Malawi’s government last month imposed a comprehensive ban on “dual practice,” prohibiting public‑sector doctors and nurses from working in private clinics, hospitals, pharmacies or diagnostic centers while still employed by the state. The directive also orders any public health worker who owns or partly owns a private facility to divest within 30 days or face dismissal and possible legal action.
The move follows an investigative report by the Nyasa Times that uncovered a coordinated system of corruption across multiple public hospitals, where patients were routinely forced to pay illegal “fees” for services that should be free. Undercover reporting documented how security guards, clerks, nurses and clinicians operated bribery networks allowing those who paid to skip queues while others waited for days without care. The probe showed how access to treatment had functioned like a cash‑based system, leaving poor patients stranded, delayed or denied services.
President Peter Mutharika said the ban was necessary to confront long‑standing abuses linked to dual practice. He argued that some public hospital staff have demanded informal payments, diverted patients from government facilities to their own private clinics, and siphoned medicines from public hospitals to resell in private pharmacies. Reports also indicate that some health workers routinely arrived late or left early from their public posts to attend private patients, creating dangerous service gaps in facilities already overstretched and understaffed. According to the government, ending dual practice will restore public trust and ensure that public resources benefit all Malawians rather than private interests.
The ban has sparked intense controversy. Health expert Maziko Matemba, executive director of the Health and Rights Education Program in Malawi, said the directive has no legal basis and is an infringement on human rights. Public‑sector wages remain low, and many doctors and nurses say private work is the only way they can meet financial needs. Specialists warn the directive may push staff to resign from public service entirely, deepening an existing staffing crisis in the country’s hospitals. Matemba also cautioned that the policy could stifle medical innovation, since owning or running private clinics can improve services and foster new approaches.
The Society of Medical Doctors in Malawi has begun preparing a legal challenge, arguing the directive is heavy‑handed and risks destabilizing the health system. Solomon Chomba, chairperson of the Human Resource for Health Coalition, called the approach “wrong” and said it infringes on economic rights, warning many health workers may resign rather than shut down private facilities. Dr. Victor Mithi, president of the Society, cautioned the ban could worsen brain drain and cause critical expertise to disappear from the public sector.
Supporters of the ban include the Malawi Health Equity Network, which called the measure a “long‑overdue intervention” aimed at protecting citizens from illegal fees, coercion and unequal access to care. Some residents welcomed the decision, describing experiences of being referred from public hospitals to pharmacies and clinics owned by health workers. DW reporting found that many of the pharmacies patients were referred to are owned by those same staff.
Analysts warn that dual practice is only one part of a larger problem rooted in systemic weaknesses such as poor oversight, chronic drug shortages and underfunded facilities — conditions that can create an environment where corruption flourishes. They argue lasting reform will require broader structural changes, not just restrictions on private work. Observers say proper guidelines and policies, developed with input from health workers and considering frontline realities, could strengthen public care without pushing doctors away.
Malawi’s health workforce challenges date back to a severe staffing crisis in the early 2000s, when the government introduced temporary dual‑practice allowances to prevent mass resignations. The recent reversal represents one of Malawi’s most aggressive efforts in years to tackle corruption in the health sector. If fully enforced, it could improve staffing levels in public hospitals, reduce medicine leakages and gradually rebuild trust in public services. But the risks are significant: if large numbers of health workers resign or emigrate, the ban could deepen Malawi’s already strained healthcare workforce crisis and potentially undermine the reforms it seeks to achieve.
This article has been adapted from an episode of DW’s AfricaLink podcast.
