Institutional reproduction, contradiction and legitimacy crisis: The politics of policy design and practice in Malawi's Ministry of Health

Abstract

This paper examines the politics and dynamics of the policy design and practical policy implementation realities of institutional transformation in a developing country context. The paper finds that there has been a mismatch between policy design templates of institutional transformation and the actual practice in terms of transformational implementation outcomes. Taking decentralisation reforms within the Ministry of Health in Malawi as a case study, the paper underscores that the contextual realities of institutional transformation in the country have been manifested by path dependence tendencies characterised by reproduction that takes shape in a contradictory fashion to the underlying institutional logics. The resultant policy of the reproduction and contradiction in terms of policy practice is institutional legitimacy crisis characterised by support from institutional entrepreneurs that are benefiting from positive feedback and increasing returns of the old institution, and challengers that regard the reproductions and contradictions as restrictive and mismatching institutional transformation design.