The SAP experience in Pakistan

What is the Pakistan Social Action Program (SAP) and what lessons can be learnt from the experiences of this - the longest running example of a sector wide approach (SWAp)? This briefing paper, produced for the UK Department for International Development (DFID) by the DFID Health Systems Resource Centre (HSRC), documents how SAP came about, how it operates, what is known about its impact to date and options for the future.

The paper explains what SAP is, why it was introduced in Pakistan and how it is intended to work. The two SAP projects are outlined. The author then comments on how SAP has actually worked in practice, and what the impact of the projects has been. The paper concludes by highlighting the lessons that can be learnt from the projects, and considers what this means for the future of SAP and SWAps.

What is SAP? How did it come about? How is it supposed to work?

• SAP was initiated by the Government of Pakistan in 1992 as a multi-sectoral policy initiative intended to increase the quality and quantity of investment in basic social services (primary health, primary education, population welfare, rural water supply and sanitation).
• SAP was initially a planning and financing exercise in which extremely low budgetary provision for basic social services were increased significantly with donor assistance, including World Bank, Asian Development Bank, the Dutch Government and DFID.
• SAP represented recognition by the administration in Pakistan that despite achieving twenty years of reasonable economic growth, this had not impacted significantly on poverty or human development in the country. SAP was seen as a means of building political commitment to the implied budgetary shift away from defence and non-social sector expenditure.
• SAP process involves the donor’s reimbursing a proportion of all expenditure, recurrent and development, which is agreed under a five-year financing plan.

How has SAP worked in practice? What has the impact been? What lessons can be learnt?

• The World Bank became the lead donor, taking ownership of the project so that it became seen as a World Bank construct, rather than a government programme.
• Initiative was taken away from Provincial Government service departments, donors paid undue attention to operational aspects and thus there was a lack of commitment at the political level. Attempts to mitigate this one-sided policy dialogue can be seen in the second project. For example, management of SAP was finally shifted to Pakistan. However, these problems persist and have slowed progress.
• Whilst SAP has increased and protected the expenditures in basic social services, improvements in performance have been much slower. However, SAP has established a sector wide approach to policy development and planning. Whilst there have been limited improvements, everyone agrees that the main reason for poor performance has been failure to recognise and address the institutional constraints.
• Progress takes time. Improved governance and institutional reform are essential for SAP’s success. Ambitious donor expectations and objectives may have to be sacrificed in order to achieve government ownership of the policy. SAP is a political agenda, which requires political engagement, whose participants must incorporate the entire range of social sector issues.