A Midwife's Story: Stronger Leaders, Healthier Newborns

Rebecca Simon

Former Manager of Strategic Communications

This blog post originally appeared in Management Sciences for Health's newsletter and blog.

Linvell Nkhoma is a midwife manager at Mitundu Community Hospital in northern Lilongwe, Malawi. She lives on the hospital premises so she can be on call 24 hours a day for emergencies or complicated cases that less experienced midwives don’t know how to manage.

“We have limited space, only three delivery beds for 400 deliveries a month,” Linvell said.

Linvell and her colleagues were concerned about overcrowding, and more importantly, the high rates at which mothers and babies were dying during deliveries.

In 2014, Malawi’s ministry of health selected Linvell to participate in the Leadership, Management, and Governance Certificate Course for Midwives. The course is run by the USAID-funded and MSH-led Leadership, Management, and Governance (LMG) Project, in close partnership with LMG Project partner Amref Health Africa. The hands-on course helps midwives learn skills like assertive communication, advocacy, mentoring, change management, and problem-solving. Using these skills, midwives use real-life challenges they face to improve health indicators at their facilities.

Linvell set her target to reduce premature neonatal mortality by 27 percent in six months by improving kangaroo mother care — skin-to-skin contact between newborns and their mothers — exclusive breastfeeding, and emotional support and bonding. Immediately the challenges to implementing kangaroo mother care became clear.

“Nurses in the maternity ward also work in the newborn unit, and premature babies did not get the attention they needed,” Linvell said. This meant adding kangaroo mother care to the responsibilities of already busy nurses.

Undaunted, Linvell put together a plan for training hospital attendants — not just nurses — on the practice, advocating for resources for a kangaroo mother care room, and ensuring that at least one midwife would be stationed in this room each day.

Six months after starting the leadership course, Linvell’s hospital decreased premature neonatal mortality by 25 percent. While this is just shy of her goal of a 27 percent decrease, there are more healthy babies in her community, and Linvell has more confidence and skills for overcoming challenges.

The Leadership, Management, and Governance Certificate Course for Midwives is one of several tools offered by the LMG Project to foster skills that promote high-quality health service delivery and responsive health systems. USAID has been investing in developing inspired leaders, sound management systems, and transparent and accountable governing boards for health for more than 30 years. MSH has been the leader of these investments since 1985.

By helping frontline health workers like Linvell improve their skills, the LMG Project is strengthening teams within clinics, organizations, networks, and governments. These stronger teams are key ingredients of stronger health systems.

“As a midwifery manager, I encounter many challenges. The LMG Project empowered me as a manager,” Linvell said. “I now have conflict-resolving skills. I acquired mentorship skills which I use to mentor students who come for clinical placement in the hospital.”

She added, “we were lacking negotiation skills, resource mobilization skills, and this course is empowering us to be assertive and use the challenge model to identify and solve our own problems."