Funding to the health sector has been erratic for a string of reasons, including economic. The situation is not getting any better to the extent that some public hospitals now only prescribe medication as their dispensaries have no frequently required basic drugs.

But somewhere, the situation is being fanned by unscrupulous health workers who are cashing-in on the little drugs that hospitals order for the poor, especially contraceptives. 

In Thunga area under Senior Chief iNkosi Bvumbwe in Thyolo, for example, some Health Surveillance Assistants are selling injectable contraceptives. 

In our special report this week, Luka Beston, looks at how this is fueling unwanted pregnancies among the youth in the area...

Thunga lies nestled among lush green tea fields deep inside the area of iNkosi Bvumbwe in Thyolo district.

Tea is the dominant economic activity here.  The majority of residents do manual labor in tea estates for a living. For thousands of people in the district, this is life.

The nearest hospital, Bvumbwe, is about five kilometers away. To access health services, locals must navigate the hilly terrain through the tea bushes. The nearest health post in Thunga, primarily serves workers, but not the many casual laborers.

This is why, for the people of Thunga, the presence of the HSAs, is considered a blessing. They may only be surveillance agents in the health sector but here they do more in the rural communities. Primary health care as well.

The HSAs provide basic disease prevention services. They are trained, specifically, to help reduce unwanted pregnancies among youth and families. They are the first line of defense in health matters in communities.

Although these services are supposed to be free, some young people from the area share a different reality.

A young woman we'll call Maria says she had to pay in order to receive contraceptive methods. She claims this is the major reason why many youth shy away from using contraceptives—they're simply unable or unwilling to pay. She felt she had no choice but to pay.

"Some demand that we give them K1000 and others K1500 per method. When we plead with them, they insist that whoever has no money, cannot access the same. 

It really becomes difficult for us as most of the times we don't have money or else we been  asking our parents to help us with the money to buy the contraceptives. This has forced many young people here to have unwanted pregnancies," she lamented.

According to the Family Planning Association of Malawi, the use of modern contraceptives in the country remains relatively low, at just about 37 percent.

The UNFPA attributes this to several factors, including gender-related cultural and traditional practices, values, and norms that often discourage the use of family planning—especially among women and couples.

The situation is made worse by limited access to quality family planning services for adolescents and relatively high illiteracy rates, particularly among women.

Another young woman we’ll call Tina shared a similar experience to Maria’s. She says she was also asked to pay in order to access contraceptives that are supposed to be free.

Discouraged by this, Tina chose not to pay and ultimately gave up on the idea altogether.

"In fact, I stay in the Thunga area but I work at Puteni. So, on that I don't know anything. 

But my question is that in Thunga, there are HSAs that provide those services, why do they forsake those community health providers and opt for paying services; should we assume that their HSAs also sell the same?" He questioned.

These young women have accused Health Surveillance Assistants (HSAs) in their area of demanding money in exchange for contraceptives.

The two HSAs from the area named in this story are Fransinsco Yonasi and Leonard Chirombo. We reached out to both, offering them a right of reply.

Chirombo dismissed the allegations as baseless, stating that although he resides in the area, his catchment area is actually Puteni in Didi.

"I recently went to a village clinic where I found some women who also wanted to access the methods including, the injectables. I asked the whereabouts of the HSA who was not around at that time. After he came, I asked one woman who accessed the method before me if they had Sayana. She told me that it is available, but she whispered in me that the methods were on sale at K1,500 each. But since I had no money, I returned home without accessing the contraceptive," she narrated.

As for Yonasi, he responded by saying he is not a family planning service provider and therefore has no knowledge of the alleged incidents.

"I was not trained in family planning and I don't make family planning at all," he dismissed.

However, a young woman named Esitele shared a different perspective. She said young people are sometimes told to take the contraceptive method and pay later, whenever they have the money.

"Of course, we understand that they are few in number for the area. However, they are not helping us because most of them sell the contraceptives to people at K1500 each method, something that poses as a hindrance for most of the youth who cannot afford that," she alleged.

We presented the Thunga case to the Health Promotions Officer at the Thyolo District Health Office, Fanuel Makina. He stated that "this was the first time he was hearing about it but promised to initiate an investigation to uncover the truth".

A women's rights organization, the Women Rights Institute (WORI), has voiced concerns over the matter.

WORI's Programmes Officer, Chisomo Phaiya, emphasized that authorities must act on the Thunga incident, as such developments undermine the demand for sexual and reproductive health (SRH) services that various stakeholders have worked hard to build in the district.

Health rights expert George Jobe also weighed in, urging district health authorities to investigate the issue. He added, "This should serve as a wake-up call to other districts to examine whether their community health workers are engaged in similar malpractices".

According to 2023 data from the World Bank, Malawi's estimated population was 21.1 million, with an annual growth rate of 2.6 percent. This places a significant burden on the government, which must allocate vast resources to provide essential services such as hospital supplies.

With a low family planning usage rate among youths and young women, the population will likely continue to grow—further straining already limited government and natural resources.

What Malawi needs now is more effort to promote the use of family planning methods, not the discouraging experiences currently happening in Thunga in Thyolo.