The article examines auditing practices in the executive agency context of public hospitals in Malawi. It is aimed at identifying auditing environmental factors that impede effective and holistic performance monitoring of individual entities. The authors used document analysis and semi-structured interviews to collect data, and a thematic approach to analyze the data. The results show that at the regulatory level, there is a lack of symmetry in the regulatory framework as only external financial auditing component is sufficiently provided. At the operational level, there are the following specific component challenges: internal audit units are centralized and they are allocated inadequate manpower. As a result, internal audit work is still based on the traditional paradigm and narrowly focuses on finances and drugs. In terms of external financial audits, they are conducted on a consolidated basis. Thus, only group, rather than individual entity audit opinions are provided. On the other hand, performance audits are thematic at the national level rather than at sector or organizational level.