This review responds to an NAO request for further work to assess the
impact of the health Sector-Wide Approach (SWAp) in Malawi. Malawi has
been a relatively strong performer in terms of health outcomes for many
years. Since the early part of the decade, key health indicators such as
infant and under five mortality rates have been better than average for
least developed countries. This raises the question as to whether the
SWAp is sustaining or even accelerating those gains or whether such
progress is being made in spite of the SWAp. There are some suggestions
that the rate of improvement is declining (suggesting that perhaps
easier gains have been made, that the SWAp is performing less than
ideally or that external factors are responsible).
Good progress has certainly been made during the SWAp period, although
Malawi is unlikely to achieve the Millennium Development Goals health
targets; it may achieve the U5MR but is well off-track to achieve the
Maternal Mortality Ratio target. This is perhaps not surprising as it
was recognised at the outset that the Programme of Work was
resource-based rather than needs-based and provided for too few
resources to achieve the MDGs. In practice, more resources have been
made available than was anticipated.
The SWAp process has undoubtedly had serious weaknesses, which largely
reflect the low level of national capacity, but also declining
commitment (according to a recent World Bank review) which means that
the process is less developed than in many other SWAp countries. This
might suggest that the question 'Has a SWAp been tried?' may be just
as relevant as Has the SWAp worked?
Pearson, M. Assignment Report: Impact Evaluation of the Sector Wide Approach (SWAp), Malawi. Human Development Resource Centre, UK (2012) 75 pp.
Assignment Report: Impact Evaluation of the Sector Wide Approach (SWAp), Malawi