1. Tanzania Health Sector Wide Approach (SWAp) Rob Cunnane Health and Population Officer USAID Tanzania Prepared for SOTA, June 2002

2. 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!

3. 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

4. Key components  Government Leadership  Phase-out of “projects”  Reducing transaction costs  Sustainable results

5. 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

6. 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%

7. Health Expenditures (millions)

8. Donor Commitments to Pool Funding Dfid16.2 DANIDA6 Ireland AID3.1 Swiss Development Cooperation 2.5 KFW2.3 World Bank10 Others (GTZ, RNE)1.5 Total Commitments/Pooled41.7 million

9. 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

10. 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

11. Serious concerns  Support to NGOs, faith-based groups is declining  Social marketing of critical RH products is at risk  Building public- private partnerships

12. For USAID: Consultation is Critical  Joint Health Sector Review  SWAp meeting  Basket group