Sector-wide approach (SWAp) as support to health sector reforms and results at operational level in rural environment in Tanzania

The sector-wide approach (SWAp) was introduced to increase the impact of donor funds and local management of resources in developing countries. It gained progressively the support of major bilateral donors. In June 1998, the Tanzanian Ministry of Health and a group of donors adopted a SWAp in order to support health sector reforms and to increase coordination between donors and government. In fine, the main aim of the health reforms was to improve availability and quality of essential health service delivery through one comprehensive and coherent health sector programme. Despite increased attention during the past few years to explore the gaps between policies and results/outcomes at operational level, scarce evidence has been produced. Our multiple-case study design used mixed methods for data collection and analyses. It intended to evaluate and understand how the health sector reforms supported by a SWAp were implemented, and how they were eventually associated with health system improvements and a better health service delivery to the Tanzanian population. To fulfil that objective, we explored the conditions for success and/or failure of the national policy implementation through an analytical framework with functional links between the national and operational level. Our evaluation supported the fact that the adoption of a health SWAp in Tanzania played a major role in the implementing the health sector reforms. This was particularly true for the decentralisation process and the application of new policy on health financing sources. In addition, the different mechanisms under the framework of the SWAp contributed to strengthen the national health system, analyzed through six building blocks (finance, human resource, information, service, drug and equipment, and governance). At operational level, despite some improvements in the planning, supervision, finance, training, salary, and infrastructures, the overall results remained modest. Several components essential to quality health services, like referral system, working and living conditions, and reliable supplying system did not really improve, and policy implementation of community health fund mechanism failed. Incoherence between policies, lack of preparedness and human capacity buildings, absence of synergy between programmes, and shortcomings in having firm grip on context-reality are some of the policy-implementation gaps pointed out. Those gaps inhibit the success of strategies implementation and threaten the slight progresses already obtained. The more recent aid effectiveness policy, including Paris Declaration and International Health Partnership are more challenging than ever. Our validated method and analytical framework could, hopefully, guide further research on policy transfer, implementation and effectiveness at operational level.(MED 3) -- UCL, 201