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Allocation of aid from international agencies to the health sector in developing countries has usually involved funding of specific projects. This process enabled donors to suggest priorities and to monitor accountability of spending. More recently, a different system using sector-wide approaches (SWAps) has been adopted by an increasing number of funders including the World Bank, World Health Organization, and the Department for International Development. Through SWAps, funds are given to the entire health sector for priorities determined by ministries of health rather than to specific projects.1 In theory the system should lead to greater efficiency through reduction of duplicative mechanisms that may occur through multiagency support.
Most of the UN agencies now recognise HIV increasingly as a societal problem. This belief would therefore seem to justify the allocation of HIV prevention funds to the whole health sector across the board. SWAps also appear justified by the contention that HIV/AIDS is associated with poverty and that the poor are more likely to access services that can be delivered at the primary healthcare level. Furthermore, this approach offers all HIV interested parties or stakeholders an opportunity to obtain funds from a central pool and have an input into HIV prevention strategies.
Serious doubts remain, however, about whether SWAps are effective.2 No evaluation of SWAps in STI control has been undertaken. While the role of STI in preventing HIV is now well established, there are still conflicting opinions and uncertainty about how STI services for the population are best delivered. Clear policy directives are even more difficult to justify following the contrasting results of the Mwanza …