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International donors

Health sector in coma

by Raphael Mweninguwe


These days, it is dangerous to fall ill in Malawi: Patients in hospitals have to go without food; doctors cannot work because essential drugs are missing; ambulances are grounded due to lack of money. Things are set to improve thanks to a new donor fund.

Since donors froze budget support to Malawi three years ago, most government services have come to a total halt, with health and education being hit the hardest. International donors stopped supporting Malawi after the “cashgate scandal”: 24 billion kwacha – the equivalent of € 38 million – were stolen by government employees and suppliers during the tenure of Joyce Banda, the former president.

With no trust in the Malawi government, donor governments now prefer to channel their financial aid through local or international NGOs. In some cases, government projects are being funded directly by international donors, without going through the Ministry of Finance’s  management system.

Indeed, donors have now set up a Health Services Joint Fund, which is based on a broader arrangement known as Common Fiduciary Oversight Arrangement (CFOA). The donor countries that have joined the fund are the UK (committing about € 8.3 million), Norway (€ 11 million) and the Belgian region of Flanders (€ 914,000). Germany has announced it will contribute € 10 million next year.  

The donors have issued a statement according to which the fund “is designated to provide critical support to key government and church health-sector activities, but the money is channelled through commercial bank accounts with externally contracted oversight and control in the form of a contracted Fiduciary Agent and a Procurement Oversight Agent". Norwegian Ambassador Kikkan Haugen says the fund “will help reduce the risk of abuse”.

The donors are bypassing the government accounting system to avoid fraud. The support to the health sector will first serve to pay utilities for the provision of water and electric power to central and district hospitals, it will boost infrastructure of rural health centres and procure  medical equipment for both hospitals and health centres.

Malawi urgently needs such financial support as the health sector is in a virtual coma. Since mid-November, nurses and midwives have been demonstrating in the streets. Health workers and civil-society organisations have been staging protests to force the government to fund the health facilities in the country. Protests all over the country may have contributed to the setting up the new fund.  


Raphael Mweninguwe is a freelance journalist based in Malawi.
[email protected]


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