Overall, the hospital staff interviewed—mainly unit heads and
people in positions of authority—showed little awareness of the
MTEF reform and PBB. Some people had heard of the reform
through budgeting workshops, but they struggled to describe
the main components or characteristics of the reform. Similarly,
the Finance personnel were not always well informed. A key
informant from the MOFDP stated, ‘MTEF as a concept has
been introduced, but we still can’t say that people understand
it . . . [MOFDP-sponsored trainings] worked at the beginning,
but like anything in government, the sustainability is questionable
. . . over time, the facilitators disappeared. There were three
from my department, but now we are left with only one’.
Responding to open-ended questions in the interviews, few
people could remember what they had learned or thought they
could explain the reform to others.
Table 3 presents the ratings of reform implementation. The
data show that there has been little progress in implementing
reform in any of the hospitals. Of the four dimensions
measured, the most progress has been made in performancebased
planning, and the least progress in monitoring and use of
information.