Malawi’s health sector is plunged in yet another crisis that has left public hospitals struggling to meet the growing demand for specialist healthcare amid limited training opportunities, funding constraints and inadequate hospital capacity.
The situation raises concerns about the country’s capacity to provide timely treatment for patients with complex medical conditions because the few available specialists have to balance between heavy workloads and competing responsibilities as well as limited access to facilities.
In an interview, oral and maxillofacial surgeon James Mchenga confided that he has about 250 patients waiting for treatment while the country’s sole paediatric endocrinologist Amos Msekandiana highlighted the pressure facing specialists in some critical fields.
The shortages extend to other disciplines, including neurology, where the country has only two adult neurologists, namely Yohane Gadama and Tiwonge Elisa Phiri. Wanangwa Collins Chisenga, Charles Mabedi and Linda Kayange are the country’s only urologists.
Mchenga, who also teaches at Kamuzu University of Health Sciences (Kuhes), said his workload is overwhelming, with limited operating theatre time, a development that restricts the number of patients he can treat.
to help everyone.
| Esnart Tembo
“I have about 250 patients on my waiting list, yet I only manage to operate four or five times a month. It is impossible to help everyone under these conditions,” he said.
Mchenga, who operates from Queen Elizabeth Central Hospital in Blantyre, said he was allocated one operating theatre day a week, which is also be disrupted by emergency cases, further limiting his ability to clear the backlog.
However, he attributed the shortage of doctors partly to delays in developing specialist training programmes, citing dentistry as an example.
Malawi’s first medical school opened in 1992 as the College of Medicine under the University of Malawi, but now a standalone Kuhes. However, dentistry training only began in 2019, a delay Mchenga said contributed to the shortage of professionals in the field.
“That delay created a gap in specialised personnel,” he said.
The challenge is also pronounced in paediatric endocrinology, a field concerned with hormonal disorders, including diabetes in children.
Msekandiana said being the country’s only specialist in the field was overwhelming, particularly as he also serves as director of Kamuzu Central Hospital (KCH) in Lilongwe and lectures at Kuhes.
He said his administrative and teaching responsibilities reduced the time available for specialist care, adding to the pressure of serving patients in a field with very few practitioners.
Msekandiana said scholarship opportunities were available through the Ministry of Health and Sanitation to help medical professionals pursue postgraduate studies and specialise.
However, he said some prospective specialists were reluctant to pursue further training because of concerns that scholarships might not cover the full cost.
“Some students are reluctant to pursue further studies because some scholarships are not fully funded. They may also prefer to start working, considering the current economic situation in the country and worldwide,” said Msekandiana.
Kuhes public health Professor Adamson Muula acknowledged that Malawi did not have enough specialists but said the country was making progress in developing its specialist workforce.
He said some medical fields previously had no locally available specialists, forcing the country to rely on expatriates to provide specialised services.
“The country does not have enough specialists, but we are making progress. In the past, there were areas where we had no specialists and had to rely on experts from outside the country,” said Muula.
He said becoming a specialist requires an additional five to seven years of postgraduate training.
“Many specialist programmes are undertaken outside Malawi, making the training process lengthy and dependent on access to funding,” observed Muula, who added that approximately 40 medical professionals travel abroad annually to pursue specialist training, a development he believes could help increase the number of specialists in the coming years.
He also challenged the perception that funding for specialist training was entirely unavailable, saying opportunities existed, although some students might not know how to access them, particularly through the Ministry of Health and Sanitation.
Muula said the shortage did not necessarily mean patients were entirely without treatment, as doctors in other disciplines and appropriately trained clinical officers could manage certain conditions.
For instance, clinical officers trained in diabetes management could assist patients, while doctors in general and internal medicine could treat some conditions outside their immediate areas of specialisation, he said, but acknowledged that such arrangements could not replace specialist expertise, particularly when patients developed complications requiring advanced intervention.
The pressure on specialist services is also evident in neurology, where the limited number of practitioners face substantial clinical demands.
In a 2025 interview published in the Malawi Medical Journal, Gadama said the shortage of neurologists had resulted in overwhelming workloads, with doctors attending to patients at Queen Elizabeth Central Hospital while also handling consultations from other health facilities nationwide.
He also cited limited diagnostic and treatment options, including the unavailability of some essential medicines and specialised treatments for conditions such as stroke.
On Friday, philanthropist and business mogul Thomson Mpinganjira gave the country’s health sector a diagnostic boost with a launch of a facility capable of early diagnoses of 100 diseases, including various cancer types.
In his remarks during the opening of the modern International Blantyre Cancer Centre (IBCC) Diagnostic and Medical Imaging Centre, he said the centre has installed advanced medical equipment, including a computed tomography (CT) scanner, magnetic resonance imaging (MRI) machine, mammogram, X-ray and 4D ultrasound machine.
Ministry of Health and Sanitation Principal Secretary (Administration) Bestone Chisamile commended Mpinganjira for the investment, describing diagnostic services as a critical foundation of healthcare delivery.
Gadama said improving neurology services required investment in patient care, research and the training of more specialists.
“I want to contribute to building a robust neurology service in Malawi,” he said.
The shortage also raises questions about the financial implications for patients and government, particularly where specialised treatment cannot be provided locally.
In the 2026/27 financial year, government allocated K3 billion for medical referrals abroad, although the amount attributable specifically to the shortage of local specialists has not been established.
Ministry of Health and Sanitation spokesperson Benedicto Mbewe said the ministry’s Principal Secretary had referred questions on the shortage to the human resource manager, who was unavailable at the time of inquiry.
A 2025 report, however, cited over 500 patients waiting for urological services, adding to evidence of pressure on specialised care in that particular area.
Meanwhile, Malawi Health Equity Network executive director George Jobe said government needed to intervene more decisively to ensure patients received timely treatment.
In an interview yesterday, he called for authorities to assess the country’s specialist healthcare needs and establish practical measures to help patients who cannot access treatment because of the shortage of experts.
Kuhes offers a six-year undergraduate medical programme that qualifies graduates as medical doctors. Those seeking to specialise must undertake further postgraduate training, often lasting another five to seven years and frequently requiring studies outside the country.
The lengthy training period, coupled with the cost of postgraduate education and the demands placed on the few specialists already practising in Malawi, presents a significant challenge to expanding the country’s specialist workforce.
In September this year, the Malawi College of Physicians said the country requires at least 300 specialist doctors, compared to a current count of only 45.
The country’s overall physician-to-population density is about 0.05 to 0.1 physicians per 1 000 people (roughly 1 doctor per 33 000 to 50 000+ people), which falls far below World Health Organisation benchmarks.
