Exploring SWAp's contribution to the efficient allocation and use of resources in the health sector in Zambia

Bibliographic Data

ID11490813
AuthorsCollins Chansa (0000-0003-0982-5087, Ministry of Health, corresponding author), Jesper Sundewall (0000-0001-5357-5754, Karolinska Institutet), D Mcintyre (0000-0003-4892-4491), Di Mcintyre (0000-0001-6319-4111, University of Cape Town), G Tomson (0000-0001-9222-3604, Karolinska Institutet), BIRGER C FORSBERG (0000-0001-6179-3970, Karolinska Institutet)
Year2008
Volume23
Issue4
Pages244-251
Publication date2008-04-19
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueHealth Policy and Planning (JOURNAL)
Journal identifiersISSN: 0268-1080 • E-ISSN: 1460-2237
PublisherOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czn013
PMID18562459
OpenAlexW2151003141
LanguageEN
Citations received13
References cited6

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.

Allocative efficiency · Business · Economic growth · Economics · Environmental health · Health sector · Health services · Microeconomics · Population · Public economics · Swap (finance) · Transaction cost · Finance · Global Health Care Issues · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine

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