36 “Which of these three do you think was a neighbor 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 Malawi’s Minister of Health, Madalitso Chidumu-Baloyi, to Bwaila District Hospital has understandably captured national attention.
By stepping into the queue as an ordinary patient — reportedly holding card number 205 — the Minister exposed what many Malawians have quietly endured for years: the emergence of an unofficial “express lane” inside facilities meant to provide free public care.
For citizens arriving at hospitals already burdened by illness, often carrying sick children or elderly relatives, the suggestion that treatment can be accelerated for 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 monetize 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.
Sometimes, they occur far away from the patient.
Reading about the Minister’s experience reminded me of another moment when questionable practices surfaced — not in a hospital ward, but within the administrative machinery of the health sector itself.
At the time, I was serving as a senior diplomat responsible for social development issues. I had been 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.
Malawi had been 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.
Yet despite the humanitarian nature of the proposal, she found herself repeatedly flying into Malawi, meeting different officials, and leaving behind envelopes in the hope that the required administrative approval would finally be issued.
The woman was Ann Gloag.
Curious to understand the scale of the challenge to her fistula ward initiative, I asked who had encouraged her to obtain the government approval letter for the project in Malawi. Her answer raised the stakes significantly.
She mentioned two friends who had advised her to first get the government nod before she could join their development (renovation of the Bwaila Hospital in the Old Town). They were former US President Bill Clinton and Scottish billionaire Tom Hunter. Together they had established the Clinton-Hunter Development Initiative, a programme aimed at reducing poverty and improving health systems in Malawi and Rwanda.
Among the projects supported by the initiative was the renovation of facilities at Bwaila District Hospital, a hospital that has long served as a critical referral centre for maternal health services in Malawi’s capital, Lilongwe.
Yet despite the involvement of internationally respected partners and a clear humanitarian objective, the project had stalled over a basic administrative requirement — a government letter allowing the addition of a fistula ward.
Determined not to allow bureaucratic inertia — or worse — to derail a project that could transform the lives of countless women and girls, I decided to intervene through official diplomatic channels.
After consultation with my ambassador at the time, Steve Matenje, the matter was escalated to the office of then Vice President Joyce Banda, who was then actively championing safe-motherhood programmes in the country. Although she was out of the country at the time, the Vice President offered clear guidance on how the matter should be resolved.
Armed with that high profiled support, I contacted senior officials at the Ministry of Health headquarters and informed them that Dr. Gloag would be arriving in Malawi the following day. I explained the purpose of her visit and the humanitarian importance of the project, and mentioning the Vice President’s interest in such maternal health initiatives.
Events moved swiftly thereafter. Dr. Gloag arrived in Malawi aboard her private aircraft. Senior health officials met her, discussions were held over lunch, and by mid-afternoon the required approval letter had been issued.
By September 2008, the fistula ward was established — becoming second facility of its kind on the African continent dedicated to treating obstetric fistula. The first is in Ethiopia.
Obstetric fistula is among the most tragic consequences of obstructed labour. When prolonged childbirth creates a tear between the birth canal and surrounding organs, women can suffer constant leakage of urine or feces. In many societies, this condition leads to stigma, isolation, and even abandonment by families and communities.
Yet medically, many fistula cases can be corrected through relatively simple surgical procedures. The establishment of the fistula ward in Malawi therefore represented more than a medical milestone. It helped to restore the dignity and hope to women and girls who would otherwise have lived in silence and shame.
For many patients across Malawi and neighbouring countries in southern Africa, the facility became a place where life could begin again.
The governance questions raised by both the Minister’s undercover experience and the earlier diplomatic episode are not new to Malawi’s health policy discourse. Analysts and civil society organisations have for years warned that informal payments and administrative opacity undermine equitable access to care.
The Malawi Health Equity Network has repeatedly cautioned that corruption in healthcare systems often thrives where reporting mechanisms are weak and patients feel unsafe raising complaints. In recent commentary, the network emphasized that tackling malpractice requires not only disciplinary measures but also reliable channels through which citizens can report wrongdoing without fear of retaliation.
The experience left me with a lingering question that remains relevant today. If a humanitarian project supported by globally respected partners could once be delayed by administrative obstacles and unofficial expectations, what does that say about the broader governance environment within which Malawi’s health sector operates?
The Minister’s undercover visit has exposed corruption at the level of service delivery — the small payments demanded from patients desperate for care.
But governance challenges in the health sector can also appear higher up the institutional ladder, where opaque administrative processes create opportunities for delay, discretion, and sometimes abuse.
Both forms of corruption ultimately produce the same outcome: they weaken public trust and undermine efforts to improve healthcare access for ordinary citizens.
The Minister’s decision to stand in line as Card 205 has given Malawi a powerful symbol of the everyday struggles citizens face when seeking care. But symbols alone cannot reform institutions. The lesson from both the hospital queue and the fistula ward episode is that corruption rarely lives in one place; it travels through systems — from the gatekeeper at the hospital entrance to the administrators behind a government desk.
If this moment is to mean anything beyond headlines, it must trigger a deeper commitment to cleaning the entire governance chain of the health sector. Because when corruption survives anywhere within that chain, the person who ultimately pays the price is not the official or the bureaucrat — it is the patient waiting quietly in line, hoping that the system will treat them with dignity rather than opportunity.