This research was originally planned to study the implementation of the Modified Budgeting System (MBS) in hospitals in the Malaysian Ministry of Health, but as it turned out from the results of the intensive case study in the Sarawak General Hospital in 1994, MBS had not been implemented in the way intended by its architects. Thus, what has been observed is not an exercise in the implementation of a fixed technology known as Modified Budgeting System, but is a process of discovery of what MBS means and construction of what MBS can become. This research, therefore, analyses the processes involved in fabricating a form of responsibility accounting system in the Malaysian Ministry of Health. The Malaysian Federal Treasury introduced MBS in 1990 as part of a pilot project to effect changes and improvements to the management of resource allocation. The newly introduced MBS is a government-mandated budgetary reform and the Ministry of Health was selected as a pilot agency to implement the reform. This study analyses not only the outcome of the project but how it was implemented (or faced resistance), and also examines how ready the Ministry of Health was to accept the challenge of implementing a devolved budgeting system. The study is considered as important not only to the Malaysian Federal Government but also in terms of its contribution to the academic literature on budgeting in developing countries. No other study is known to have been attempted to investigate how MBS operates in practice in the Malaysian Ministry of Health or in any other organization in Malaysia that uses MBS. The research methods used were semi-structured interviews, reference to documentary materials, attending MBS workshops, attending management meetings and non-participant observation.