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Rethinking Health Sector Wide Approaches through the lens of Aid Effectiveness


  • Andrew McNee

    () (Development Policy Centre, Crawford School of Public Policy, The Australian National University)


Sector Wide Approaches (SWAps) are an approach to aid management that aim to support recipient government leadership. Health aid has grown rapidly in the past 20 years and in this time SWAps have become an important health aid delivery approach. However, the empirical evidence is that the performance of health SWAps is, at best, mixed. Outcome and impact benefits of health SWAps are inconclusive, and overall process level performance is poor. The key insight offered by this paper is that a divergence has developed between the underlying theory of change of health SWAps, and their implementation. The paper argues the theory of change underlying SWAps is highly consistent with effective aid, however the practice is not. Health SWAps have been characterised by cumbersome architecture that is partially implemented and used, and which does not facilitate government ownership and commitment to indigenous institutional development. A core stream of the analysis as to why this is the case relates to technical shortcomings within the SWAp architecture itself, however this is not sufficient to understand the reasons for the limited success of SWAps. Rather it is clear there are a range of broader incentives and understandings within both donors and governments that have shaped the implementation of SWAps at a process level. The paper concludes with some suggested actions which may assist in realigning health aid with the underlying SWAp theory of change, whilst taking into account at least some of the incentives and understandings that have cut across SWAp implementation. The essence of the proposed approach is a more realistic understanding of the nature of health systems, combined with a more politically informed set of strategies to support the development of these systems.

Suggested Citation

  • Andrew McNee, 2012. "Rethinking Health Sector Wide Approaches through the lens of Aid Effectiveness," Development Policy Centre Discussion Papers 1214, Development Policy Centre, Crawford School of Public Policy, The Australian National University.
  • Handle: RePEc:een:devpol:1214

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    References listed on IDEAS

    1. Pritchett, Lant & Woolcock, Michael, 2004. "Solutions When the Solution is the Problem: Arraying the Disarray in Development," World Development, Elsevier, vol. 32(2), pages 191-212, February.
    2. Gre[ss], Stefan & Niebuhr, Dea & Rothgang, Heinz & Wasem, Jurgen, 2005. "Criteria and procedures for determining benefit packages in health care: A comparative perspective," Health Policy, Elsevier, vol. 73(1), pages 78-91, July.
    3. Mishra, Prachi & Newhouse, David, 2009. "Does health aid matter?," Journal of Health Economics, Elsevier, vol. 28(4), pages 855-872, July.
    4. Stephen Howes, 2011. "An overview of aid effectiveness, determinants and strategies," Development Policy Centre Discussion Papers 1101, Development Policy Centre, Crawford School of Public Policy, The Australian National University.
    5. Easterly, William & Williamson, Claudia R., 2011. "Rhetoric versus Reality: The Best and Worst of Aid Agency Practices," World Development, Elsevier, vol. 39(11), pages 1930-1949.
    6. Stephen Howes & Sabit Otor & Cate Rogers, 2011. "Does the World Bank have a micro-macro paradox or do the data deceive?," Development Policy Centre Discussion Papers 1105, Development Policy Centre, Crawford School of Public Policy, The Australian National University.
    7. Daniel Adler & Caroline Sage & Michael Woolcock, 2009. "Interim Institutions and the Development Process: Opening Spaces for Reform in Cambodia and Indonesia," Global Development Institute Working Paper Series 8609, GDI, The University of Manchester.
    8. Wilson, Sven E., 2011. "Chasing Success: Health Sector Aid and Mortality," World Development, Elsevier, vol. 39(11), pages 2032-2043.
    9. Howard White, 2007. "The Bangladesh Health SWAp: Experience of a New Aid Instrument in Practice," Development Policy Review, Overseas Development Institute, vol. 25(4), pages 451-472, July.
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    Cited by:

    1. Independent Evaluation Group, 2016. "Program-for-Results," World Bank Publications, The World Bank, number 25770, January.
    2. Stephen Howes, 2014. "A Framework for Understanding Aid Effectiveness Determinants, Strategies and Tradeoffs," Asia and the Pacific Policy Studies, Wiley Blackwell, vol. 1(1), pages 58-72, January.

    More about this item


    SWAps; aid effectiveness; health aid;

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • F35 - International Economics - - International Finance - - - Foreign Aid
    • O20 - Economic Development, Innovation, Technological Change, and Growth - - Development Planning and Policy - - - General
    • O21 - Economic Development, Innovation, Technological Change, and Growth - - Development Planning and Policy - - - Planning Models; Planning Policy

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