Eileen S. Natuzzi and Thomas Novotny

International aid policy is evolving. The Rome Declaration on Harmonization, the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action have shifted development assistance efforts toward recipient countries assuming stronger leadership roles in prioritizing, implementing, and coordinating aid programs within their own countries. Central to these donor and recipient partnerships is alignment of aid so that it supports country priorities, harmonizes accountability reporting among donors, and reduces redundancy in programs in order to engender efficiency and cost savings. Sector Wide Approaches (SWAps) for health care bring donor agencies, civil society, and recipient governments together to work on health systems and health outcomes. The cooperative nature of SWAps and their embrace of the principals endorsed by the Rome and Paris Declarations as well as the Accra Agenda on Aid may enhance aid effectiveness. However, SWAps that have been implemented in over 35 countries have yielded mixed results and have been met with some skepticism. This paper will review what SWAps are, where they have demonstrated success, and where they have failed. Development assistance for improving health system capacity building, achieving Millennium Development Goals (MDGs), and the development of sustainable health programs will be discussed.