Foreign aid, Cashgate and trusting relationships amongst stakeholders: key factors contributing to (mal) functioning of the Malawian health system

Radha Adhikari*, Jeevan Raj Sharma, Pam Smith, Address Malata

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)
33 Downloads (Pure)


Malawi has a long history of receiving foreign aid, both monetary and technical support, for its health and other services provision. In the past two decades, foreign aid has increased, with the aim of the country being able to achieve its Millennium Development Goals by the end of 2015. It is currently moving towards achieving the sustainable development goals. Despite increased donor support, progress in the Malawian health service has remained very slow. This article discusses how trusting relationships amongst the stakeholders is vital in proper financial management, including of foreign aid and effective functioning of the health system in Malawi. This article is based on a qualitative study, using a range of research approaches: the in-depth case study of foreign aid funded Maternal and Child Health (MCH) projects (n = 4); Key Informant Interviews (n = 20) and reviews of policy documents to explore the issues around foreign aid and MCH services in Malawi. During the study period 2014–16, the country continued to face significant financial and other resource management challenges. The study has identified key factors, notably the issue of financial mismanagement, particularly Cashgate, news of which broke in 2013. This scandal has resulted in a great deal of mistrust amongst key stakeholders in health. The concomitant deterioration of working relationships has had a major impact on the health system resulting in further mal-distribution of resources and programme duplications. After highlighting key issues around foreign aid, Cashgate and trusting relationships amongst stakeholders, this article makes policy suggestions, with the aim of assisting donors and external development partners to better understand Malawian socio-political networks and relationships amongst key stakeholders. This understanding will help all those involved in the effective financial management and dispersal of foreign aid.
Original languageEnglish
Pages (from-to)197-206
Number of pages10
JournalHealth Policy and Planning
Issue number3
Publication statusPublished - 21 Apr 2019


  • foreign aid
  • health system financing
  • external development partners
  • Cashgate
  • trusting relationships
  • Malawi


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