Malawi this month issued a sweeping ban on dual practice, forbidding public doctors and nurses from working in private clinics, hospitals, pharmacies or diagnostic centers while employed by the state. Public health workers who own or co‑own private facilities were given 30 days to divest or face dismissal and potential legal action.
The order followed an investigative report that exposed coordinated corruption across several public hospitals, where patients were routinely charged illicit fees for services that should be free. Undercover reporting described networks of security guards, clerks, nurses and clinicians who took bribes to let some patients skip long queues while others waited or were denied care. The probe found that access to treatment had, in practice, become a cash‑based system that left poor patients stranded.
President Peter Mutharika said the ban is needed to tackle long‑standing abuses linked to dual practice. He accused some public staff of demanding informal payments, diverting patients from government facilities to their own private clinics, and siphoning medicines from public hospitals to sell in private pharmacies. Officials also said some health workers routinely arrived late or left early to attend private patients, creating dangerous service gaps in already overstretched facilities. The government argues that ending dual practice will restore trust and ensure public resources serve all Malawians rather than private interests.
The policy has provoked strong opposition from parts of the health sector. Critics say the directive lacks a legal basis and infringes on rights. Public salaries remain low, and many clinicians rely on private work to make ends meet. Health groups warn the ban could push staff to resign from public service, worsening an already severe staffing crisis. The Society of Medical Doctors in Malawi is preparing a legal challenge, calling the move heavy‑handed and likely to destabilize the health system. Coalition leaders say the policy risks accelerating brain drain and removing critical expertise from public hospitals.
Supporters view the ban as a long‑overdue measure to protect patients from illegal fees, coercion and unequal access. Civil society groups and some residents recounted being referred from public hospitals to privately owned pharmacies and clinics run by health workers, a practice the government says the ban aims to stop. Reporting found that many of the pharmacies patients were sent to are indeed owned by staff from public facilities.
Analysts caution, however, that dual practice is only one symptom of deeper problems: weak oversight, chronic drug shortages and underfunded facilities create conditions where corruption can thrive. They argue that lasting improvement will require broader structural reforms — clearer guidelines, fairer pay, better oversight and policies developed with input from frontline workers — rather than an outright ban that risks unintended consequences.
Malawi has a history of temporary allowances and compromises over dual practice, introduced during past staffing crises to prevent mass resignations. This reversal is among the most forceful moves in years to curb corruption in the health sector. If fully enforced and paired with systemic reforms and better pay, the ban could improve public staffing, reduce medicine leakages and rebuild trust. But if many health workers quit or emigrate in response, the measure could deepen shortages and undermine the very public services it seeks to protect.
This article was adapted from an episode of DW’s AfricaLink podcast.