Making a case for increasing efficiency in Malawi’s health sector

Of late, there has been a lot of talk on the poor state of health care delivery in Malawi. Cited in the debates are factors such as shortage of drugs, inadequacy of in-patient food in district and central hospitals, inadequacy of health workers, and shortfalls in funding from the central government, and how these negatively affect the delivery of health services in the country.

This paper argues that granted the shortfalls in the stated areas, health facilities in the country can delivery basic health care with the available resources if management practices were to improve. Using data from recent (2015) studies commissioned by the Ministry of Health on drug leakages, detailed analysis of expenditures on the other recurrent transactions (ORT) budget lines, and management practices in hospitals, the paper shows that the current management processes facilitate and encourage inefficiency, waste, pilferage, fraud , nepotism and corruption. These drain the available resources, which in turn results in the system failing to deliver. No amount of additional resources allocation will change the situation without first addressing efficiency issues.

The current public sector reforms may contribute to some improvements, but only if they are backed by commitment to action against resource abusers, and increased oversight by health resources users and beneficiaries. At the moment there is no indication that the health system is ready to face these conditions much as there is talk about them.