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Deadly plague of illegal clinics

Malawi government’s inability to deliver to Malawians decent health services is throwing this nation’s poor to the gallows of small private clinics some of which are operated by untrained, profiteering individuals.

Desperate for proper medical attention, low-income Malawians are turning to these facilities where they can afford to pay anything between K700 and K3, 000 for a ‘treatment’, Malawi News has established.

But this sector, while helping in some way to plug the gaping holes in health service delivery in Malawi, is known to be plagued by illegal dealings.

Some of the clinics have been found to be run by quacks whose sole intention is to exploit the vulnerable while operating from dubious, medically-unfit environments.

Our compilation of accessible media accounts show that between 2008 and June 2015, the Media Council of Malawi, the policeman of medical practice in the country, shut down over 400 illegal clinics across the country.

Almost all these facilities were small private facilities operating in townships, rural trading centres, people’s homes in the villages and from travelling bags.

But such crackdowns are clearly not working as illegal private clinics culture continues to flourish in the country, going by recent media reports of more of such shutdowns and arrests.

We can report that one of the principal reasons for the proliferation of these small clinics was government’s inability to provide efficient and reliable health services and within distances easily accessible by the populations.

We have also found that while some practitioners may have benign reasons for deciding to operate clinics, others venture into the industry motivated by interest to make money.

“I noticed there is an opportunity to make money, so I opened this clinic,” said a qualified practitioner in Zomba who although his clinic is certified by the government, opted to have his name withheld –apparently because of being ashamed with the reason he gave for opting to start a clinic.

Over a period of three weeks last month, we spoke with low-income citizens in Mulanje, Blantyre, Zomba, Liwonde, Balaka and Ntcheu over their health requirements.

All our contacts said they would prefer to access medical attention at public hospitals because these facilities offer free services and have “people who know their job”.

“Government cannot employ a person who is not trained to work as a nurse or a doctor. So when I am being treated at a public hospital, I feel I am in very safe hands,” said Esme Ashani in Liwonde.

But all our interviewees said they are forced to turn to private clinics in their localities because such facilities are close to their homes, they offer their services fast and they always have drugs.

However, none of them said they cared to establish whether the practitioners they consulted were trained in the field.

A few admitted they were wary they could be subjected to improper treatment in these clinics.

“When we get better, we start to trust the clinic. When someone opens a hospital, we assume that he is a qualified person; so I don’t think anyone bothers to find out. That would be difficult,” said Elufe Stande in Ntcheu.

Two doctors, one working as a District Health Officer (DHO) and another heading a department in the Ministry of Health, corroborated our findings.

The Ministry of Health official said inefficient and unreliable service in public health sector is creating grounds for some unscrupulous individuals to crack the ceiling of one of the world’s most respected professions by engaging in illegal operations.

“These individuals are capitalising on poor service in public hospitals. People are desperate for better public health services. These illegal practitioners are feeding on this desperation,” he said.

He added that weak controls in public health sector were also contributing to the chaos.

“We have laws to regulate medical practice in the country but we fall chronically short on enforcement. The laws themselves are disappointingly deficient in terms of punishment meted out to someone who has been found to be practising illegally,” he said.

A case in point, in December, police arrested Samuel Mukhwiri, for illegally operating a private clinic in Mulanje and peddling government medical drugs without a licence. He was not a trained health worker.

While his actions may have put scores of lives in real danger, he was handed a paltry 36 months in prison.

But the Pharmacy, Medicines and Poisons Board surprisingly hailed the conviction and the jail term.

“Indeed for the first time, a drug peddler has been imprisoned for a jail term that is this long,” said the Board in a statement published in this paper on December 19.

Our Ministry of Health official also revealed that taking advantage of weak policing mechanisms in public health, illegal private clinics are also conduits through which public hospitals are being bled medical supplies meant for the citizens.

In many of the illegal clinics that are being shut down, operators are found using government drugs.

Mukhwiri was found with medical supplies such as forceps and disposable syringes and 15 types of drugs –all of them stolen from government hospitals, police said.

According to Ministry of Health, Malawi’s hospitals lose K5 billion worth of drugs every year to theft.

Our DHO source based in the Southern Region described the situation as “a circle of crisis.”

“By not providing decent services to our people, by not tightening the controls in the system to curb drug theft, we are sending our citizens to the deathbeds of illegal private clinics. Such operators are motivated by money. They are not specialists. They don’t care about human life.

“The longer we remain inefficient, the more Malawians will trust these shady clinics, effectively discrediting the public system. That is disastrous. It means we are sending our people to be given wrong, experimental prescriptions. It means our people are being delayed from accessing proper medical attention and denied proper treatment. So we are killing them, practically,” he said.

Health rights activist Maziko Matemba said the public health sector cannot be allowed to continue to hold Malawians at ransom.

“It is the duty of the Ministry of Health and Medical Council of Malawi to revisit their monitoring systems. The people of Malawi deserve their right to good health. It is their fundamental human right,” he said.

Both Registrar of Medical Council of Malawi Abel Kaonga and Minister of Health Peter Kumpalume had not yet responded to our emailed question as we went to press, although they had promised to do so in telephone reminders.

In the progress report on Public Sector Reforms which the government is pursuing, the Ministry of Health attributes the sickness in the sector to “severe, chronic health financing gaps”.

The ministry says it would establish a National Health Insurance Scheme and a health fund to generate additional revenue and improve the efficiency of the health system.

It also says it would reform operations of central hospitals and the district health system, among other measures.

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