Conditionality, Path Dependence and Veto Points: The Politics of Hospital Autonomy Reforms in Malawi

Abstract

This paper argues that policy space ownership dynamics, political and historical institutional variables determine the implementation of reforms advocated within the context of the international transfer of public sector reform models to Africa. Through the case of the Malawi Hospital Autonomy reforms, this paper demonstrates that although policies transferred by international donor organisations to African countries through aid conditionality may be initially adopted so as to secure the much-needed developmental aid, the actual implementation of such reforms is not an automatic process. This is due to contextual factors, which in part include the neo-colonial struggle for policy ownership in the face of conditionality, path dependency tendencies and veto players that are constrained by deeply entrenched political and historical institutional proclivity that lead to policy stability even in the context of coercive policy transfer pressures. Taking a qualitative approach, the analysis combines the use of primary and secondary data. The study findings show that while other African countries successfully implemented such reforms, Malawi has not, due to specific implementation, historical, political and institutional factors.