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[Publisher's abstract:] A case study of experiences with an advanced sector-wide approach for health development in Tanzania, where a significant number of activities in the health sector are supported by pooled donor funds disbursed through the government system. These funds are integrated into the government budget cycle, with donors increasingly agreeing to make commitments and disbursements in line with government budgetary requirements. The case study opens with an overview of the country's economic, political, and health situation, concentrating on the implications of recent public sector and government reforms. The next section explains the financing, monitoring, and management of the country's sector-wide approach to donor coordination and budgeting. Eight strategies, adopted to improve the availability and quality of essential health services, are also briefly discussed to illustrate how adoption of a sector-wide approach can help tackle inequities in the health system. Having examined key features of the country's advanced sector-wide approach, the case study considers lessons learned and their applicability to similar efforts in other countries. Questions discussed include the importance of government leadership and ownership, the role of donor involvement in joint disbursement procedures, and the extent to which signed agreements can make donor funds more predictable. The study concludes that, despite high aid dependency, government ownership of the programme is growing, and national commitment to sector programmes and public expenditure reform has created a positive environment for expansion. The high costs of transactions and the additional administrative burden imposed on governments remain major problems
