ACTION (Advocacy to Control Tuberculosis Internationally), an international partnership of advocates fighting for resources to treat and prevent the spread of TB, released a report today (available here) evaluating the effectiveness of Sector Wide Approaches (SWAps) for health. SWAps are a funding mechanism that helps donors to pool their funding for a particular sector – in this case, healthcare – in order to pool donor funds for efficient administration and facilitate a country-led and country-owned process.
The report titled ‘Aid without Impact: How the World Bank and Development Partners Are Failing to Improve Health through SWAps,’ assesses whether efforts to strengthen health systems with SWAps have been successful in fighting TB and in delivering health outcomes. The overall conclusion is that while SWAps are an important component of the international aid architecture, changes need to be made to the way they work in order to increase their effectiveness and ensure they deliver real positive outcomes.
The report focuses initially on TB. TB continues to play a significant role in development as it disproportionately affects the poor. Approximately 2 billion people, or one third of the world’s population, are infected with TB. TB kills 1.8 million people every year, roughly the equivalent of 4,500 people dying every day. Ninety-five percent of those who are infected with and die from TB live in developing countries. Fighting TB has become all the more urgent as TB is the leading cause of death among people living with HIV. About 80 per cent of all TB deaths among people living with HIV occur in Africa. Furthermore, the emergence of multi- and extensively drug-resistant TB seriously threaten TB control underlining the need for a successful approach to fight the disease.
ACTION’s report notes that while the World Bank has made TB-specific investments in countries such as China and India, its strategy to address TB in Africa has been through Sector-Wide Approaches (SWAps). The idea behind SWAps has been to pool donor finances and coordinate efforts between development agencies and governments to achieve health sector development, which is a great idea in principle as it leads to greater donor harmonisation and a more country-led and country-owned process.
However, ACTION’s report found a lack of evidence demonstrating that SWAps have worked to create positive health outcomes in sub-Saharan Africa, stating:
There is an unacceptable dearth of scientific assessment that demonstrates the impact of SWAps on health outcomes, despite the billions of dollars that have been invested in this approach since the mid-1990s.
While most people ACTION interviewed for their research identified SWAps as an essential approach to development, they admitted that “SWAps are not yet being implemented in a way that has led to improvements in health outcomes in effective, efficient, measurable, or sustainable ways.” Additionally, the report found that SWAps have not adequately addressed or prioritised TB.
The report concludes that the World Bank and its development partners must recognise “the failure of SWAps to consistently promote better health outcomes” and should focus more on these outcomes than on process. The report recommends:
- Regular reviews of SWAps health programmes by an independent technical team and publicising the findings.
- Making the World Bank’s “Annual Joint Programme Reviews” that are already being done public to increase transparency and public oversight.
- Rigorously monitoring and evaluating SWAps to establish what works and what doesn’t.
ACTION’s report coincides with International Development Secretary Andrew Mitchell’s announcement last week to create a new, independent watchdog to certify that UK taxpayers are receiving value for money. RESULTS urges the UK and development partners to identify the release of this report as a key opportunity to improve its approach to SWAps to achieve a greater impact on health development and to focus development aid on strategies that work.
Read the full report here.