The issue of dual practice among medical professionals, despite being backed by Ministry of Health (MoH) policy, has raised eyebrows among stakeholders, with the Medical Council of Malawi (MCM) acknowledging that there was potential for abuse.
The Global Fund (GF), in a recent report, indicated that 35 out of every 100 private healthcare facilities in Malawi were owned by people in the public healthcare service delivery system.
The GF report further indicates that 30 percent of medical resources allocated to public healthcare facilities are stolen.
The findings on private healthcare facility ownership have been corroborated by MCM, which has acknowledged that the medical regulator was overwhelmed with reports bordering on abuse of part-time private practice and dual practice by public servants.
Section 38 of the Medical Practitioners and Dentists Act, No 17 of 1987, allows public medical doctors and allied health professionals to engage in private practice while serving as civil servants.
However, there are mixed reactions to the Act, with some stakeholders feeling that the Act promotes potential abuse of public resources and time by some public servants. The revelations come at a time some public hospital clients claim to have been coerced to access care in private hospitals.
MCM acting Registrar Richard Ndovie said patient coercion and advertising were not allowed.
“There is a thin line between informing patients of available services at [a] private hospital which may not be available at public health facilities and coercing patients to access care at a private hospital. If it’s coercion, then it’s unethical and should be reported to the Hospital Director or the Hospital Ombudsman or [those affected] can report directly to Medical Council of Malawi,” Ndovie said.
Meanwhile, health rights activist Maziko Matemba has called on the government to urgently investigate dual practice and ensure that it was not abused.
“Access to quality healthcare services requires public healthcare workers to be available to provide services as per public services regulation in the Civil Service. The government must swiftly investigate revelations that 35 percent of private healthcare service points are owned by public officers and establish the causes,” he said.
Governance and social accountability expert Brian Kunkwezu said the country had, of late, witnessed increased cases of drug and medical equipment misuse, a development he attributed to the government’s part-time private practice policy.
“Abuse of part-time private practice window is an accountability issue and has impacts on healthcare service access, distributive justice, quality care and efficient use of public resources. The government must swiftly address this issue through its public sector reforms’ programme,” he said.
MoH spokesperson Joshua Malango said dual practice was allowed on condition that it was done during off hours, during holidays and on weekends.
“[On issues of] ethics and drug pilferage, healthcare workers take oath before they start practising and they are supposed to make sure that issues of conflict of interest are observed,” he said.
Malango added that the ministry makes sure that medical practitioners are assisting patients in their private facilities without using public resources.
He said MCM and other bodies were also there to ensure that practitioners were adhering to ethics.
Earlier this year, police in Mchinji District arrested four medical officers for allegedly stealing essential drugs and equipment from Mchinji District Hospital.