Globalization, Health Sector Reform, Gender and ... - Ford Foundation

Core Components of Sector Program AssistanceThe components of sector program assistance are agreed through extensive negotiations among donorsthemselves and between the recipient government and the donor consortium. These core componentsare summarized below:• Donor assistance and ministry finance are pooled into one coordinated sector program rather thana series of separate donor projects.• A sector-wide strategy is formulated and implemented by the Ministry of Health on the basis ofextensive consultation between ministry officials, all donor partners and stakeholders.• A common budget and accounting framework, common procurement arrangements and joint reviewprocedures for sector program activities are established.• Local capacity in the management and delivery of health services is strengthened.• Government sets up systems to ensure more effective and accountable resource utilization.Most countries undergoing SWAPs have a history of structuraladjustment where cuts in the public sector deficit have been acentral feature. A common starting point, therefore, for manySWAPs and the associated health sector reforms (HSR) is “tight”or constrained public-sector financing. This partly explains theemphasis within HSR on developing alternative sources of financeand streamlining the sector to provide “basic,” “essential” or “core”services to meet the needs of the poor and vulnerable. Withoutimprovements in quality and patterns of service delivery, cuts inhealth expenditure are unlikely to strengthen women’s reproductivehealth—especially where public-sector interventions havebeen shown to have a positive impact. However, in view of thepoor targeting of health expenditure in the past, one cannot saywith certainty that a decline in health expenditure will necessarilyresult in worse health outcomes. For instance, if cuts in expenditureby the Ministry of Health are accompanied by an increase (orbetter targeting) in investment in sanitation, particularly cleanwater, and this results in increased access to clean water amongthe poor, the outcome for women’s reproductive health may actuallyimprove.In many ways SWAPs are a “continuation of several elements of theclassic HSR agenda, notably reforming health management systemsand ministries of health and setting clear priorities for the publicsector” (Standing, H., 1999). However, certain aspects of sectorwideprograms represent efforts to learn from past mistakes. Forinstance, the strong emphasis on government ownership representsthe attempt to avoid the pitfalls of “conditionality” associated with20