Government spends more on locum

Government spends K2 billion annually in allowances for locum nurses and midwives and other medical officers, an amount enough to engage 1 000 full-time employees.

While that figure may enable government engage 1 000 health workers that may include nurses and midwives, public and private nursing schools combined graduate only 250 nurses and midwives yearly, according to Ministry of Health.

Recruited nurses and midwives, according to our findings, receive a monthly salary in the range of K120 000 to K180 000, depending on qualifications.

Ministry of Health spokesperson Joshua Malango confirmed in response to a questionnaire that the ministry spends K2 billion annually in locum allowances, but also admitted that the programme faces management challenges in some health facilities.

What it means is that based on the outlined monthly salary scale for recruits, government may be spending an average monthly salary of K150 000 per nurse, translating to K450 million for 250 nurses that graduate from public and private nursing schools annually, which is less than a quarter of the K2 billion spent on locums annually.

Assuming our calculations have not taken into account other financial aspects such as promotions that come with salary adjustments allowances payable when a worker is transferred or has died and require repatriation, annual savings of over K1.5 billion from the K2 billion paid to locums would be enough to take care of that. 

Health and Rights Education Programme executive director Maziko Matemba in response to a questionnaire collaborated the information that nurses and midwives receive K120 000, K150 000 to K180 000 depending on qualifications.

Malango said government was now focusing more on recruitment to reduce the amount in allowances being channelled to locum. 

He said the ministry has been recruiting health workers using government resources, Global Fund and other partners such as Medicines’ San Frontiers.

“To date, the ministry has recruited 858 health workers of which half are nurses under Global Fund.

“In addition, 1 793 health workers were recruited in different cadres using domestic resources and these have been deployed to central and district hospitals, now under Local Government Services Commission and Christian Health Association of Malawi (Cham) hospitals,” said Malango.

He added that in 2018/19 financial year, government has recruited 240 nursing officers and 439 nurse midwives technicians deployed to both public and Cham facilities.

He further disclosed that the ministry has briefed leadership of concerned unemployed nurses on what government has been doing to ensure that they are employed.

The concerned nurses recently held demonstrations nationwide to force government employ them.

But Matemba said government must be sincere on the appointment claims, arguing that the figures being given out were contrary to concerns of the unemployed nurses.

He said while K2 billion is spent on allowances for locums, management of that programme, as feared by the ministry, is problematic as some officers get the allowances without working for them.

Matemba said the qualified and unemployed young people end up on temporary employment in public health facilities where they receive locum allowances.

Recently, 2 032 yet to be employed nurses and midwives held nationwide demonstrations and gave President Peter Mutharika a 30-day ultimatum to employ them.

Matemba said the locum programme, which was introduced around 2010/11 as an incentive when the country faced a brain-drain crisis, is doing more harm than good to the nation’s finances.

Malawi has a nurse/patient ratio of 34 nurses per 100 000 patients, but this ratio is a far cry compared to the recommended WHO ratio of 500 nurses per 100 000 patients.

The low numbers of nurses in Malawi’s public hospitals risk exposing both health workers and patients to infections and unprofessional conduct due to fatigue and other disappointments, health activists have warned.

The National Organisation of Nurses and Midwives of Malawi (Nonm) is on record to have said the country’s average nurse/patient ratio at 1 to 80 is one of the highest in the world.

The International Council of Nurses (ICN), a federation of over 130 national nurses’ associations worldwide, recommends one nurse for six ‘average sick’ patients. n