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  1. E. John Blunt
    E. John Blunt February 26, 2012 at 7:40 pm

    I agree that SWAps have offered the prospect of health aid being more efficiently provided through processes that were aligned and harmonised both amongst donors, and with Government systems; offered the prospect of a more holistic approach to financing that encompassed and linked capital and recurrent budgets; promised to reduce the burden on government officials of managing the often competing and onerous demands of donors; and most importantly, sought to increase the effectiveness of health aid in improving health services and outcomes.

    The theory of change underpinning SWAps is premised on the aid effectiveness principle that robust, legitimate institutions are central to the sustainable development of effective health systems, and that these institutions will only develop through deeply-embedded local, political and cultural contestation and processes.

    However, many SWAps have failed to properly strengthen health institutions.

    Some Health SWAps in the Pacific, Asia and Africa have not included sufficient focus on planning, budgetary, management, procurement and supply issues; some have only partially focused attention on these issues rather focusing on technical health issues; and some have divided focus among a number of Donors leading to systems that are sometimes disjointed. Is it any wonder that health practitioners sometimes, following a significant intervention, still do not have the required pharmaceuticals, medical consumables, medical equipment and the other ‘hundred-and-one’ items necessary for the health system to work! Remember that health planning, budgeting, management, procurement and supply do not operate in isolation, but rather operate within ‘whole-of-government’ systems. Do Health SWAps always consider the ‘whole-of-government’ context and indeed the necessity of designing interventions to strengthen these systems before focusing on strengthening the health system?

    The recent intervention to strengthen the health system of the Government of Swaziland is a good example of the requirement to design interventions at government and ministry level to compliment required health interventions.

    Perhaps a more strategic view is required when planning, designing and implementing Health SWAps is required.

    E. John Blunt is an Institutional and Public Procurement Expert with extensive experience in leading public procurement reforms in a variety of international development environments. He has worked in the Health environment in the Pacific, Asia and Africa. He is currently on assignment with the Southern African Development Community Secretariat in Botswana.

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