Case study of a "successful" sector-wide approach: the Uganda health sector SWAp

Case study of a "successful" sector-wide approach: the Uganda health sector SWAp

Health sector SWAp succeeds in Uganda: what lessons can be learned?

This paper, from the Swiss Tropical Institute, explores some of the factors for the success of a sector wide approach (SWAp) in the Ugandan health sector.. The paper seeks to understand why it is working, the factors for success, what has not worked well and why, and draws out lessons for other countries. The author highlights how decentralisation became more fully effective, with increased funds and leadership of the central ministry of health (MOH), after the SWAp was implemented. The Ugandan experience demonstrates how a decentralised health sector can help resist the centralising tendencies of SWAps. Moreover, the study shows how SWAp conditions allowed the MOH to abolish user fees on essential health services as a result of more decentralised funds and increased efficiency.

The study concludes that a SWAp should not be rushed into. It also argues that a decentralised (or decentralising) health system or local government structure can increase the effectiveness of a SWAp. General budget support, while resisted by some health sector donors, has helped to strengthen government ownership and control over their budgeting process and accountability to parliament. The paper also highlights the need for donors to consider helping MOHs implement the SWAp through other, temporary, funding mechanisms; and stresses that a long term commitment is essential for all partners. [adapted from author]

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