The private health sector in Malawi: Opening pandora's box?

In 1987 the Malawi government liberalized its Medical Practitioners and Dentists Act, allowing doctors in the public sector to undertake part‐time private practice, and permitting paramedical and allied health professionals to enter into private practice. Using a policy analysis approach, the authors trace the context within which policy change occurred, the actors involved, and how the process was initiated and implemented. A rapid survey was undertaken of about half the paramedicals and one fifth of the doctors practising privately. This showed that growth of private practice has been greatest among paramedicals, that a typical private clinic has a single practitioner, is located in a township, trading centre or peri‐urban area, and that although charges per patient visit are relatively low, incomes in the private sector are considerably higher than in the public sector. Growth in the private health sector raises a number of policy questions around control and quality of care for the majority of Malawians.