation with German stakeholders (KfW, DED, DSE/InWent, CIM) in Tanzania and Germany, which is endorsed by the BMZ and after consultation agreed upon with the GoT (MoH & MoF)
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Shared Goal and Objectives
• Shared Goal with Government of Tanzania and Development Partners :
„To improve the health and well-being of all Tanzanians with a focus on those at most risk and to encourage the health system to be more responsive to the needs of the people”
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Points of interest (1):
Linking interventions at the micro-, meso- and macro-level:
• Support implementation at the district level
• Strengthen the Regional Administration (as facilitator of decentralisation and reform)
• Contribute to national strategies
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Points of interest (2):
Co-operation with a whole series of partner institutions – Central level : MOH, PORALG, MOE, TACAIDS,
IPH..
– Regional level: Training institutions, ZTC, RAS, RHMT...)
– District level: District-Councils, CHSB, CHMT) Public and private health care providers, NGO
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Harmonisation of the complementing instruments of German development co-
operation:
• Financial co-operation (KFW: investment programmes, contribution to „basket“)
• Technical Co-operation (GTZ,GDS, DSE/InWent, CIM)
Points of interest (3):
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Points of interest (4):
And the other SWAp and basket partners….
• There are several mechanisms to coordinate the partners which means a lot of meetings and takes a lot of time……..Bi and Multilateral Health Forum, Basket Fund Committee.
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What is the current state of the Programme Building Process in
Tanzania?
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Current state (1)
• The TGPSH operates in 4 Regions and covers about 15% of the Tanzanian population
• The programme is structured according to 6 components
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Components
1. District Health and Quality Management
2. Reproductive Health
3. HIV / AIDS
4. Health Financing
5. Public Private Partnership
And an overarching issue
6. Human Resources for Health
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Current state (2)
• Sessions are organised in all four regions in order to familiarise them with the Programme
• Regions and Districts can request support where they see TGPSH overlaps with their needs
• Respective activities should be taken up in the District Health Plans
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Ownership of TGPSH
• Thus when districts request TC from the TGPSH in accordance with their agenda then a shared responsibility for the outcome is taken.
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Constraints (1)
become apparent when issues of cross- and multi-sectoral ramifications are considered
• Multisectoral approach to fight the AIDS pandemic
• Reproductive health is not a concern of the health services alone
• Decentralisation of health services needs the local government
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Constraints (2)
Capacity gap• Districts are overwhelmed with HSR –
issues (planning, budgeting, reporting)• Regions and districts will probably have
absorption problems to take on board the innovative Programme components (AIDS- boards, CHF, Quality Management)
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Lessons being learned along the way...
• What experiences do we have in terms of building/development of a health programme?
• What do we have to look out for?
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Lessons learned... (1)
• Very time consuming process to develop SSP involving all German institutions locally and at HQ-level
• Only the high commitment of GTZ project staff for partnership avoided donor driven (German) strategy
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Lessons learned… (2)
• Programme development for the technical cooperation needed new approaches to involve maximum involvement of stakeholders (both Tanzanian and German)
• Advocacy had to be done for various stakeholders: Participation of some stakeholders was lukewarm in the beginning.
• Several rounds of discussion needed to reach consensus with all stakeholders
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Positive Points:
• Synergy between the different German institutions eg. InWent and GTZ viz. HRH
• German contribution in Health and HIV/AIDS more visible
• Best practice inputted into strategic developments in the health sector and in the fight against AIDS
• GTZ key player in donor constituency in health• GTZ Co-oordinator chairs DAC-HIV/AIDS
group
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Thank you for your attention!