Foreign aid, Cashgate and trusting relationships amongst stakeholders: key factors contributing to (mal) functioning of the Malawian health system

Adhikari, Radha; Sharma, Jeevan; Smith, Pam; Malata, Address

doi:10.1093/heapol/czz021

Cited by 23 publications

(26 citation statements)

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“…It is highly unlikely that the ambitious goal of Universal Health Coverage (UHC) by 2030 and improvements in all health-related SDG targets and indicators will be achieved in these countries (1,(4)(5)(6), whilst financing and service delivery issues remain. For example, in Malawi, there are issues of financial mismanagement, an inadequate health workforce (in terms of numbers and of training), poor healthcare access for rural communities, poor quality health services, increasing prevalence of non-communicable diseases, and drug shortages (7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…between the government, donors, non-government organisations (NGOs) and faithbased providers). For this reason, an essential route to improving the governance of the health system in low income settings is working effectively with non-government stakeholders (9,14).…”

Section: Introductionmentioning

confidence: 99%

“…The Minster for Health acknowledges that the country's health sector is highly dependent on external financing, and the vital importance of continued aid to support both the health gains achieved and intended. Demonstrating improved governance, including building better relationships with stakeholders, is essential for rebuilding the damaged relationship between the government and donors to achieve the government's aims of continued donor contributions and a more coordinated approach to the funding and provision of healthcare in Malawi (9,32). For example, a reinvention of the Health Sector Wide Approach (SWAp) which aimed to map international funding and the activities of external development partners in Malawi so that resources could be more fairly allocated across the country.…”

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confidence: 99%

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Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Masefield

Msosa

Grugel

2020

Preprint

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Background: All countries face challenging decisions about healthcare coverage. The scare resources of low income countries prevent improvements in equitable access and quality. Malawi, one of the poorest countries in the world, has committed to achieving Universal Health Coverage (UHC) by 2030. The health sector is highly dependent on donor contributions, but recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 updated National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve it, including greater harmonisation with health stakeholders. This study explores health sector stakeholders’ perceptions of challenges to improving governance in the national health system. Methods: A qualitative study design was used. Interviews were conducted with 22 representatives of the major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. The transcripts and field notes were analysed using inductive content analysis.Results: Stakeholders view governance challenges as a barrier to achieving a more effective and equitable health system. Three types of challenges were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).Conclusions: Health sector stakeholders see a range of serious challenges to improving governance in the national health system in Malawi which will impact on the government’s goal of achieving UHC by 2030. These can be categorised as political, structural, and financial challenges. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the NHP II and HSSP II, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC in the timeframe set out by the Sustainable Development Goals (SDGs). The difficulties stakeholders perceive in relation to building equitable and effective health governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Masefield

Msosa

Grugel

2020

Preprint

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“…The Minster for Health acknowledges that the country's health sector is highly dependent on external nancing, and the vital importance of continued aid to support health gains. Demonstrating improved governance, including building better relationships with stakeholders, is essential for rebuilding the damaged relationship between the government and donors in order to achieve continued donor contributions and a more coordinated approach to the funding and provision of healthcare in Malawi (10,24).…”

Section: Malawi Contextmentioning

confidence: 99%

“…between the government, donors, nongovernment organisations (NGOs) and faith-based providers). For this reason, an essential route to improving the governance of the health system in low income settings is through working effectively with non-government stakeholders (10,11).…”

Section: Introductionmentioning

confidence: 99%

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Masefield

Msosa

Grugel

2020

Preprint

View full text Add to dashboard Cite

BackgroundAll countries face challenging decisions about healthcare coverage. Malawi has committed to achieving Universal Health Coverage (UHC) by 2030, the timeframe set out by the Sustainable Development Goals (SDGs). As in other low income countries, scarce resources stand in the way of more equitable health access and quality in Malawi. Its health sector is highly dependent on donor contributions, and recent poor governance of government-funded healthcare saw donors withdraw funding, limiting services and resources. The 2017 National Health Plan II and accompanying Health Strategic Plan II identify the importance of improved governance and strategies to achieve more effective cooperation with stakeholders. This study explores health sector stakeholders’ perceptions of the challenges to improving governance in Malawi’s national health system within the post-2017 context of government attempts to articulate a way forward.MethodsA qualitative study design was used. Interviews were conducted with 22 representatives of major international and faith-based non-government organisations, civil society organisations, local government and government-funded organisations, and governance bodies operating in Malawi. Open questions were asked about experiences and perceptions of the functioning of the health system and healthcare decision-making. Content relating to healthcare governance was identified in the transcripts and field notes and analysed using inductive content analysis.ResultsStakeholders view governance challenges as a significant barrier to achieving a more effective and equitable health system. Three categories were identified: accountability (enforceability; answerability; stakeholder-led initiatives); health resource management (healthcare financing; drug supply); influence in decision-making (unequal power; stakeholder engagement).ConclusionsHealth sector stakeholders see serious political, structural, and financial challenges to improving governance in the national health system in Malawi which will impact the government’s goal of achieving UHC by 2030. Stakeholders identify the need for improved oversight, implementation, service delivery and social accountability of government-funded service providers to communities. Eighteen months after the introduction of the policy documents, they see little evidence of improved governance and have little or no confidence in the government’s ability to deliver UHC. The difficulties stakeholders perceive in relation to building equitable and effective healthcare governance in Malawi have relevance for other resource-limited countries which have also committed to the goal of UHC.

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How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II

Walsh

Mwase

Allegri

2020

Health Planning & Management

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Foreign aid, Cashgate and trusting relationships amongst stakeholders: key factors contributing to (mal) functioning of the Malawian health system

Abstract: Foreign aid, Cashgate and trusting relationships: key factors contributing to (mal)functioning of the Malawian health system.

Cited by 23 publications

References 9 publications

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

Challenges to effective governance in a low income healthcare system: a qualitative study of stakeholder perceptions in Malawi

How actors, processes, context and evidence influenced the development of Malawi's Health Sector Strategic Plan II

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