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Stefan Leiderer et al. Table 1: Population per Health Personnel Ratios (MoH and CHAM personnel) 2000 2002 June 2003 June 2004 Recommended Doctors 31,746:1 70,725:1 89,962:1 106,397:1 9,000:1 Nurses 4,871:1 4171:1 3,240:1 3,035:1 2,000:1 Source: Hanson (2005) Another major problem is the severe shortage of drugs and materials, despite of relatively regular funding. The Central Medical Stores are responsible for supplying and distributing drugs to public hospitals and health centres. In recent years, it has become a common phenomenon for drugs and materials to disappear; therefore, some donors headed by DFID are now pushing for a reform of the central medical stores system. Another problem consists in a severe lack of basic infrastructure, especially in rural health centres. Health centres in remote areas often do not have electricity, running water or even a telephone available, seriously limiting the effectiveness of these facilities. Many health centres do not have ambulances at their disposal, making transport of patients extremely difficult in rural areas. 54 German Development Institute
Public Financial Management for PRSP Implementation in Malawi Part II: Empirical Findings 5 Worlds Apart: The Theory and Practice of Public Financial Management in Malawi The formal legal and institutional framework for public financial management in Malawi has undergone a series of reforms since the first free multiparty elections in 1994 and even prior to that. New legislation regulating finance, audit and procurement was written, providing for relatively clear-cut responsibilities and time schedules of the budget process in Malawi. Accordingly, various recent studies on Malawi’s PFM system conclude that the legal and institutional framework for PFM in Malawi is relatively well designed. In principle, it provides a good starting point for a sound management of public finances (c.f. Rakner et al. 2004, 14–15, 18). For example, the World Bank’s 2003 Country Financial Accountability Assessment for Malawi states: “When compared to most developing countries, Malawi has a good legal and institutional framework for public sector financial management and accountability.” (World Bank 2003, v). Therefore, one could expect that the formal legal and institutional PFM framework in Malawi should provide in principle for effective fiscal and expenditure planning, budget preparation, execution, and control in line with the priorities set in the Malawi Poverty Reduction Strategy Paper (MPRSP). At the same time, however, many assessments judge the budget process in Malawi to be extremely weak (c.f. IMF 2004a; IMF 2004b; see Table 4 and Figure 6 below). The main reason for this is that formal institutions and procedures bear little relevance for PFM practice in Malawi. As a recent study on Malawi’s formal and informal PFM institutions commissioned by DFID states: “The budget process is a theatre that masks the real distribution and spending. All the actors, from civil society, government, and donors seem aware that many of their statements and actions have little bearing on [the] actual distribution of resources” (Rakner et al. 2004, iv). The cited studies of Malawi’s PFM tend to focus on central government. However, the findings of the field study conducted for this research in 2005 confirm that their assessment is also valid for local government in Malawi. It found ample evidence that Malawi’s local PFM-system is characterised even German Development Institute 55
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Public Financial Management for PRS
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Studies Deutsches Institut für Ent
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Preface The present study on ‘Pub
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4 The Case of Malawi 44 4.1 Why Mal
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Bibliography 151 Annexes 157 Tables
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Boxes and Tables in the Annexes Box
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DS EHP ESAF EU GBS GDP GoM GRF GTZ
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TOR UDF UNCDF UNDP UNV USAID VAP VD
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Discussion Paper 16/2007 Schirm, St
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