May 5, 2022

How trained midwives are saving lives in rural Zambia

During this International Day of the Midwife, we celebrate all those working to save the lives of women and babies by supporting safer pregnancies and deliveries— workers such as Paul Bwalya, a midwife and trained mentor working in Zambia’s Northern Province.

Paul is a nurse/midwife practitioner, nurse manager, and lead clinical mentor in Kasama, the provincial capital. Paul enrolled in the School of Nursing at Kasama College of Nursing in 2006, becoming a midwife in 2013, before pursuing a Bachelor of Science degree in nursing at the University of Zambia.

Paul’s passion for women and newborn health pushed him from his comfort zone in the heart of Kabwe to Nsama District— one of the most rural places of the country. In addition to providing midwifery services, Paul actively mentors young nurses and midwives, equipping them with knowledge and skills that make a difference between life and death.

“Over a decade ago I stepped into something I came to realize I couldn’t do without: a life of service to humanity, saving lives of women and children.”

—Paul Bwalya

The Clinton Health Access Initiative (CHAI) has been working with the Zambian government since 2018 to significantly improve services to reduce maternal and newborn deaths in Northern Province.

The core element of CHAI’s integrated sexual, reproductive, maternal, and newborn health (SRMNH) strategy ensures that all deliveries, no matter where they occur, have access to high-quality prevention, treatment, stabilization, and referral services. This means not only improving services at health facilities, but also within communities.

In many countries where CHAI works, a large proportion of mothers give birth outside health facilities. Midwives play an important role in coordinating efforts to reach women in remote areas and provide quality delivery and postnatal services when they arrive at facilities.

In Zambia, CHAI partnered with the government to implement its integrated SRMNH strategy in Northern Province, covering 146 health facilities and a total population of 1.5 million. A key component of the strategy is building capacity and skills of midwives to deliver effective and high-quality care and referral. CHAI worked with the government to develop skills-based trainings and structured mentoring to strengthen skillsets, knowledge, confidence, and practice to effectively identify, manage, and treat emergency childbirth complications before they become life-threatening and address or escalate issues such as equipment and medication stock outs and failures.

At the start of the program, Northern Province was the most underperforming region in the country, with a high number of unplanned pregnancies and less than half of all deliveries attended by a skilled provider. About 63 percent of women delivered outside a health facility. To address this, CHAI worked with the Ministry of Health and midwives based in health facilities to coordinate community interventions to reach women with preventative services and strengthen referral and transport systems. This approach included strong engagement with traditional leaders, training, and equipping community health workers, deploying community referral and transport systems, as well as training, equipping, and mentoring nurses and midwives at facilities.

In 2019, before the onset of the COVID-19 pandemic, the percentage of women delivering at health facilities in the province rose to 93 percent, achieved through, among other things, the dedication and sacrifice of midwives. The onset of the COVID-19 pandemic in particular brought about fear of contracting the disease through facility visitation. Efforts are now focused on reengaging key community gate keepers and equipping community volunteers to safely provide services to increase facility deliveries once again.

Kasama District Health Office, where Paul works, has been conducting mentorship for midwives and nurses in the district with support from CHAI. These mentorships have enabled facility staff— especially those newly qualified— to acquire skills and competences that enable them to conduct clinical procedures with confidence.

Paul stated, “This has benefitted both the Ministry of Health and the community at large. Communities that were not accessing specialized services like resuscitation of newborns, control of bleeding in women who are pregnant, giving birth, and after childbirth as far as 156 km away from the hospital can now access them from their local clinics where health care personnel are now mentored to carry out the services.”

Paul Bwalya with a mentee Helen Miti after a successful mentorship session at Misengo Rural Health.

One such example was at Misengo Rural Health Centre (RHC), 92 km away from Kasama General Hospital. After an antenatal mentorship session at Misengo RHC, a woman accompanied by her mother, husband, and two other relatives walked in. She complained of vaginal bleeding and had history of amenorrhea for three months. The woman was examined using a speculum and it was discovered that she was hemorrhaging due to an incomplete miscarriage and could die without urgent care.

Paul used this moment to mentor a midwife. The midwife had never conducted manual vacuum aspiration in a real-life setting. The procedure was needed to save the woman’s life. Paul started the procedure as a mentor and allowed the midwife to continue with the vacuum aspiration until the procedure was done. Using the side-by-side approach, the patient was managed from admission to the point when she was resuscitated and stabilized. The mentee expressed confidence in carrying out this task and any other that might arise. This will save not only many other lives but also resources that were supposed to be expended on referral of such cases.

Paul has also been involved much in promoting the health of women and children in communities. He has advocated for strengthening community systems so that leaders and stakeholders can mobilize resources to prepare for childbirth emergencies, including village food banks and transport systems, so that pregnant mothers and newborn babies with complications may have access to health services in a timely manner.

Paul and Helen during a mentorship session on Manual Vacuum Aspiration (MVA) procedure using a demonstration mannequin.

As we celebrate International Day of the Midwife, we call on governments to ensure midwives and other health workers— especially those like Paul serving in remote areas— are adequately supported and motivated. CHAI will continue to work with governments like Zambia to ensure well-functioning health systems that support health workers—the backbone of every health system and extending to the most rural of communities.

Learn about our work on maternal, newborn, and reproductive health

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