Health SWAps and external aid--a case study from Tajikistan

As it moves from a relief to a development phase, the Republic of Tajikistan (RT) needs to attract more external aid and to ensure adequate alignment of this aid with health systems development priorities. A potential response to these two needs is a Sector-Wide Approach (SWAp), a method originating from post-colonial Africa and Asia that is increasingly being introduced in new contexts. However, little is known about whether SWAps are appropriate in the context of the former Soviet Union (FSU). This paper explores SWAps using Tajikistan as a case study. A number of lessons are identified for the Tajik health system, for other FSU countries and for health SWAps in general, covering issues of practical relevance to national and international health policy-makers.We conclude that context-specific SWAps may be developed to suit Tajikistan, and other FSU countries. Tajikistan currently does not yet have all the key SWAp elements in place, but this should be seen as a motive for, rather than an impediment to, developing a SWAp. Other FSU countries have a more favourable environment for implementing health SWAps.