Exploring SWAp's contribution to the efficient allocation and use of resources in the health sector in Zambia
1 SWAp Secretariat, Department of Planning & Development, Ministry of Health Headquarters, Lusaka, Zambia.
2 Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
3 Health Economics Unit, Department of Public Health and Family Medicine, University of Cape Town, South Africa.
4 Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
* Corresponding author. SWAp Secretariat, Department of Planning & Development, Ministry of Health Headquarters, Ndeke House, P.O. Box 30205, Lusaka 10101, Zambia. Tel: +260 95 833 178. Email: cchansa{at}moh.gov.zm.
Zambia introduced a sector-wide approach (SWAp) in the health sector in 1993. The goal was to improve efficiency in the use of domestic funds and externally sourced development assistance by integrating these into a joint sectoral framework. Over a decade into its existence, however, the SWAp remains largely unevaluated. This study explores whether the envisaged improvements have been achieved by studying developments in administrative, technical and allocative efficiency in the Zambian health sector from 1990–2006.
A case study was conducted using interviews and analysis of secondary data. Respondents represented a cross-section of stakeholders in the Zambian health sector. Secondary data from 1990–2006 were collected for six indicators related to administrative, technical and allocative efficiency.
The results showed small improvements in administrative efficiency. Transaction costs still appeared to be high despite the introduction of the SWAp. Indicators for technical efficiency showed a drop in hospital bed utilization rates and government share of funding for drugs. As for allocative efficiency, budget execution did not improve with the SWAp, although there were large variations between both donors and year. Funding levels had apparently improved at district level but declined for hospitals. Finally, the SWAp had not succeeded in bringing all external assistance together under a common framework.
Despite strong commitment to implement the SWAp in Zambia, the envisaged efficiency improvements do not seem to have been attained. Possible explanations could be that the SWAp has not been fully developed or that not all parties have completely embraced it. SWAp is not ruled out as a coordination model, but the current setup in Zambia has not proved to be fully effective.
Key Words: SWAp, sector-wide approach, development assistance, efficiency, resource allocation, Zambia
Accepted for publication 18 April 2008.