Austerity and the “sector-wide approach” to health: The Mozambique Experience

Publication Date:

04 May 2017


Pfeiffer J, Gimbel S, Chilundo B, Gloyd S, Chapman R, Sherr K. (2017). Austerity and the “sector-wide approach” to health: The Mozambique Experience. Soc Sci Med. 187(208-216). doi: 10.1016/j.socscimed.2017.05.008



Fiscal austerity policies imposed by the IMF have reduced investments in social services, leaving post-independence nations like Mozambique struggling to recover from civil war and high disease burden. By 2000, a sector-wide approach (SWAp) was promoted to maximize aid effectiveness. ‘Like-minded’ bilateral donors, from Europe and Canada, promoted a unified approach to health sector support focusing on joint planning, common basket funding, and streamlined monitoring and evaluation to improve sector coordination, amplify country ownership, and build sustainable health systems. Notable donors – including US government and the Global Fund – did not participate in the SWAp, and increased vertical funding weakened the SWAp in favor of non-governmental organizations (NGOs). In spite of some success in harmonizing aid to the health sector, the SWAp experience in Mozambique demonstrates how continued austerity regimes that severely constrain public spending will continue to undermine health system strengthening in Africa, even in the midst of high levels of foreign aid with the ostensible purpose of strengthening those systems. The SWAp story provides a poignant illustration of how continued austerity will impede progress toward Sustainable Development Goal 3 (SDG 3); “Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”. However, the SWAp continues to offer an alternative model to health system support that can provide a foundation for resistance to renewed austerity measures.


Read the Full Article


Stand with HAI

Stand with HAI


When you support Health Alliance International, you take a stand for a more equitable and respectful model of global health. Your donation not only helps us expand our reach, it is an investment in our shared values of health equity and solidarity. 

Join the Alliance

Our alliance is made up of supporters, partners, staff, and volunteers who share our commitment to universal access to quality health care. Just like a health system, every person plays a role in keeping us working toward this ultimate goal. Will you join us? 

Get Engaged

The kind of change we seek requires sustained action.  Whether you want to engage in HAI's advocacy work or help spread HAI's mission and model, we rely on our friends and supporters to stand beside us when we stand up for equity in global health.

Didn't find what you were looking for?

Didn't find what you were looking for?