Steffen Flessa

• Background: 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. Methods: 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. Findings: 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. Conclusions: 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.