Service Level Agreements are contracts between the Ministry of Health and the Christian Health Association of Malawi (CHAM), for the delivery of essential health services to populationsserved by CHAM facilities. Through SLA agreements obstetric care and care of new-borns and children up to the age of 5 years is without cost to the client. SLA agreements increase access of the rural poor to essential health care. In 2021, Nkhoma Hospital continued its support of SLA agreements by expanding the services of the hospital contract and by signing new contracts for health centres. We appreciate the financial support of the Medical Benevolence Foundation to bridge the difference between government reimbursement and the true cost to the hospital of some of the services provided.