This description represents the first major stage in a surveillance sector review aimed at identifying high priority improvements to these integrated sector-wide systems.
This confirms the general axiom that approaches initially designed as disease and program-specific are not easily joined into sector-wide systems [ 70].
External assistance for health sector reform should strengthen coordination and adequately address the relationship between health systems reform and the reforms of public administration necessary to enable sector-wide health systems reform.
The emphasis on sector wide issues reflects the challenges to health systems today and suggests that countries consider as important the macro-level analysis as the micro.
This was followed by more systemic topics, such as quality initiatives, integration of programmes, referral systems, health financing schemes, outsourcing of services and Sector Wide Approaches (SWAp).
This is envisaged to establish an evidence base to inform future initiatives utilising a sector wide approach whilst ensuring coherence with national priorities and policies, ministerial/departmental strategic plans, child protection systems building, and other broader developments.
That said, the translation of recommendations to actual resource shifts is dependent on the incentives in the health system and in particular whether funding arrangements are compatible with the health sector wide context and disease/health problem framework.
The article sparked a sector wide debate with some praising Peter's assessment that we pay too much attention to donors and not enough attention to new systems while others stating that he oversimplifies the problem without offering any solutions.
The 1995 Medium Term Health Strategy (MTHS) and the subsequent Sector Wide Approach (SWAp) which seeks to create a common basket for funding MOH priorities [ 19], tackle some of the systemic problems in the health system.
While the "Sector-Wide Approach"—a resource allocation system that pools all health sector resources from all sources and allocates funds based on need had been effective in Malawi for coordinating donor support, lack of accountability of funds provided directly to the government limited contributions to the basket fund.
Such interventions can deliver dramatic sector and system-wide improvements.
