Developing a framework for expenditure management in the Malawian public healthcare sector

Abstract

The purpose of this study was to develop a framework for improving expenditure management for the public healthcare delivery sector in Malawi. A good public healthcare sector system must deliver high quality service. This can be linked to healthy and productive citizens who, consequently, are instrumental in contributing to the economic growth of the country. The need for improved expenditure management is, consequently, vital as governments struggle with the constrained resource environments in which they operate. The need for the framework of the present study arose due to the fact that the public healthcare delivery sector in Malawi is marred by financial management deficiencies relating to budget formulation and implementation, funding, financial waste and leakages. This study was inspired by revelations that the Sub-Saharan Africa, including Malawi, reports the worst health outcomes as it is less efficient in translating health expenditure into health outcomes. The public sector in general, and the health sector in particular, has been experiencing deficiencies in managing finances. Over the years, the Malawi government and donor community have been making efforts to improve public financial and procurement management; however, cases of financial mismanagement and inefficiencies still arise. The study adopted a mixed-methods exploratory sequential design. The study collected qualitative data that informed the quantitative data collection instrument. Qualitative data was collected through semi-structured interviews; whilst quantitative data was collected through self-administered questionnaires. Qualitative data was analysed thematically; whilst quantitative data underwent factor and univariate analysis. The findings reveal that the healthcare delivery sector experience resource allocation, staffing, management, procurement and supply chain management, financial management, legislative and political challenges and shortfalls which affect public expenditure management. The specific issues include compliance and funding challenges; low staff morale and integrity; lack of political will, weak financial management systems, weak enforcement of compliance and disciplinary issues; dual management and central government control, centralised procurements; weak supervisory and monitoring functions; inequitable funds allocation, as well as planning and budget issues.

The study recommends enhanced domestic funding, improved supervisory and monitoring functions to enforce compliance as well as improved capacity of oversight functions. Furthermore, the study recommends working towards an improved formula for allocating government funding to hospitals; staff training and recruitments are necessary in order to boost staff capacity; consultations on budget and funds allocation must take place; improved quality and availability of financial information to monitor public spending is necessary; and the sector must foster constructive dialogue with the civil society and strengthen performance and financial management systems. The recommendations emerging from this study could assist in addressing the challenges in the public healthcare deliver services sector in Malawi. The adoption of the recommendations would result in improved management of public expenditure and, consequently, there would be improved service delivery in the health sector.