Joseph Mandala, from Traditional Authority Kaphuka in Dedza, has been at the National Cancer Centre for three gruelling weeks, his condition deteriorating with every passing day. Frail and unable to eat, Mandala was first diagnosed with oesophagus cancer in 2023. This year, the disease resurfaced, and now he waits.
“At the centre, they took my samples for tests, but I am yet to know the next step,” Mandala said. “As you can see, I am weak because I cannot eat. I was told I have a swelling on my neck which requires an operation.”
His ordeal is tragically common here. Labson Lemasi, also from Dedza, is enduring his second visit. Diagnosed with cancer on his leg in 2023, he underwent an amputation. The cancer has returned, requiring chemotherapy, but Lemasi has been waiting three weeks just for the prescription. He struggled to afford the K120,000 palliative drugs prescribed earlier.
“What I have noticed here is that officials take long to prescribe our next steps,” Lemasi observed.
“Most patients are referred here when the situation has already worsened. The longer they take, the more the situation deteriorates. I have seen people dying while waiting for prescription. It is something authorities can improve to save lives.”
His fears are backed by statistics: Malawi records over 19 000 new cancer cases each year, up from just 10 000 in 2009. Crucially, over 13 000 people die annually from cancers that could have been treated—a burden significantly driven by cervical cancer, where Malawi ranks among the highest in the world for incidence and mortality.
Critical shortages undermine operations
Almost five months after the National Cancer Centre’s full operationalisation, the facility is struggling to save lives, operating far below capacity and expectations.
Officially opened in July by former president Lazarus Chakwera, the centre was touted as the solution to end decades of costly referrals abroad, expenses that often exceeded K3 billion annually.
Our investigation, however, reveals that the dream has been shattered; patients are still flying out of the country, while those who remain face systemic failure.
Kamuzu Central Hospital director general Amos Msekandiana admitted the National Cancer Centre is facing a critical staffing challenge that cripples its daily operations. The facility runs on just 30 percent of the required specialist care, with most oncologists currently borrowed from UNC Project Malawi.
Msekandiana highlighted impossible workload: “The centre has 15 specialist doctors that comprise clinical oncologists, medical oncologists, gynaecologists, pathologists and radiologists among others. They have a huge task of treating 19 000 people annually.” He noted that the hospital would normally require about 50 specialists, suggesting the current international benchmark of one oncologist per 500–800 new cases is unworkable under current conditions.
On the drug front, Msekandiana admitted the facility often lacks essential medicines, including Morphine, Granisetron, Dexamethasone, and radiopharmaceuticals, as they are not stocked at the Central Medical Stores Trust (CMST).
The bureaucratic tendering process further complicates matters, forcing the facility to prescribe drugs costing hundreds of thousands of Kwacha like the K300 000 worth of medication prescribed to cervical cancer patient Maria Chizongolo—which patients must struggle to buy from private pharmacies.
For context, common cancer drugs like Docetaxel 120 mg cost K60 000 while Trastuzumab costs an astronomical K950 000.
Secretary for Health Dan Namarika admitted the centre faces innumerable challenges, chief among them understaffing. “We admit that the centre is understaffed and that is an area that we are working on,” he said.
“We want to explore possibilities of partnering with the International Blantyre Cancer Centre and other centres abroad to share knowledge.”
Namarika, however, also expressed worry about a new problem: the facility is being overwhelmed by nationals from neighbouring countries accessing services free of charge, adding pressure at Malawians’ expense.
He also noted a trend of people who can pay accessing services for free, suggesting the government may explore possibilities of charging those capable of paying to ensure resources are available for those in genuine need.
Amid the crisis, Finance Minister Joseph Mwanamvekha, in the mid-year budget statement, acknowledged the country’s hospitals are struggling with drug shortages and allocated K17 billion for buying drugs, of which K8 billion has been directed to central hospitals.
For patients like Mandala and Lemasi, this measure remains a distant promise, as they continue to wait in the shadow of a facility designed to save them.
