Beyond the hospital gate, another face of corruption

36 “Which of these three do you think was a neighbour to the man who fell into the hands of robbers?” 37 The expert in the law replied, “The one who had mercy on him.” Jesus told him, “Go and do likewise.” – Luke 10:36-37 The recent undercover visit by Minister of Health and Sanitation Madalitso Chidumu-Baloyi to Bwaila District Hospital in Lilongwe has understandably captured national attention. For citizens arriving at hospitals already burdened by illness, often carrying sick children or elderly relatives, the suggestion that treatment can be accelerated for at least K10 000 is more than an inconvenience. It represents a distortion of the very principles upon which Malawi’s public health system was built.

In overcrowded facilities where waiting times stretch for hours, sometimes an entire day, informal systems have developed that quietly monetise access. The result is a two-tier experience within a service that is officially free — one for those who can afford the unofficial fee, and another for those who cannot. In this regard, the minister deserves commendation.

Her approach was both creative and courageous, and it has validated what countless patients have long reported but struggled to prove. Yet while the country applauds the exposure of corruption at the hospital gate, it is important to recognize that some of the most damaging forms of malpractice in the health sector do not always occur in waiting rooms or consultation corridors. At the time, I was serving as a senior diplomat responsible for social development issues, I was invited to attend an international dinner event focusing on the global fight against obstetric fistula, a devastating childbirth injury that affects thousands of women in developing countries.

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Malawi was included in the conversation because a philanthropist was exploring the possibility of establishing a specialized fistula treatment facility in the country. Armed with briefing notes and a prepared statement from officials at the Ministry of Health headquarters in Lilongwe, I attended the dinner expecting a routine diplomatic engagement. Instead, I encountered a story that left a lasting impression.

During the dinner, I found myself seated next to a woman whose confidence and presence immediately suggested influence and determination. After introductions, she spoke with disarming frankness. “I am tired of giving envelopes of cash to health officials in your country,” she said.

The statement was jarring. When I asked why she felt compelled to do so, the answer was even more troubling. She explained that she had been trying to obtain a simple letter of approval from Malawian authorities — permission to add a 12-bed fistula ward to an existing hospital renovation project. The addition to the initiative was entirely philanthropic and aimed at addressing a condition that devastates the lives of thousands of women and girls.

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