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Follow-up of development aid funding of the health sector in Malawi must be improved

There are considerable weaknesses associated with the follow-up and use of Norwegian development aid funding of the health sector in Malawi. Medicines disappear in the chain out to the patients at hospitals and health centres, creating shortages of important medicines. - The Ministry of Foreign Affairs must strengthen its oversight of the use of the funds, says Auditor General Jørgen Kosmo.
Published 2/19/2013 12:40 PM

Document 3:8 (2012–13) The Office of the Auditor General's investigation of Norwegian development aid to the health sector in Malawi was submitted to the Storting on 19 February 2013.

The OAG has looked at the distribution of medicines, human resources and operating resources to hospitals and health centres in Malawi. Norway is one of the largest donors of health aid to the country, disbursing NOK 940 million in bilateral health aid in the period 2004-2011, in addition to NOK 400 million in general budget support. Located in southeast Africa, Malawi has a population of 15 million.

Norwegian development aid is helping to push the development of child and maternal health and basic health services in Malawi in the right direction. Major progress has been made, e.g., in vaccinating children and treating persons afflicted with AIDS. At the same time, other important goals for reducing child and maternal mortality and strengthening the health system have not been met. The audit revealed large losses in connection with the procurement, distribution and dispensing of important medicines. The country has a very limited number of doctors, nurses and other health personnel. Moreover, absence is considerable among employees due in part to high allowances for travel, courses and seminars.

- In conjunction with other donors and local authorities, Norwegian development aid authorities should take steps to increase the availability of health personnel, medicines and medical equipment. This is necessary for ensuring that the development aid benefits the entire country, says Kosmo.

A large part Norway's development aid to the health sector in Malawi is provided as support through the fiscal budget and health budget. The OAG found major weaknesses in the country's public financial management system.

- The Ministry of Foreign Affairs should undertake a review to ensure that budget support practices and guidelines are in compliance with the Storting's intentions. As the situation currently stands, it is questionable whether such support should be granted to Malawi, says Kosmo.

There are weaknesses in the Norwegian Embassy's follow-up of local audits of the health sector programme - known as the Health Sector Wide Approach - Programme of Work (SWAp-POW) - in the country. The Embassy failed to adequately follow up several documented cases where the use of funds was unaccounted for.

The Ministry of Foreign Affairs emphasises that Malawi is one of the world's poorest countries, and given that background, it must be said that the country has achieved very good results in the health sector. The Ministry believes that its practices and guidelines for budget support are in line with the intentions of the Storting.

According to the Ministry, the risk in Malawi is acceptable with the measures that have, in part, been implemented to strengthen public financial management. The follow-up of accounts and local audits will be strengthened.

You can download the document through the link to the right.

Public institutions can order the document from the Government Administration Services, tel. (+47) 22 24 20 00, Others can order it from Fagbokforlaget AS, tel. (+47) 55 38 66 00,

The deferral of public access to documents prepared by or for the Office of the Auditor General in connection with Document 3:8 (2012-2013), cf. the Act relating to the Office of the Auditor General section 18 second paragraph, is hereby set aside.

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