The Malawian 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. This directive extends further, ordering any public health worker who owns or partly owns a private facility to divest within 30 days or face dismissal and potential legal action.

The move follows an investigative report by the Nyasa Times newspaper, which uncovered a coordinated system of corruption across multiple public hospitals. The report documented how patients were routinely forced to pay illegal "fees" for services that should be free, with undercover reporting revealing that security guards, clerks, nurses, and clinicians operated bribery networks, allowing those who paid to skip queues while others waited for days without care.

Malawian President Peter Mutharika stated that 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 even siphoned medicines from public hospitals to resell in private pharmacies. Reports also indicate that health workers often arrived late or left early from their public-sector posts to attend private patients, creating service gaps in already overstretched facilities.

However, the ban has sparked intense controversy. Health expert Maziko Matemba called the directive "baseless" and "an infringement of human rights." Public-sector wages remain low, and many doctors and nurses argue that private work is the only way to meet their financial needs. Specialists fear the new policy may push them to resign from public service entirely, deepening an existing staffing crisis in the country's hospitals.

The Society of Medical Doctors in Malawi is preparing a legal challenge, arguing that the directive is heavy-handed and risks destabilizing the health system. Dr. Victor Mithi, president of the society, warned that the ban could worsen brain drain, with critical expertise potentially disappearing from the public sector.

Supporters, including the Malawi Health Equity Network, have hailed the ban as a "long-overdue intervention" aimed at protecting citizens from illegal fees, coercion, and unequal access to care. They assert that the measure is an essential step toward curbing corruption and reinforcing ethical standards in public hospitals, with some residents welcoming the decision as a response to systemic issues like medication shortages and referrals to privately owned facilities.

Source: www.dw.com