Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
expenditures for two recruitment galas (Table 8). 45 No costs were incurred for these
activities in 2004.
Top-ups for established HSAs began in October of 2008, thus representing only three
months of top-ups paid. Top-ups for non-established HSAs began at the start of 2007.
MOH top-ups for the 11 cadres saw some fluctuations over the EHRP for two reasons;
firstly, due to a Functional Review in 2007, whereby the salary and grade structure was
revised, causing a drop in the total salaries and corresponding top-up payments, despite
increases in staff numbers. Secondly, a salary revision, in addition to payment of arrears,
caused a large increase in top-up payments in September 2008, then again in September
2009.
Total expenditure for Element 1 increased steadily, starting at USD 2.9 million in 2005
and ending at USD 10.6 million in 2009. The total amount expended on Element 1 up to
2009 was USD 34.3 million.
Table 8. Total Cost of Element 1, 2004-2009 (USD)
Activity
MOH Top‐
2004 2005 2006 2007 2008 2009 Total
Ups (11
Cadres)
CHAM Top‐
‐ 2,424,530 4,832,833 4,377,856 4,273,838
Ups (11
Cadres)
HSA Top‐ups
‐ 429,393 1,386,515 1,433,845 2,266,615 2,756,918
Established
HSA Top‐ups
‐
‐
‐
‐ 252,543 825,478
Non‐est
Recruitment
‐
‐
‐ 886,552 982,098 987,185
Galas
TOTAL
‐
‐ 71,644
‐ 97,425
‐
‐ 2,853,923 6,290,991 6,698,253 7,872,518 10,552,155
Source: MOH and CHAM
Discussion
5,817,572 21,726,628
8,273,286
1,078,021
2,855,835
169,069
34,267,841
The evidence points to the success of the salary top-ups, the recruitment strategies, and
the three-year contracts to increase the number of health workers in the designated 11
cadres.
Overall, staffing numbers in the 11 targeted cadres have increased (by 53%) in the MOH
and CHAM since Element 1 (salary top-ups) began implementation in 2005, although not
all of the individual targets per cadre were met. With improved staffing arising from
EHRP, overall health centres conforming with staffing norms for Malawi of 2/2/1 (2
45 All expenditures in Malawi Kwacha (MK) were converted into US Dollars (USD) using an average
annual exchange rate for the year in which the costs were incurred (see Annex P). A table of all costs in
MK and GBP can be found in Annex Q.
EHRP Evaluation Final Report Page 31