Jeppsson Anders
Ministry of Health, P.O. Box 7822, Kampala, Uganda.
Soc Sci Med. 2002 Dec;55(11):2053-60. doi: 10.1016/s0277-9536(01)00345-8.
This paper examines the role of the Ministry of Health (MoH) in Uganda in the process of developing a Sector-Wide Approach (SWAp) within the health sector. Power dynamics are integral to any understanding of development assistance, and SWAps bring with them new opportunities for the deployment of influence. The SWAp process has changed the interaction between the donors and the Government, and the perspective of this interaction has shifted from various technical areas to the entire health sector. It is argued that although the decentralization of the public sector has transferred considerable responsibilities and duties from the central level to the districts, significant power, defined as a social construct, has been generated by the MoH in the very process of developing SWAps. The MoH has been able to exercise significant influence on defining the content and boundaries of the SWAp process, as well as the direction it is taking. This development has largely followed blueprints drawn by donors. Through the institutional framework associated with SWAps, the MoH has redefined the interaction between the central level and the districts as well as between the MoH and the donors. While the SWAp process is now moving from the planning to the implementation phase in Uganda, we see a number of new, changing, ambiguous and contradictory strategies emerging.
本文探讨了乌干达卫生部在卫生部门制定全部门办法（SWAp）过程中所发挥的作用。权力动态是理解发展援助的不可或缺的部分，而全部门办法为影响力的施展带来了新机遇。全部门办法进程改变了捐助方与政府之间的互动，且这种互动的视角已从各个技术领域转向了整个卫生部门。有人认为，尽管公共部门的权力下放已将大量责任和职责从中央层面转移到了各地区，但卫生部在制定全部门办法的过程中产生了一种被定义为社会建构的重要权力。卫生部能够对确定全部门办法进程的内容和范围以及其发展方向施加重大影响。这一发展很大程度上遵循了捐助方制定的蓝图。通过与全部门办法相关的体制框架，卫生部重新界定了中央层面与各地区之间以及卫生部与捐助方之间的互动。虽然乌干达的全部门办法进程目前正从规划阶段进入实施阶段，但我们看到出现了一些新的、不断变化的、模糊的和相互矛盾的策略。
