Malawi is moving ahead with reforms to grant greater autonomy to central hospitals, a policy shift health authorities say will improve efficiency, accountability and the quality of care in public referral facilities.
Discussions on granting greater decision-making power to central hospitals began about 11 years ago, driven by concerns that excessive centralisation was slowing service delivery and weakening accountability.
Despite policy debates and technical work over the years, implementation stalled, leaving most public hospitals operating under tightly controlled systems that limited flexibility at facility level.
Hospital autonomy allows selected public hospitals to manage their operations within a defined regulatory framework while remaining under government oversight.
Kamuzu Central Hospital Director General Amos Msekandiana said the reform is critical for institutions that operate under constant pressure and handle specialised services.
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“Central hospitals deal with complex cases every day, yet many operational decisions have traditionally required clearance from the centre.
“Autonomy allows hospital management to make timely, results-oriented decisions that directly affect patient care while still complying with national policies and standards,” Msekandiana said.
He added that hospital autonomy should not be mistaken for privatisation.
“These are public hospitals and they remain accountable to government. What changes is the flexibility to manage resources more efficiently and respond faster to operational needs,” he said.
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Minister of Health Madalitso Baloyi said the renewed push to implement hospital autonomy reflects the government’s recognition that delays in reform have affected service delivery.
“Our focus is to improve governance, efficiency and accountability in public hospitals so that Malawians receive better care.
“Centralised control helped maintain standards but it also limited hospital-level flexibility. Autonomy is meant to address that imbalance,” Baloyi said.
Baloyi said the phased approach allows the government to draw lessons from pilot sites before extending the model to other facilities.
The minister added that central hospitals play a critical role as referral centres and must be empowered to manage specialised services, especially in a resource-constrained environment.
“Hospital autonomy is expected to improve decision making, enhance management of allocated resources and strengthen service planning based on catchment population needs and referral patterns,” she said.
