Ministry of Health and Sanitation has increased by 250 percent revised locum rates for healthcare workers from April 1 2026, drawing mixed reactions from stakeholders.
While welcoming the increment, the healthcare workers and industry players argue that while it will motivate the workforce, it would be important for authorities to make timely payment of the same. They said in some cases payment delays for up to six months.
Further, suggestions have emerged that government should prioritise permanent recruitment of healthcare workers to cut down on spending a lot on locum, which attracts higher sums than permanent workers.
In a memo dated March 18 2026, Secretary for Health Dan Namarika said day and shifts have been revised from K4 800 and K6200 to K12 000 and K15 500, respectively, while for district hospitals, day and night shifts have been revised from K3 750 and K5 250 to K9 375 and K13 125 respectively.
On the other hand, anaesthetic and orthopaedic clinicians, radiology, dental audiology and other rare specialised cadres, have moved from K35 000 to K87 500 for one, then from K26 250 to K65 625 for two and from K21 000 to K52 500 for three.
Reads the memo: “The revised rates aimed at ensuring fair compensation for healthcare workers that are providing locum services due to staffing gaps, with the intention of improving overall efficiency in service delivery across all public health facilities.
“Heads of institutions must ensure that locum guidelines are strictly adhered to and are within the approved budgetary provisions. Institutional heads shall be held accountable for any abuse of locum.”
Reacting to the development, Human Resource for Health chairperson Solomon Chomba said while they are happy with the increase, Government should consider revising these rates on a yearly basis to align with the economic situation.
He hoped the increase will also motivate health workers, noting that the K3 750 that they were getting, was not even enough for food or transport, which forced health care workers to dip deeper into their pockets to survive.
Said Chomba: “Locum was introduced to cushion acute health care worker shortage, it’s a temporary measure. This should not substitute the main thing which is recruitment of the health workforce because sometimes government relaxes because of locum.
“We need to address the critical healthcare worker shortage by mass recruitment of health care workers. Paying someone on locum is more expensive than paying someone on permanent recruitment.”
Chomba also decried that sometimes it takes six months, or even a year before locum is paid, saying, the situation was worse from health workers in rural setups.
On his part, Malawi Health Equity Network (Mhen) executive director George Jobe noted that locum has increasingly become routine, suggesting a deeper systemic problem in workforce planning and financing.
He wondered that despite an increase in the number of trained and employed health workers, the demand for locum has remained consistently high.
Said Jobe: “This points to underlying inefficiencies such as m mal-distribution of staff in health facilities, absenteeism or weak accountability systems, skills mismatch in critical service areas and gaps in workforce deployment and planning.
“Locum payments are repetitive and do not contribute to long-term health system strengthening. This is why Mhen and the Universal Health Coverage [UHC] Coalition have been advocating for recruitment of more healthcare workers, even against the issue of Wage Bill cap dictated by some development partners.”
International Coalition on Health Financing Advocacy chairperson Maziko Matemba said government needs to consider using the locum resources in recruiting additional health workers.
Responding to the queries, Ministry of Health and Sanitation spokesperson Adrian Chikumbe said locum is revised in consideration for cost of living, as well as taking into account the annual budgetary allocation to cost centres so as not to choke core business.
He said: “The ever increasing demand for health services means additional health workers are not fully matching the demand and certain managers couldn’t adjust 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.”
A study by three experts from Kamuzu University of Health Sciences Mabel Chinkhata, Masauko Msiska and Rodwell Gundo in 2024, examined factors that influence locum practice in public and faith-based hospitals in Malawi.
It revealed that locum staff overworked, beyond the normal 40 hours per week, to increase their chances of having more money and this excessive working negatively affects patient care.
“However, with the shortage of staff, the same healthcare workers may work additional shifts to cover the gaps in the rota within the same week, thus influencing the quality of care.
“The study revealed that hospitals use the same permanent staff for locums, resulting in locum healthcare workers working 32 hours more per week. The finding points to the need for tighter management and regulation and improved supervision and monitoring of locum practices,” it reads in part.
Figures from the ministry show that by 2020, the ratio was at 2.85 health workers per 1 000 population against the WHO target of 4.45 per 1 000.
Generally, locum rates, according to health professionals, are the hourly or daily pay rates for temporary healthcare professionals who fill in gaps left by permanent staff, and are regarded as higher than permanent salaries.
