Three years after its launch, the Malawi Government’s medical scheme has signed up 34 688 civil servants, representing barely 14 percent of the estimated 250 000 on the payroll.
With the Department of Human Resources Management and Development (DHRMD) stating that “nearly 1 000” join each month, that translates to about 12 000 enrolment per year.
At that pace, The Nation’s illustrative calculations show that it could take roughly 18 years to bring on board the remaining 215 000 employees and cover the entire civil service.
In a written response, DHRMD spokesperson Ken Mtonga said the total figure of about 250 000 that The Nation used to calculate coverage is “not definite. It’s just an average”.
“I don’t agree with your projection. How many officers and in what grades will be there in 2043?” he asked.
Mtonga further said that the government “had publicly expressed a desire to establish its own medical scheme, which will change this entire current situation. So, surely your assumption is not right”.
But while he disputed The Nation’s calculations, he fell short of providing DHRMD’s or government’s own official projections for full enrolment or timelines.
The current enrolment level raises questions about both financial viability and the scheme’s original purpose: to ease pressure on public hospitals while protecting civil servants from catastrophic health costs.
DHRMD data that Mtonga provided show that the 34 688 members are split across the three schemes of Medical Aid Society of Malawi (Masm), notably 688 on VIP at K63 000 each, 11 000 on Executive scheme at K30 000 per person and 23 000 on Econo scheme at K9 000 per head per month.
That means each month, VIP scheme premiums cost K43.3 million, Executive attracts K330 million and Econo costs K207 million, bringing the total employer-employee monthly remittances to roughly K580.344 million or K6.964 billion annually.
With the government paying 90 percent of premiums, an illustrative calculation based on the DHRMD figures puts Treasury’s monthly contribution at above K522 million, which is about K6.3 billion a year.
Mtonga said DHRMD does not handle government payments and referred questions on whether Treasury is paying Masm monthly and if there are arrears.
However, Treasury pushed The Nation back to DHRMD, with spokesperson Williams Banda saying: “Those are human resources issues handled by DHRMD.”
When The Nation contacted Masm to find out the status of the government’s premiums, we were referred to the society’s legal services manager James Chiundira.
However, he did not pick our call and was yet to respond to our WhatsApp questionnaire by press time at 8pm.
On the other hand, public service trade unions leaders point to implementation failure.
In an interview, Civil Servants Trade Union (CSTU) president Lameck Magawa said the scheme “encountered challenges soon after its introduction” with members joining “without following proper procedures,” leading to mismatches between government payroll and Masm records.
But Mtonga disputed the claim of improper enrolment, stating: “Every HR in every MDA [ministry, department and agency] knows how to register an officer.”
He also said he had “never talked about any discrepancies on data” in response to CSTU’s claim about arrears caused by data mismatches.
Teachers Union of Malawi (TUM) secretary general Charles Kumchenga said many teachers have quit the scheme.
He said most teachers were on the Econo Plan scheme which only enabled them “to access selected lower-tier health facilities. Some were even turned away”.
Kumchenga said some teachers “do not even know whether they are enrolled in Masm or not”.
To this, Mtonga asked: “Was this officially raised with us?”
He said HR officers from MDAs interact with DHRMD every month “to submit new forms, collect cards, lists of accredited facilities…etc. etc”.
Federation of Civil Service Unions president Solomon Chomba blamed voluntarism: “Many people are not enrolling, only a few are, perhaps due to misconceptions.”
In response, Mtonga said: “Maybe, some civil servants are yet to understand it fully. But Masm and our department have jointly worked on sensitisations and we hope this will change.”
He also confirmed the scheme remains voluntary. “No. You don’t force people to do what they don’t want. This is voluntary.”
Chiefs wait in the wings
Meanwhile, chiefs, who government promised Masm enrolment from April 1 2026, are still in limbo.
Paramount Chief Kawinga said in an interview that he has “never been approached to complete enrolment forms” while Senior Chief Lukwa replied: “I didn’t. I don’t know.”
Minister of Local Government and Rural Development Ben Phiri, who announced the medical scheme for chiefs during meetings with council authorities and chiefs in Rumphi, Chitipa and Karonga districts last December, had said at the time that the scheme would start with Paramount Chiefs and Senior Chiefs from April 1 this year.
He envisaged the move easing the financial burden the traditional leaders face whenever they seek medical treatment.
At the time, Paramount Chief Kyungu of Karonga welcomed the initiative, describing it as long overdue.
Few days later, the ministry’s spokesperson Chimwemwe Njoloma confirmed the plans to “put all chiefs on Masm” to cut on expenses incurred when they are either taken ill or die.
But in an interview yesterday, when The Nation asked Phiri what has caused the delay in chiefs’ Masm enrolment and when they can join, he said plans are still underway.
In his brief WhatsApp response, he said: “The fact was ‘it was not a promise, but exploring’, of which we are advancing! It will be a game changer.”
Malawi currently has seven paramount chiefs and 177 senior chiefs, bringing the total to 184, according to the ministry’s records.
If the chiefs will be put on VIP, which will be at K63 000 per person per month at current Masm rates, the taxpayers could pay an extra K11.5 million on the wage bill per month and K139 104 000 per year, according to The Nation calculations.
Cost, coverage and sustainability questions
Scaling the scheme raises fiscal questions. An illustrative calculation based on current premiums and with just 14 percent of the civil service costing government K6.3 billion in annual remittances, it could take K45 billion to cover all the 250 000 civil servants per year excluding dependents. However, again, Mtonga questioned the basis of such calculations.
“You mean at what grades? Grades determine the category one is registered into,” he said. He did not provide an alternative government projection.
The fiscal risk is heightened by government’s track record with similar schemes. The Public Service Pension Fund Trust has in recent years reported substantial arrears due to non-remittance of employer and employee contributions by government, with outstanding amounts estimated at K90 billion.
Pension Fund officials have previously said the arrears undermine the fund’s ability to meet obligations on time.
Scotland-based Malawian economist Velli Nyirongo said value for money must be demonstrated at any scale.
He said: “A contributory medical scheme can provide valuable financial protection for civil servants, but the key question is whether it delivers better value for money than investing directly in the public health system.
“If government contributions reach the billions annually, policymakers must demonstrate that the scheme improves health outcomes, reduces financial hardship and offers good value. In a country where public hospitals continue to struggle with medicine shortages, equipment gaps and staff constraints, there is a strong argument that improving frontline healthcare could benefit a much larger share of the population.”
On sustainability, he said three factors matter, namely the government’s ability to continue funding its contribution, regular premium payments by members and effective cost control.
Nyirongo also flagged risk from low membership, saying: “An enrolment rate of about 14 percent based on the available average raises questions about long-term viability..”
On mandatory enrolment, he noted trade-offs, observing that a larger membership base would strengthen risk pooling and improve the scheme’s financial stability. He said compulsory enrolment should only be considered if the scheme is affordable, transparent and delivers clear value to members.
With a potential shift to a government-run scheme flagged by DHRMD and voluntarism keeping numbers low, with questions over remittance discipline, and experts questioning value-for-money against public hospital investment, the medical scheme launched to ease the burden on public servants risks remaining a selective benefit rather than a pillar of public sector welfare.
