<p>Although the under-five mortality rate in Malawi has been declining since 1960, it still remains one of the highest in the world. In order to appropriately target interventions to achieve substantial reductions in deaths among children under the age of five years in Malawi, there is an ongoing need for better knowledge of the proportion of cause-specific under-five mortality in the country. The aim of this study was to estimate the direct contribution of HIV/AIDS to the observed level of under-five mortality in Malawi during the period 2000 to 2004.</p>

<p>Although the under-five mortality rate in Malawi has been declining since 1960, it still remains one of the highest in the world. In order to appropriately target interventions to achieve substantial reductions in deaths among children under the age of five years in Malawi, there is an ongoing need for better knowledge of the proportion of cause-specific under-five mortality in the country. The aim of this study was to estimate the direct contribution of HIV/AIDS to the observed level of under-five mortality in Malawi during the period 2000 to 2004.</p>

After discussing the Malawian context and summarising the remittance research, I focus on remittances in rural Malawi. I follow remittances from the giver’s motivations through to the receiver’s view of remittances and how the receiver uses them and finally to their impact as a means of moderating the effect of negative shocks on the receiving household. Results show that parents remit to respondents for altruistic purposes, or for insurance motivations (e.g. to help out the respondent if they are sick). Respondents remit to parents for altruistic motivations and inheritance. There is strong bi-directionality in the remittance flows. Children remit to respondents as an “insurance premium”, and for inheritance motivations. Altruism motivates respondents to give to their children. There is strong evidence of co-insurance between respondents and their siblings with both insurance payouts and premiums being paid. Respondents and their siblings also remit to each other for altruistic motivations. There is strong evidence of “mental accounting” amongst both male and female headed households. Remittances exhibit a much lower MPC than salary and farming income. Male and female headed households differ in their use of income from different sources, however one result is consistent: remittances are used for education. Probit models indicate that households are more likely to receive remittances from local areas if someone in the household is sick (local remittances insure a health shock). Households that suffer from drought are more likely to receive remittances from more distant areas (other districts, a city, abroad). Drought has a major negative impact on consumption levels but distant remittances insure affected households who suffer from these. Local remittances, which make up most remittance flows, are unable to insure these community shocks. Only around 10 per cent of households receive remittances from outside their home district however. Remittances help to insure household consumption against health shocks, but only food consumption is insured.

Policy transfer defies the notion of national boundaries in policy making and development. With globalisation processes in the picture, purely state centric policy making models are not the only option. International and domestic policy entrepreneurs have been pivotal in transfer processes. For developing countries, international donor organisations have been instrumental through conditioning assistance to policy reform. Due to the prevailing hierarchical aid regimes, the assumption is that developing countries would implement these policies for the fear of losing the much-needed aid. However, this study argues that the actual implementation of reforms emanating from the global arena is not an automatic process even in the context of coercive transfers, as it is mediated by country specific contextual frameworks. Moreover, even if implemented, the extent to which the transfers attain the promised transformation ends depends on prevailing environmental factors, appropriateness of the reforms, and the implementers' in-depth understanding of the reform instruments. The analysis used the cases of hospital autonomy and district health management decentralisation reforms which are based on the new public management (NPM) paradigm to examine the mechanisms of policy transfer; factors constraining or facilitating the adoption and/or implementation of transferred policies; and the impacts of the policy programmes on service delivery transformation in Malawi. A multilevel framework was used to analyse the dynamics at international, national and application levels. It used a qualitative research strategy. Therefore, data was collected through in-depth interviews, focus group discussions, documents, and observations. The study finds that due to Malawi's heavy aid reliance, international donor organisations attempted to introduce the hospital autonomy and district health management decentralisation reforms on its policy agenda through aid conditioning mechanism which has coercive attributes. In the former, USAID as an international institutional entrepreneur was the driving force through its non-project assistance (NPA) aid regime while in the later case it was the European Commission within the institutional framework of the Lome IV Convention. A comparative analysis of the two reforms revealed that a combination of contextual issues of: mode of transfer, policy content and political-economic context, path dependence, parliament-cabinet configuration, bureaucratic politics, pressure from citizens, institutional compatibility and prerequisites, and social economic forces; determined their adoption and subsequent implementation. While hospital autonomy was rejected by cabinet, and not implemented, despite large amounts of donor resources invested in the transfer processes because of these contextual issues, decentralisation was implemented as the environment was favourable, although it met bureaucratic resistance. However, the study found that when implemented, decentralisation faced several contextual challenges including modest levels of application, reproductions, reversals, cultural factors, and unintended consequences so that it has not achieved the intended transformational results. To this end, the findings provide a better understanding of the dynamics of policy transfer in developing countries and work as a springboard for donor organisations to reorient their approach in aiding policy development in developing countries.