Foreign Aid, Cashgate and Trusting Relationships Amongst Stakeholders: Key Factors Contributing to (mal) functioning of the Malawian Health System

Malawi has a long history of receiving foreign aid, both monetary and technical support, for itshealth and other services provision. In the past two decades, foreign aid has increased, with theaim of the country being able to achieve its Millennium Development Goals by the end of 2015. It iscurrently moving towards achieving the sustainable development goals. Despite increased donorsupport, progress in the Malawian health service has remained very slow. This article discusseshow 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 isbased on a qualitative study, using a range of research approaches: the in-depth case study of for-eign aid funded Maternal and Child Health (MCH) projects (n¼4); Key Informant Interviews (n¼20)and reviews of policy documents to explore the issues around foreign aid and MCH services inMalawi. During the study period 2014–16, the country continued to face significant financial andother resource management challenges. The study has identified key factors, notably the issue offinancial mismanagement, particularly Cashgate, news of which broke in 2013. This scandal hasresulted in a great deal of mistrust amongst key stakeholders in health. The concomitant deterior-ation of working relationships has had a major impact on the health system resulting in furthermal-distribution of resources and programme duplications. After highlighting key issues aroundforeign aid, Cashgate and trusting relationships amongst stakeholders, this article makes policysuggestions, with the aim of assisting donors and external development partners to better understandMalawian socio-political networks and relationships amongst key stakeholders. This understandingwill help all those involved in the effective financial management and dispersal of foreign aid.