3 Whether the Department is driving
improved outcomes from the services it helps to fund
13. We pressed the Department on its ability
to influence the Government of Malawi to pursue policies and actions
that are sensible, and to spend UK money wisely.[41]
The Department argued that providing Budget Support gives it leverage
to shape what the Government is doing. For example, the Department
contributed only 5% of the cost of the agricultural subsidy in
2008-09 through direct funding and through Budget Support, but
still has been able to help shape this programme.[42]
14. Malawi is a sovereign government and there
are limits to what the Department can do.[43]
The Department cited relatively few examples of occasions when
they had disagreed with and challenged the Government of Malawi
on its actions, and where that challenge had been both timely
and evidently successful.[44]
15. In 2007-08 and 2008-09 the Government of
Malawi exceeded limits it had formally agreed with the Department
over the amount of fertiliser it would buy for its agricultural
subsidy. It takes between two and three months to get fertiliser
into Malawi. Evidently the Government was concerned in December
2008 that there was not going to be enough fertiliser for the
programme, and bought stocks from people who already had it in-country.
In the event purchases of excess fertiliser at unexplained high
prices cost US$35 million in 2008-09. The Department became aware
too late to prevent this over-procurement; instead it obtained
the Government's agreement to store the surplus for use in the
next year's programme. Given that storage costs money, and that
such stocks are vulnerable to pilferage or decay, this appears
to be making the best of a bad situation.[45]
Malawi is a small country with links between government and private
entities. The Department has no evidence of ulterior motives or
corruption involving the fertiliser suppliers,[46]
although it had not received a full explanation from the Government
of why it procured extra fertiliser at such high prices.[47]
In 2008-09 this additional procurement threatened macro-economic
stability.[48]
16. The Government of Malawi's agricultural subsidy
was not designed to directly benefit the poorest, although they
were expected to benefit indirectly from lower food prices.[49]
High food prices reflect Government of Malawi decisions on grain
storage, markets and exports, besides high international food
prices. The Department argued that increased rural wages have
mitigated the effect of high food prices. However, this will not
assist those who are unable to work.[50]
We asked the Department about the environmental risks of Malawi's
over-dependence on maize, including fertiliser run-off into the
water supply. The Department has started a conversation with the
Ministry of Agriculture to look at diversifying crops because
soils have been depleted by dependence on Maize. It has not looked
specifically at run-off, but it is working with other donors to
look at Malawi's most serious environmental issues.[51]
17. There are acute disparities in the provision
of doctors and nurses across Malawi (Figure 2), affecting
efficiency as well as equity. By the end of 2007 one-third of
districts for nurses and two-thirds of districts for doctors remained
behind the 2005 national average baseline, let alone targets for
subsequent improvement. Conversely other districts, mainly those
with urban centres, had already approached or surpassed targets
for 2011.[52] We questioned
why more progress had not been made in Malawi to address such
disparities. The Department committed to consider tailoring its
salary top-up so as to incentivise doctors and nurses to work
in under-served rural areas. The Government of Malawi is also
looking at other approaches.[53]
Figure
2: Ratios of nurses to population vary by district
Source: Q14; C&AG's Report, Figure 6
18. The Government of Malawi spent some US$1.2
million mainly on cancer treatment abroad for 15 patients, equivalent
to the recurrent health budget of an entire district. The Department
appear not to have been aware of these practices at the time,
but were subsequently assured by Malawi's Ministry of Health that
the unidentified patients were not drawn from the wealthy, and
that decisions had been made on clinical criteria. At the same
time the Department conceded that diverting scarce resources to
cancer treatment overseas, away from areas like high maternal
mortality which would save as many lives as possible, would not
have been their choice.[54]
And it appears still open to question whether any of these people
were related to members of the Malawian elite.[55]
41 Qq 17, 18 and 116-118 Back
42
Q 17 Back
43
Q 116 Back
44
Qq 116-118 Back
45
Qq 105, 108, 109 and 110 Back
46
Qq 128-133 Back
47
C&AG's Report, para 3.9 Back
48
C&AG's Report, para 1.9 Back
49
Q 47; C&AG's Report, para 3.11 and 3.12 Back
50
Q 47; C&AG's Report, para 3.11 Back
51
Qq 134-136 Back
52
C&AG's Report, para 2.16 Back
53
Qq 48-52 Back
54
Qq 18, 72, 73 and 122 Back
55
Q 122 Back
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