Ministry of Health and Sanitation today rolls out the revised locum rates that have pushed the annual bill to K4.55 billion for all district facilities for a sector that faces a 54 percent vacancy rate.
While stakeholders welcome the 250 percent increase as a motivation, they are worried that facilities may struggle to balance staffing with availability of critical inputs, as all resources come from Other Recurrent Transactions (ORT).
Figures from the Ministry of Health indicate that districts were spending between K50 million and K80 million per annum on locum before the increment, translating to about K1.82 billion per year for all facilities.
Ministry of Health and Sanitation spokesperson Adrian Chikumbe said ever increasing demand for health services means additional health workers are either not fully matching the demand or that certain managers are not adjusting the number of locum staff in light of additional staff recruited.
“That is why we have put in place strict locum administration guidelines, including holding accountable any manager under whose charge locum is being abused,” he said.
For instance, Rumphi, Chiradzulu and Karonga had been spending K1.8 million, K2.5 million and K3 million respectively each month on locum, but with the revision, they will now be spending K2.5 million, K6.25 million and K7.5 million.
Director of Health and Sanitation for Chiradzulu Nelson Kamwana and his Karonga counterpart David Sibale said the increment will help motivate workers, but hoped that Capital Hill will provide more resources towards ORT.
Spokesperson for Rumphi District Health office, Esau Mkamanga noted that the increase in locum rates will place considerable pressure on the district’s ORT budget.
“Given that ORT also caters for essential services such as fuel, utilities, maintenance, outreach activities, and procurement of basic supplies, the higher locum costs may lead to reallocation of funds, potentially affecting the implementation of some planned activities,” he said.
Human Resources for Health (HRH) Chairperson Solomon Chomba, insisted that even with the 250 percent increase, the money is not enough to cater for the needs of the workers, but indicated how stressful this presents for ORT.
“Locum is a short-term measure, so the government or councils must put much emphasis on recruiting additional health care workers, especially those with unique disciplines or specialties,” he said.
As such, Chomba, who doubles as President of Physician Assistants Union of Malawi (Paum) called for other measures to raise more revenue lik enhancing paying wings which can generate more to cushion ORT.
For Malawi Health Equity Network (Mhen) executive director George Jobe, the increase highlights systemic issues, particularly understaffing.
“Government should consider moving locum to the personnel emoluments or should factor the increased locum costs into ORT allocations or provide additional dedicated funding,” he suggested.
Jobe, who also chairs Universal Health Coverage Coalition, called for long-term investment in recruitment and retention of health workers, but also that wage bill restrictions propagated by donors should spare the health sector.
On his part, Kamuzu University of Health Sciences professor of public health and epidemiology Adamson Muula said people must not look at the amounts, as other professionals are getting more than health workers.
“Let’s compare with other professions, a lawyer for one hour gets a lot of money, but we are talking about a health person working for about eight hours.
“The main factor is the availability of the resources. My sense is that the Ministry would have wanted to increase it a little bit more, but the budget is always needed for other expenses,” he said.
While issuing new locum guidelines on March 19 2026, Secretary for Health and Sanitation Dan Namarika said government expects that as more recruitments are being made, the costs and demand for locum should go down.
He said: “In order to achieve proper and efficient application of locum, management shall ensure that a well-developed monthly roster is in place; staffing gaps are clearly identified.”
