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.
By stepping into the queue as an ordinary patient, reportedly holding card number 205, the minister experienced 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 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.
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 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.
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.
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.
(To be continued next week
