Zambia: the role of aid management in sustaining visionary reform

As part of its ongoing reform of the health sector, Zambia has developed a number of systems and structures to coordinate and manage external resource s. With increasing attention being given to the potential for sector-wide a pproaches (SWAps) to enhance the efficiency and effectiveness of health sys tems in low-income countries, Zambia provides an interesting case study of how this is emerging in practice over time. The paper outlines the differen t coordination mechanisms and assesses them in terms of selected criteria o f effectiveness, finding that the potential to meet reform objectives is cu rrently not being met. Factors influencing the effectiveness of these mecha nisms are identified as falling into categories around personalities and hu man interaction, the nature of reform processes, and the impact of broader context. The need to maintain dialogue in the face of external constraints and uncertainties is stressed.