On 21st September, our team held a final learning event in Lilongwe that celebrated the work they had done in collaboration with the Government of Malawi.
At the event, our team was praised by DFID as being crucial in the coordination of funds from aid partners in the health sector.
In partnership with the Ministry of Health and Population (MOHP), National Local Government Finance Committee (NLGFC) and the Christian Health Association of Malawi (CHAM), MHSP-TA has safeguarded the provision of free health services, strengthened partner coordination, enhanced community participation, improved the quality and use of data to inform decision making, and supported District Councillors to act as public health advocates and curb the misuse of resources.
Touching on the programme’s focus areas, Charles Mwansambo, Chief of Health Services at the MOHP remarked in his opening speech, “We are grateful for this support, that has seen a big difference to the work we are doing; by strengthening the delivery of our health systems, enhancing health planning, coordination, financial management and accountability.”
Harmonising health sector assistance
Central to MHSP-TA’s success was the flexible, responsive and adaptive approach that was taken. This enabled the programme to provide TA support in areas where the government identified it was needed most. One such area was the need to strengthen the coordination of aid as approaches to development assistance were shifting in Malawi, following the public finance corruption scandal in 2013.
MHSP-TA support was fundamental to the development of the Health Sector Joint Fund (HSJF); an off-budget funding mechanism that pooled and harmonised assistance from various development partners, including the Department for International Development (DFID).
From 2016, an MHSP-TA advisor has supported the Aid Coordination Unit (ACU) to develop an aid coordination strategy and guidelines document. We supported them to map annual resources, and create a database of over 300 partners, which included multi-lateral organisations, faith based organisations and the private sector. We also helped develop a Memorandum of Understanding (MoU) template to formalise their partnerships with Government.
On behalf of MOHP departments, the ACU supported motions for activities that HSJF could fund, and provided support to ensure necessary proposal and financial management processes were followed. This facilitated spending of more than USD 8 million in 2017/18 alone, on activities such as monitoring of drug and equipment procurement, and the construction of health facilities.
“We are very pleased with the way (MHSP-TA) has evolved to make sure that health systems are delivering for people across the country,” said Dave Beers, Head of Office, DFID Malawi. “In particular, through establishing the HSJF as a closely aligned and effective piece of the overall health sector architecture. We believe this has provided excellent value for money… and has been vital in giving us, the donors, the confidence to work so closely with government and providing the fiduciary assurance, and verification results that we need to continue (delivering health sector support).”
Re-asserting local democracy and accountability
“The other major part of the piece,” Beers continues, “is the set of innovative initiatives that are enhancing delivery at the district and community level, such as (mentoring of) Health Centre Advisory Committees, enhancing the use of data, and supporting decentralisation”.
Strengthened accountability at the district level was the message from multiple discussions at the event. One example was the enhancement of district council financial management.
The NLGFC was unable to monitor district councils’ management of their finances due to limited funds. MHSP-TA provided financial support to fund Finance Committee meetings at Local Government Authorities (LGAs), and technical assistance to improve monitoring visits and conduct a peer-to-peer support programme. This support enabled representatives from well-performing LGAs to mentor colleagues at less well-performing LGAs. Tools were developed to enable district councils to self-assess financial management performance. Guidelines for Financial Management Analysts (FMA) provided direction and standard procedures for officers to carry out their duties and produce high-quality district status reports.
“The visibility of the NLGFC was not there in the districts and standards had reduced. MHSP-TA made it possible for FMAs to go to the districts, and in turn, the districts felt that they were being supported through supervision and monitoring,” noted Catherine Kazembe, the programme’s Financial Management Coach. “Also, peer to peer support didn’t exist before. This was pioneered by the programme, and it has proved to be a very effective way of helping councils; motivating staff and increasing morale so that the poor performing LGAs can emulate the performance of the good performing LGAs. They would say, ‘If our friends can do it, we can also do it!’”
Community empowerment: the way forward for Malawi
Partners including MOHP officials, District Council chairs and representatives from NLGFC and the CHAM shared thoughts on the way forward. A resounding message was that empowering communities and supporting districts to drive the agenda was vital. Participants acknowledged the renewed focus on decentralisation by both government and development partners.
Among the variety of discussions that were held throughout the day, were presentations reflecting on MHSP-TA’s lessons and key achievements, working closely with government partners, including:
- Reforming the health sector through the launch of Malawi’s first ever National Health Policy. Central hospitals have been made autonomous, empowering them to make timely and informed decisions on service delivery, procurement and staffing.
- Mentoring community-led Health Centre Advisory Committees, and providing them with grants to improve health facilities. Intensive training and tools were provided for Health and Environment Committees to represent communities’ health concerns and hold District Councils to account.
- Strengthening health service planning and monitoring at district level, through the development of District Implementation Plan guidelines, facilitating peer reviews, and funding supervision visits to health facilities.
- Scaling up free maternal and newborn health, and paediatric services, at health facilities under CHAM, reaching more than 3.4 million Malawians.
The event was attended by more than 80 participants, including representatives from the MOHP, CHAM, District Councils, NLGFC, HCAC Chairs, DFID, and other development partners.