Flessa Steffen
Department of Business Administration and Health Care Management, University of Greifswald, 17489 Greifswald, Germany.
Int J Environ Res Public Health. 2024 Dec 17;21(12):1682. doi: 10.3390/ijerph21121682.
The sector-wide approach (SWAp) is an instrument of cooperation between external development partners (EDPs) and the government of a country. Its main purpose is the coordination, alignment and harmonisation of activities between EDPs and between EDPs and the respective government by covering the entire sector with one major programme.
The main objective of this paper is to analyse the performance of the SWAps in two countries and draw conclusions about the appropriateness of SWAps as financing instruments in the healthcare sector under certain conditions. This paper analyses the development and achievements of the SWAp in healthcare of Bangladesh and Nepal in order to gain insights into the development and relevance of SWAps in the healthcare sectors of low- and lower-middle-income countries in general. We scrutinised the respective documents and conducted qualitative interviews with key stakeholders of the country's sectors. The design of the questionnaires and the analysis of the interviews were built utilising a framework model reflecting the DAC criteria of development cooperation and the principles of the Declarations of Paris and Accra.
The SWAps in Nepal and Bangladesh began rather early and cover about 20 years of cooperation. The components and interventions of SWAps were quite relevant for the health of the population, and their implementation was effective and efficient. The cohesion between partners strongly improved. However, for both countries, the interview partners do not perceive SWAps as the future of healthcare financing.
SWAps were an appropriate instrument of cooperation between the respective governments and EDPs for almost two decades. However, as the share of government budgets in the sector finance has strongly increased and the management capacity of the respective ministries has gone up, there will come a point in time where EDPs can focus more on financing and implementing innovations instead of standard care.
全部门办法（SWAp）是外部发展伙伴（EDP）与一国政府之间的一种合作工具。其主要目的是通过一个主要方案覆盖整个部门，协调EDP之间以及EDP与各自政府之间的活动，使其保持一致并实现协调统一。
本文的主要目标是分析两个国家全部门办法的实施情况，并就在某些条件下全部门办法作为医疗保健部门融资工具的适用性得出结论。本文分析了孟加拉国和尼泊尔医疗保健领域全部门办法的发展与成就，以便总体上深入了解全部门办法在低收入和中低收入国家医疗保健部门的发展情况及其相关性。我们仔细研究了各自的文件，并与两国各部门的主要利益相关者进行了定性访谈。问卷设计和访谈分析是利用一个反映发展合作的发援会标准以及巴黎宣言和阿克拉宣言原则的框架模型进行的。
尼泊尔和孟加拉国的全部门办法起步较早，涵盖了约20年的合作。全部门办法的组成部分和干预措施与民众健康密切相关，其实施有效且高效。伙伴之间的凝聚力大大增强。然而，对于这两个国家来说访谈对象都不认为全部门办法是医疗保健融资的未来方向。
近二十年来，全部门办法一直是各自政府与外部发展伙伴之间合适的合作工具。然而，随着政府预算在部门融资中的份额大幅增加，以及各自部委的管理能力有所提高，总有一天外部发展伙伴可以更多地专注于为创新供资和实施创新，而非提供标准护理。
