THE PUBLIC-PRIVATE MIX IN THE HEALTH-CARE SYSTEM IN MALAWI

The makings of a mixed health care system in Malawi go back to the time before independence when Mission Hospitals coexisted with Government District Hospitals. This public/private mix is what has defined health care provision in Malawi from about the 1930s to the end of the 1980s. Recent changes in policy towards private health care provision, dating back mostly to the 1987 Medical Practitioners and Dentists Act, have opened the flood-gates to another form of private provision: that by private for-profit providers. For a long time since independence, the government stifled the growth of this subsector through legislation and requirements on registration. Now, thanks to liberal registration of medical practitioners, the relaxation of policies restricting private practice by government doctors, and early retirement, the subsector is fast expanding. Occurring simultaneously with these policy shifts have been other developments, among them the emergence of a health insurance industry and the expansion of drug outlets. These developments are mutually re-enforcing in that each relies on the success of the other. Recognizing the benefits to be gained from a properly coordinated health care system, the Ministry of Health is reaching out to the other private providers - be they for-profit or not-for-profit - in order to tap into their resources. The paper discusses some of these developments and examines the future of health care in Malawi. Some future needs are identified if this 'boom' in private practice is to benefit consumers of health care.