PhD: Government purchasing of health care from not-for-profit providers: a review of service level agreements in Malawi

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The Government of Malawi has entered into service level agreements (SLAs) with the CHAM healthcare facilities in order to expand access to a basic package of healthcare services. The objectives of the package are to guarantee universal access and improve equity of access to healthcare. Under the SLAs, pregnant women, and children aged less than 5 years, are exempted from paying the user fees charged at the CHAM health centres. The government in turn reimburses the providers. It is, however, not known what the impact of the SLAs has been. This study assessed the effect of the SLAs on utilisation – whether use of health services covered in SLAs increased; equity – who, between the poor and the better-off, has benefited from SLAs; and health outcomes for targeted populations. Health and healthcare indicators were compared before and after introduction of the SLAs for CHAM providers with and without SLAs. The results of this study provided evidence on whether government investment in SLAs has yielded positive benefits.

Outcome and Translation

This research informed the proposal in the current health sector strategic plan (HSSP) 2011–2016 to increase the number of SLAs. The research received a prize from the African Health Economics & Policy Association (AfHEA) Scientific Review Committee to present at the AfHEA biennial conference in 2016. The prize included a substantial cash prize and a sponsorship package to attend the conference.

PhD Student: Gerrard Manthalu

Supervisors: Shelley Farrar (HERU)



Manthalu, G. (2014) 'The impact of user fee exemption on maternal health care utilisation and health outcomes at mission health care facilities in Malawi', PhD Thesis, HERU, University of Aberdeen.

Manthalu, G., Yi, D., Farrar, S. and Nkhoma, D. (2016) 'The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi', Health Policy and Planning, 31(9), 1184-1192.