THE SECTOR-WIDE APPROACH IN HEALTH: WHAT IS IT? WHERE IS IT LEADING? DAVID PETERS* AND SHIYAN CHAO The World Bank, Room J8±112, 1818 H St, NW, Washington DC, 20433, USA SUMMARY This paper describes early experience with the Sector-Wide Approach (SWAp), an emerging trend in development practice in low-income countries. The paper describes what a SWAp is, and why it is now being pursued. The SWAp is characterized as a sustained government-led partnership with donor agencies and other groups. By apply- ing sector-wide policies to an expenditure framework and national implementation systems, explicit health sector reforms are undertaken to meet sectoral and national development objectives. The approach has changed the dynamic between governments and donor agencies, requiring systemic changes in policy-making and management in both governments and donor agencies. With the SWAp, ongoing joint assessment and negotiations around sectoral plans and review of performance replaces the old way of preparing and supervising projects. Early experiences in countries undergoing SWAps are discussed, including the problem of reconciling priority programs and old practices with broader health sector reforms and new ways of managing development assistance. The paper concludes by identifying some of the key challenges for the future of SWAps. # 1998 John Wiley & Sons, Ltd. KEY WORDS: health reforms; development assistance; aid; international health policy; health planning INTRODUCTION In a number of low-income countries, governments and donors are departing from traditional ways of doing business, and embarking on a new approach to reforming the health sector. Known in other sectors as the Sector Investment Program, this approach has recently been called the Sector-Wide Approach to Health Development (SWAp) (Cassels, 1997). The SWAp is based on a new type of partnership, led by government, and involving a number of donor agencies and other groups in civil society. The approach has changed the tools used to promote sector reforms and manage development assistance. It has also raised new challenges in implementation and coordination, and provided new ways to deal with long-standing con¯icts over priorities of values, technologies, and processes. CCC 0749±6753/98/020177±14$17.50 # 1998 John Wiley & Sons, Ltd. INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT Int. J. Health Plann. Mgmt. 13, 177±190 (1998) *Correspondence to: David Peters, MD, MPH, DrPH, Public Health Specialist, The World Bank, Room J8±112, 1818 H St, N.W., Washington DC, 20433, USA.