Health Budget Transparency and Accountability in Malawi

Following the success of Health Budget Transparency and Accountability in Mzimba, Nkhata Bay and Rumphi, E4A-MamaYe has been asked to support a similar effort in Ntcheu district.

The exercise was aimed at reviving trust and good working relationship among ordinary citizens and public health service providers in rural districts. 

The idea has always been aimed at ending the business as the usual approach in health sector budgeting and spending at district level, and at least bringing representation of the actual beneficiaries of the funds that are meant for spending in health sector in their districts.

A team of ordinary citizens that is referred to as District Implementation Team (DIT) which includes four councilors, a local chief, a CSO representative, a District Health Office representative, one council secretariat representative and one media representative, is assigned the responsibility of assessing the district on accountability and use of resources. This team was trained on collecting data by interviewing different departments on how they operate and how they keep records. The composition of the team also ensured that there is no biasness in reporting on the findings.

According to data collected in the three districts E4A-MamaYe has been advocating, it was shown that the initiative goes even a step further by helping to improve delivery of services as well. This was achieved by giving responsible officers at council timely feedback on how they should improve their performance to ensure transparency and accountability.

In Rumphi for example, the scorecard showed that it was very difficult to meet most of the conditions under the budget dissemination section, in the first two rounds of the study conducted in April 2016 and October 2016.

However, next to a poor trend of results, the council at least performed well in the last round of February 2017 as they ensured that the Rumphi annual budget is heard in public, that council secretariat publically posted details of the annual budget, showing allocations to and within each sector and publicizing a summarized audit report of the council.

After the assessment of the first round, it was observed that one of the missing key elements in the district council to obtain high marks was the absence of an internal auditor. During the assessment report, it was revealed that this was putting a strain on audit services as the district did not have an audit work plan to ensure transparency and accountability in the implementation of various projects.

Looking ahead, MHEN learnt that Ntcheu district council did not hold any public hearing session within the period of project implementation, thus showing that the budget process was not participatory and did not include views of the communities. HBTA emphasizes that there will be active participation in getting views from the grassroots so that they are served better.

The team made some recommendations on how the district can improve transparency and accountability. Firstly, non-governmental organizations (NGOS) should declare budgets to districts councils before implementation of their projects. According to MHEN this will ensure transparency and accountability.

It also recommended that councils should engage people in their districts by holding annual public budget hearings with a motive of incorporating views of the public in various projects.

The district was also recommended that it requests the central government for the deployment of an internal auditor who should oversee all the district transactions and report accordingly. 

Being the first time for the district to hold such an exercise and the district’s score card showing some shortfalls, it is believed that such approach is going to have a significant impact on health service delivery since it gives feedback to public health service providers with recommendations on how they can improve how they reach out to their beneficiaries.

The district has shown a lot of enthusiasm on how this approach will improve all government sectors and departments to provide quality services.

For more on Mzimba and Nkhata Bay Transparency and Accountability sucess stories, click here and here

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