The shadow family-planning network putting women at risk in Machinga

People pose as healthcare providers administering prescription-only contraceptives, selling medicines and allegedly reusing injection equipment, while claims of government contraceptives being diverted into the black market raise urgent questions about supply-chain controls and accountability.

BY MAYESO MIDESA

The Citizen Eye’s investigation has uncovered an illegal network of unqualified individuals allegedly posing as healthcare workers, administering contraceptive injections, dispensing prescription medicines and charging women for services that are supposed to be provided free through Malawi’s public health system.

The months-long investigation also uncovered that government-supplied contraceptives are being diverted from public health facilities into a thriving underground market and that some illegal providers reuse syringes when injecting women, exposing them to potentially life-threatening infections, including HIV and hepatitis.

Our findings point not only to the illegal practice of medicine but also to serious failures in public health oversight, medicine supply chain security and law enforcement.

Working undercover, The Citizen Eye team met several self-proclaimed healthcare providers operating in rural communities across Machinga District.

During separate secretly recorded meetings, the suspects admitted administering injectable contraceptives and supplying contraceptive pills to what they described as hundreds of women and girls.

Among the medicines displayed were Depo-Provera and Sayana Press (104 mg/0.65 mL), both prescription-only injectable contraceptives designed to prevent pregnancy for approximately three months.

The suspects also possessed sildenafil tablets, a prescription medicine commonly used to treat erectile dysfunction.

They claimed that they sell the sildenafil tablets to men to keep them longer and strong during sex.

One suspect only identified himself as Zipangani from Mkuzumba village in Traditional Authority Nsanama admitted purchasing contraceptives from some Health Surveillance Assistants (HSAs), claiming the medicines originate from government health facilities where they are intended to be distributed free of charge.

“They are normally given the contraceptive drugs by their health facilities to administer for free to women and girls who need family planning services. We buy them from the HSAs at a fair price and sell them to the women at a good profit,” he told The Citizen Eye.

He further claimed that the sildenafil tablets are purchased from private pharmacies, which according to the new evidence, continue to sell out despite a recent ban by the Pharmacy and Medicines Regulatory Authority (PMRA) following it’s severe effects including deaths.

The Citizen Eye could not independently verify the allegation that HSAs are selling government contraceptives. However, the claim raises serious questions about possible diversion of public health commodities that warrant urgent investigation.

Beyond the alleged illegal sale of contraceptives, Citizen Eye documented practices that public health experts describe as deeply alarming.

During undercover engagements, one suspect was unable to identify all the medicines in his possession or explain how some contraceptives work, their side effects or the conditions that make hormonal contraceptives unsafe.

Our team also gathered testimonies alleging that some providers reuse syringes without proper sterilisation when administering contraceptive injections.

The experts have warned that such practices could expose women to HIV, hepatitis B, hepatitis C and other serious infections.

Interviews with affected women, community leaders, health officials and other sources suggest the illegal practice has spread across several communities, exposing women to improperly administered contraceptives, inadequate medical assessment, poor infection prevention practices and the absence of professional follow-up care.

“I really wanted to prevent getting pregnancy, and I resorted to them (illegal dealers) because I couldn’t manage to walk long distance to the health centre to get contraceptives,” said one of the affected young women asked for anonymity for fear of reprisals.

The victim said she was not aware that the contraceptive providers were untrained, and that she didn’t know of the severe effects of engaging with untrained service providers .

Machinga District Health Office spokesperson Wongani Nyirenda confirmed that contraceptive services are legally provided only by trained Health Surveillance Assistants, nurses and clinicians.

However, despite the evidence gathered during this investigation, he said the district had not received reports about the alleged malpractice.

“Contraceptives are provided to clients by trained providers, HSAs, nurses and, at times, clinicians. So far, we have not received any reports to that effect,” Nyirenda said.

When asked whether the district would investigate the allegations uncovered by our publication , Nyirenda said:

“As I indicated earlier, we have not received any reports to that effect. Once we receive one, we will act.”

Public health governance expert Maziko Matemba described the findings as evidence of a serious breakdown in health governance.

“This investigation reveals a severe breakdown in health governance, supply chain security and patient safety that demands immediate, coordinated intervention,” he said.

He warned that administering prescription-only hormonal contraceptives without proper medical assessment can expose women to strokes, blood clots, severe hypertension and other potentially life-threatening complications because unqualified providers cannot adequately screen for medical conditions that make hormonal contraceptives unsafe.

Matemba also warned that improper injection techniques and the reuse of needles could result in abscesses, tissue damage and the transmission of blood-borne infections, including HIV and hepatitis B and C.

He said The Citizen Eye’s finding that some suspects could not identify the medicines in his possession raises concerns that women could receive expired medicines, incorrect dosages or even the wrong drugs, increasing the risk of contraceptive failure, adverse drug reactions and unintended pregnancies.

Matemba called for immediate intervention by the Machinga District Health Office, the Malawi Police Service and the Pharmacy and Medicines Regulatory Authority (PMRA).

He recommended a criminal investigation into individuals allegedly practising medicine without licences, a forensic audit of contraceptive stocks handled by HSAs in affected areas, and disciplinary action against any public health workers found to have diverted government medicines.

Matemba’s concerns are echoed by an epidemiology and public health expert from Kamuzu University of Health Sciences, who requested anonymity because they were not authorised to speak publicly on the matter, said the investigation raises urgent questions that authorities can no longer afford to ignore.

“Most importantly, if you have been able to uncover evidence suggesting an illegal network operating in rural communities, why have the institutions responsible for regulating healthcare and protecting the public failed to detect and stop it?”

“In fact, you are sharing crucial findings with the relevant authorities. The evidence now places responsibility on health regulators and law enforcement agencies to establish the facts, investigate those implicated and, where criminal conduct is proven, ensure those responsible are held accountable,” he said .

The Citizen Eye repeatedly sought comment from the Pharmacy and Medicines Regulatory Authority and the Malawi Police Service regarding the investigation’s findings. By the time of publication, repeated telephone calls had gone unanswered.