Purpose – The purpose of this paper is to explore the nature of governance reforms also called conceptual
innovation for public hospitals in Malawi.
Design/methodology/approach – It focuses on the reforms for central and district hospitals. It uses semi-structured interviews to collect data and thematic approach to analyse it.
Findings – The results show that the reforms for central hospitals are structurally well characterised as aimed at corporatisation though they are termed as automatisation. The terminological seems not to pose any harm on the direction of the reforms due to the thorough structural characterisation. On the other hand, reforms for district hospitals are vague as such implementation is retrogressive, in that, instead of progressively moving the hospitals towards greater autonomy the opposite is happening.
Originality/value – The paper highlights the significance of characterisation of the intended outcome on the direction of the reforms and proposes a framework to guide conceptual innovation for public hospitals in a devolution-mediated environment.