It’s a sunny day at St. Mary’s Hospital in Zambia’s rural Copperbelt Province. Mable Chewe is spending her day with a small group of colleagues ticking through a checklist designed to help health workers provide the highest standard of quality care to pregnant women.
“The zeal to help the sick mother and child helped me decide what to do later in my life. When I look at a pregnant woman and think of the life of the unborn child, and when I think about the effects of malaria in pregnancy, mother, and fetus, I am deeply moved to do the best I can to help pregnant women protect themselves from malaria.”
Born and raised in Zambia, Mable grew up helping care for younger children. This set the stage for her future role in helping others as a nurse and midwife. “Malaria infection in pregnancy is a major threat to pregnant women and the health of their babies.” Pregnant women are particularly vulnerable to malaria when they become infected because pregnancy reduces a woman’s immunity, increasing the risk of illness, severe anemia, and death. Maternal anemia increases the risk of miscarriage, still birth, premature delivery, and low-birth weight. Malaria is the number one cause of hospitalization in Zambia and a major cause of morbidity and mortality, particularly in pregnant women and young children. Recent surges of malaria in sub-Saharan Africa have made Mable’s role more important than ever.
To improve the quality of malaria services she provides to pregnant women, Mable participated in a training supported by the U.S. President’s Malaria Initiative’s (PMI) Impact Malaria project in spring 2022. This training is part of PMI Impact Malaria’s quality improvement approach to malaria service delivery called Outreach, Training, and Supportive Supervision Plus (OTSS+). The approach allows supervisors to provide support to health facility personnel through regular mentoring and on-the-job training. Equipped with digital checklists, staff and supervisors share the feedback and agree on corrective action points to follow up on during the next supervision visit.
After participating in the training, Mable felt “enlightened and more confident” in her job. “I was very excited that I had acquired the knowledge and skills I needed most to personally contribute to the elimination of malaria,” she shared. The supportive supervision training “helped me facilitate onsite training and orientation of nurses and midwives in prevention and treatment of malaria in pregnancy. This helped me focus on ensuring adherence to all guidelines, job aids, and strategy documents pertaining to malaria in pregnancy and antenatal care at the health center levels.”
Additionally, Mable used the OTSS+ approach to mentor other nurse midwives as they offered advice and guidelines on preventing malaria in pregnancy, screened pregnant women for malaria symptoms, and performed malaria rapid diagnostic tests when a patient showed symptoms. “OTSS+ helps me improve provider performance through quality supportive supervision at the facility level… [and] provide technical leadership and guidance to the malaria clinical and nursing staff in the implementation and monitoring of malaria in pregnancy at the district and provincial levels.”
Mable also goes the extra mile to understand that many of the pregnant women she works with can be nervous, especially if they are first time mothers and don’t know what to expect. While the checklist is clear and helpful, Mable knows that a friendly, warm approach complements the checklist and can make all the difference when working with pregnant women to protect them from malaria. She has learned through OTSS+ that making patients feel comfortable is part of a holistic approach in providing high-quality care. Her warm, friendly style helps make the antenatal clinics inviting. “I get to know patients individually, learning where they work, their hobbies, and what other challenges they have at home” to humanize the experience. “Their first impression will come from the waiting area, so we make sure it is clean and welcoming. I strive to make patients feel valued and special [which has contributed to why] they are much more likely to come back.”
Mable is optimistic about ending malaria in her country. “We have many reasons to be hopeful: Communities and partners are more engaged in the elimination of malaria with strong political commitment and getting everyone on board from the community to higher levels of care.”
“A future without malaria sounds ambitious, but of course, why not be optimistic? If we continue our campaign and quality malaria services, then it is absolutely possible that we could eliminate malaria in Zambia!”
PMI Impact Malaria is funded and technically assisted by the U.S. President’s Malaria Initiative (PMI) and is led by Population Services International (PSI) in partnership with Jhpiego, MCD Global Health, and the Malaria Elimination Institute (MEI) at the University of California San Francisco.