The ward or office: Where should our doctors work?


A call came on the clinician’s phone. It was from another health worker at the hospital.

There was what medical practitioners call “foetal distress situation” and they needed the help of this clinician who was at that time granting an interview to the media.

“Prepare her for theatre. I’m on my way,” responded the clinician, whose name we will not disclose.


And the interview with the media ended abruptly as the clinician went on putting on his theatre uniform before scampering to the ward.

The hospital has two trained doctors, the District Health Officer (DHO) and District Medical Officer (DMO).

The two rarely work in the ward since they are also overwhelmed with administrative duties at the hospital in the Eastern region.


There has been debate on whether graduate doctors should be working in administration roles instead of being full time in the ward to serve situations like what this clinician encountered.

However, our random interviews among some DHOs across the country established that the doctors themselves do not see it as a problem to do duo roles.

DHO for Blantyre Dr Medson Matchaya says it is not true that working as a DHO compromises a doctors’ practice in the ward.

“Why should it be an issue when doctors work as DHOs while teachers can serve as Dem [District Education Manager] and Police Officers can serve as officer-in-charge without being questioned?” He says.

Matchaya also argues that the College of Medicine graduates at least 60 doctors every year but there is still acute shortage of health workers in the country’s facilities.

That shortage, he says, cannot be attributed to the fact that some doctors are combining their role in the wards with administrative duties.

“I have worked as a DHO in Nsanje and I combined these two very well,” he says.

DHO for Mangochi Dr William Peno says the issue of working as DHO and attending to patients in the wards is only the question of time management.

“I spend 25 per cent of my time in the ward and the rest of my time on administrative and other related work,” he says.

Peno says most doctors may be moving away from bedside practice because there is less motivation as compared to administrative work.

DHO for Lilongwe Dr Mwawi Mwale also says it is possible to balance the two responsibilities.

“This doubling is not what is contributing to under staffing in the health sector in the country.

There is a job description for us and we are not misplaced at all,” he says.

Executive Director for Malawi Health Equity Network (Mhen) Martha Kwataine says the problem is that the system in the health sector has created better incentives for administrative related work than the actual medical practice.

“We propose increase in budget for doctors so that they save lives of Malawians instead of them being in the office. The same is happening in the nursing profession. Once a registered nurse midwife gets a Masters Degree, they stop serving on the bed side of the patient,” she says.

She says the current Public Sector Reforms and the reforms within the public health sector should address this matter.

Kwataine adds:

“The current Health Sector Strategic Plan focuses on quality and equity. What is currently happening in the health sector is not equity: Why should there be favour for a certain group of people when all of them spent sleepless nights in college learning about the human body and how to treat it when it is dysfunctional?”

On his part, Executive Director for Health and Rights Education Programme, Maziko Matemba, says it is high time the country acted on “this anomaly”.

“Policy makers must have a heart for poor Malawians by creating an enabling environment for qualified health care workers to remain in the system and save lives,” he says.

Data from the College of Medicine shows that the institution has graduated 676 Bachelor of Medicine and Bachelor of Surgery (MBBS) doctors between 1992 and 2014.

That however has not stopped the country from experiencing shortage of doctors in the wards of the country’s hospitals.

Acting Principal for the college Mwapatsa Mipando says the institution’s recent research has shown that over 80 per cent of its graduates are working in Malawi.

“Furthermore, of the 20 per cent that are outside the country, 62.2 per cent of them are doing further studies in South Africa under the sponsorship of the Ministry of Health with support from the Global Fund,” Mipando says.

Early this year, the Ministry of Health said the country’s health service is under staffed to the level that health worker to patient ratio is at four health workers per every 100,000 patients.

This is way below the World Health Organisation (WHO) recommendation of 20 doctors per every 100,000 patients.

Ministry of Health Deputy spokesperson Adrian Chikumbe says the ministry is aware of this problem and is working on it.

“We already have a few doctors and giving them administrative positions has worsened this. We are working on normalising this and you will soon notice that these doctors are back into the wards,” he says.

Still, it is not clear whether the assignment of doctors into DHO positions is a major contributing factor to shortage of qualified doctors in the country’s hospitals.


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