Public Financial Management for PRSP - Deutsches Institut für ...

Public Financial Management for PRSP Implementation in Malawi
leading to reduced workload on all sides thanks to harmonised monitoring
and reporting requirements.
Most votes within the health budget (around 80–90 %) are classified as Poverty
Priority Expenditures (PPEs) and thus cannot be cut back during the
budget year in case of cash fluctuations (see Section 5.1.2). As a result, funding
for salaries and drugs appear to be disbursed relatively regularly and
without substantial fluctuations during the financial year. 7 This seems to
apply less so to expenditures for administration at headquarters. Furthermore,
operational costs are often cutback substantially during the fiscal year, because
expenditure items such as fuel, electricity, water etc are not classified
as PPEs.
Similar to teachers in the education sector, one major problem in the health
sector consists in the lack of qualified medical staff. Table 1 shows the population
to health personnel ratios for doctors and nurses in Malawi. Approximately
50 % of key positions, such as doctors, clinical officers and nurses
cannot be filled; this leads to a severe shortage of medical professionals in
public hospitals and health centres. Although the government produces a
number of qualified professionals in nursing schools and universities, a large
share of these graduates are absorbed by private facilities offering better
salaries or they emigrate to Europe and other countries where salaries are
generally much higher than public sector pay in Malawi. 8 Among the reasons
for the poor staffing situation are the cumbersome recruitment process and
poor coordination between different departments in the MoH. For example, it
is common for new staff to receive their first salary 3–4 months after taking
up their job in the public health service.
7 However, this does not mean that drugs and supplies are readily available in all regions of
the country, as explained below,
8 Especially the UK is blamed for luring urgently needed nurses and doctors away from
Malawi. As a counter-measure, the British Department for International Development
(DFID) has recently agreed to top up the salaries in Malawi’s public health sector. This
measure should attenuate the brain drain and contribute to attracting and retaining more
qualified medical professionals in the public sector.
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