Evaluation of Malawi's Emergency Human Resources Programme

Management Sciences for Health
EHRP so far and that expenditure targets are being met. 72 Further analysis indicates that
national health spending has increased in real per capita terms from $7.32 in 2005/06 to a
projected $9.23 in 2009/10. 73 However, the 2009/10 approved budget was less than the
revised budget for 2008/09 and this represents a reduced allocation to health which has
been criticised by civil society. Even though actual expenditure may be higher than
budget, this is cause for concern.
Government funding has shown an increasing trend towards the health sector, which is
likely to continue over the next five years, given Presidential support for the EHP and
SWAp. In the 2010/11 budget, as analysed by the Malawi Economic Justice Network
(MEJN), health has been allocated MK45 billion representing 15.5% of total budget. 74
The 15.5% appears to represent an increase over the figures in previous years and
indicates that the Abuja target for health spending of 15% may be met. 75
For 2010/11, donor contributions represent 30% of the total budget; this represents a
reduction from the two preceding years (33% and 35%, respectively), due to increased
domestic resource contribution. 76 Furthermore, the GOM has allocated resources for
scholarship of students in CHAM training institutions. This amount, targeting 1,200
students and translating into MK329.166 per student, should present a sufficient
allocation with fees ranging from MK330.000 to MK350,000 per student per year. The
MEJN report commends the GoM for sourcing the money within the domestic budget as
a sustainable, predictable solution compared to donor reliance.
IMPACT
Impact on Health Service Provider Density
As described in Part I, this evaluation found a 53% overall increase in the number of
MOH and CHAM health workers from 2004 to 2009. Physicians, in particular, saw a
large increase, from 43 in 2004 to 241 in 2009, which represents a 460% increase. Nurses
– a cadre that has historically experienced the greatest losses due to migration – also
increased by 36% between 2004 and 2009. The original goal of meeting the level of
physicians and nurses to population in Tanzania has been met, although this is also partly
due to decreasing ratios in Tanzania over the last six years. 77 When compared with
African countries, Malawi in 2009 remains low in terms of physicians to population at
0.02 per 1,000; Zambia, Kenya, Uganda, and Rwanda have ratios of 0.14, 0.14, 0.08, and
72
See: Common Approach to Budget Support (CABS) Development Partners. Joint Analysis of the
Government of Malawi’s 2009/10 National Budget. October 2009. See also Health Portfolio Review for
Malawi. Full report. Initially prepared by Cameron Bowie and Takondwa Mwase for DFID and the Malawi
Health Sector July 2009.
73
Ibid.
74
2010/11 Budget Analysis Report. Malawi Economic Justice Network. June 2010
75
Abuja Declaration on HIV/AIDS, Tuberculosis, and Other Related Infectious Diseases. Abuja, Nigeria;
24-27 April 2001.
76
2010/11 Budget Analysis Report. Malawi Economic Justice Network. June 2010
77
Please note that staff to population ratios are used as rough illustrative comparisons and may be subject
to variations in numerators and denominators (i.e., the definition of what cadres comprise a nurse).
EHRP Evaluation Final Report Page 57