Malawi's ban on dual practice divides health sector

Malawi has introduced a ban on dual practice, blocking public health workers from holding private medical jobs. The government says the move tackles corruption, but doctors warn it could deepen staff shortages. HealthMalawiMalawi's ban on dual practice divides health sectorBouba Jalloh03/06/2026March 6, 2026Malawi has introduced a ban on dual practice, blocking public health workers from holding private medical jobs. The government says the move tackles corruption, but doctors warn it could deepen staff shortages.https://p.dw.com/p/59rEXAn investigation reveals how corruption has turned Malawi's public hospitals into 'markets of life and death' [FILE: January 2023]Image: Thoko Chikondi/AP Photo/picture allianceAdvertisementMalawi'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 goes even further, ordering 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 the publication of an investigative report by the Nyasa Times newspaper that uncovered a coordinated system of corruption documented across multiple public hospitals, where patients were routinely forced to pay illegal "fees" for services that should be free.The probe showed how access to treatment had functioned like a cash‑based system for access to careImage: Thoko Chikondi/AP Photo/picture alliance Undercover reporting documented how security guards, clerks, nurses and clinicians operated coordinated bribery networks, allowing those who paid to skip queues while others waited for days without care. The investigation showed how access to treatment had functioned like a cash‑based system for access to care, leaving poor patients stranded, delayed or denied services across multiple facilities. Ending dual practice to restore trust in public care Malawian President Peter Mutharika said the ban was necessary to confront long‑standing abuses linked to dual practice. Mutharika 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 some health workers routinely arrived late or left early from their public‑sector posts to attend private patients, creating dangerous service gaps in facilities already overstretched and understaffed. According to Malawi's government, ending dual practice will restore public trust and ensure that public resources benefit all Malawians rather than private interests. Experts warn of possible unintended consequences The ban has sparked intense controversy. "I think the directive has no basis," health expert Maziko Matemba, executive director of the Health and Rights Education Program in Malawi, told DW. "It is illegal and an infringement of human rights." Public‑sector wages remain low, and many doctors and nurses argue that private work is the only way they can meet their financial needs. Specialists fear the new directive may push them to resign from the public service entirely, deepening an existing staffing crisis in the country's hospitals. Malawi: Physiotherapy center helps kids with disabilitiesTo view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Matemba also warns that the policy could stifle medical innovation. "One of the issues coming out is that the medical community foresees a future that lacks innovation, because ownership or running private clinics goes a long way toward improving health services in the country," he told DW. The Society of Medical Doctors in Malawi has begun preparing a legal challenge, arguing that the directive is heavy‑handed and risks destabilizing the country's health system. Solomon Chomba, chairperson of the Human Resource for Health Coalition, says the approach is "wrong" and infringes on economic rights. He warns that many health workers may resign rather than shut down their private facilities. Dr. Victor Mithi, president of the Society of Medical Doctors, cautions that the ban could worsen brain drain, noting that critical expertise could disappear from the public sector. Health equity groups applaud action against illegal fees Supporters, however, argue the opposite. The Malawi Health Equity Network has called the ban a "long‑overdue intervention" aimed at protecting citizens from illegal fees, coercion, and unequal access to care. They say the measure is an essential step toward curbing corruption and reinforcing ethical standards in public hospitals. Some residents interviewed by DW also welcomed the decision. "The directive is quite okay because here in Malawi we've seen that sometimes you go to a public hospital and there is no medication," one resident said. "They refer you to a certain hospital or pharmacy." DW's Chimwemwe Padatha in Lilongwe reported that investigations revealed that "most of the pharmacies people