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Investing in nurses and midwives to achieve universal health coverage in Zambia and Malawi

Nurses and midwives are the center of health systems and often the first and sometimes the only health professionals that people have access to. In Zambia, nurses and nurse-midwives lead over half of rural facilities and guide primary healthcare delivery in almost all facilities.

[1] Nurses not only provide a wide range of services—from maternal health to cancer diagnosis—they also occupy critical roles as caregivers, teachers, counselors, managers, and leaders in their communities and facilities.

The Zambia government continues to demonstrate its strong commitment to addressing the country’s human resource for health (HRH) gaps including by expanding the nursing workforce; since 2012, the average number of nurses in public facilities has grown by four percent each year. The government is currently leading a mass recruitment of 11,276 healthcare workers, including 3260 registered nurses and 516 registered nurse-midwives.[2]

Through the PeACe Health Project, CHAI is partnering with the Ministry of Health to determine the number of health workers—including nurses—needed for service delivery through workforce optimization analysis. Findings from this analysis will help the government train, recruit, and deploy the right number and type of health workers where they are needed most. CHAI has also provided training for nurses and other healthcare workers providing sexual reproductive, maternal, newborn, child health, and nutrition services in Eastern and Southern provinces, and is supporting the government to construct staff housing in these provinces to promote health worker motivation and retention. CHAI Zambia is a passionate advocate for workforce development and works closely with the government to develop and support its nursing workforce.

In commemoration of International Nursing Day 2022, Mrs. Chowa Tembo Kasengele – Chief Adolescent Health Officer, and Dr. Caren Chizuni – Chief Safe Motherhood Officer at the Ministry of Health speak about their experience in service.

“Nurses are the backbone of the healthcare system. Therefore, the conduct and attitude of the nurse are as important as the knowledge and the skills he/she possesses. It is not how much you do for the patient, but how well it is done that matters.”

– Dr. Caren Chizuni

Chowa Tembo Kasengele, Chief Adolescent Health Officer, Ministry of Health, Zambia

“I have been a nurse for 23 years now. In my service, I have encountered several challenges; one specific challenge I can point out during my course of duty was when I resigned from the mines at Malcolm Watson Mine Hospital in Mufulira to join my husband who was transferred to Nchelenge district, Luapula province. At Malcolm, we had everything we needed such as linens and equipment to carry out our duties effectively and efficiently. However, at a government clinic in Nchelenge, we did not have linen, and the equipment was inadequate to even do a sterile or clean procedure. I lobbied the Director of Health (a midwife by profession) Nchelenge District Health Office to help us with money to buy linen, equipment, and other necessities to provide quality care. Things were provided to us according to the quantities we requested, and so I learned that as service providers, we need to be bold and practice leadership to achieve what we need to serve our communities.”

Dr. Caren Chizuni, Chief Safe Motherhood Officer, Ministry of Health, Zambia

“I have 28 years in service, and have worked at the health center, district, general, and central hospitals both e urban and rural setups. I have also worked at a nursing school as a clinical instructor and nurse tutor at a registered nursing school. I have spent the last 12 years in administration at provincial and national levels.

As a young nurse, I was entrusted to manage wards and departments from the first day I reported for work. Managing wards and departments often needs one to be more knowledgeable and skilled compared to the people that you lead. Additionally, you are also expected to advocate for the patients and clients under your care. This gave me the motivation to upgrade myself quickly and learn to raise my voice for the voiceless. Inadequately skilled providers, and medical and surgical supplies stock-outs were common then. But as a nurse in charge, I made sure that I mobilized resources and advocated for more staff to ensure that clients received quality healthcare. Being knowledgeable and having a good attitude towards patients increases the confidence that your clients have in you, and motivates you to do more. This results in job satisfaction. Nurses are the backbone of the healthcare system. Therefore, the conduct and attitude of the nurse are as important as the knowledge and the skills he/she possesses. It is not how much you do for the patient, but how well it is done that matters.”


Like in many health systems around the world, nursing and midwifery are critical to healthcare delivery in Malawi.[3] An increasing and shifting burden of disease in the country has resulted in a growing number of patients who require quality, round-the-clock care provided predominately by nurses and midwives.[4] COVID-19 exacerbated the problem and doubled the pressure on nurses and midwives. As Nyembezi Gausi, a nurse from Bwaila Hospital in Lilongwe, described: “My job is very stressful as I am basically handling two tasks: that of COVID-19 and the workload from my department.”[5] CHAI is working to alleviate this.

For over a decade, CHAI has worked closely with the Malawi government to support planning and training for its health workforce. CHAI Malawi is supporting the Ministry of Health to quantify the workforce required to meet service demand, cost staffing, and training gaps for nurses and midwives, among other essential cadres, as part of a broader effort to achieve the goals of the National Health Sector Strategic Plan III. We are also partnering with the Ministry of Health and training institutions to determine the investments required to expand and upgrade the nursing workforce, including expanding general nurse training and introducing new programs such as critical care nursing and neonatal nursing.

In commemoration of this year’s International Nurses Day, Mrs. Emily Gondwe-Gama, Deputy Director of Nursing and Midwifery Services (Education) at the Ministry of Health, and Mrs. Ndaona Nkhambule-Botha, Senior Nursing Officer (ICU), Kamuzu Central Hospital share their experiences in service.

“If I can walk away after my shift in the ICU knowing that I have eased a person’s worries or seen them through the night and brought some sort of peace to them, then my day is fulfilled. And the best part is that I get many opportunities every day to do that as a nurse.”

– Ndaona Nkhambule-Botha

Ndaona Nkhambule- Botha, Senior Nursing Officer (ICU), Kamuzu Central Hospital, Malawi

After graduating from Kamuzu College of Nursing in 2010, I wanted to be a theatre instead of a bedside nurse. In an unexpected turn of events, I was posted to work in the intensive care unit (ICU), though it was not what I had wanted. Twelve years later I look back, and I have no regrets. I am a proud critical care nurse. If I can walk away after my shift in the ICU knowing that I have eased a person’s worries or seen them through the night and brought some sort of peace to them, then my day is fulfilled. And the best part is that I get many opportunities every day to do that as a nurse.

In all my years as a nurse, I have never had to show bravery and show up as a leader as I had to at the peak of the COVID-19 pandemic last year as most of the patients needed critical care. During the second COVID-19 wave, I was one of the nurse managers of the 300 bedded field hospital at Bingu National Stadium. Suffice to say, managing over 150 staff amidst an emergency with limited resources was quite challenging—you had to manage logistics and supplies, staff, patient safety, and many other things. It required both emotional and physical stamina and the ability to juggle different variables as they relate to the condition of critically ill patients. Nonetheless, the fact that we managed the crisis as a team was satisfactory.

I left Bingu National Stadium having learned many lessons as a leader but the most important of them all is the importance of a good and dedicated team during a crisis. It makes leading much easier.

Emily Gondwe- Gama, Deputy Director of Nursing and Midwifery Services (Education), Ministry of Health, Malawi

I am a nurse and midwife practitioner and a public health specialist with over 22 years of experience managing district health systems and providing nursing and midwifery services. I am currently a Deputy Director in the Ministry of Health involved in the development of policy and guidelines that regulate the training of nurses and midwives, and healthcare provision.

In my 22 years, I have served as a District Nursing Officer (DNO) and Director of Health and Social Services (DHSS) across different district councils in the country. What this means is that as you traverse the country you meet a wide variety of characters, systems, and socio-economic contexts (urban and rural) that in themselves test your resolve to deliver on your work as a leader. Some districts in Malawi are better resourced than others; as such, supervising nursing and midwifery service provision in the districts, planning, and budgeting for resources, and monitoring the distribution of resources is easier in the more economically vibrant districts.

source: https://www.clintonhealthaccess.org/investing-in-nurses-and-midwives-to-achieve-universal-health-coverage-in-zambia-and-malawi/