In Malawi, Nurses Are Leaders Amid COVID-19

As COVID-19 struck and millions of people worldwide quarantined at home, health workers did the opposite—they walked straight through hospital doors, ready to care for patients, even as little was known about the deadly new virus.

Isaac Mphande, primary care nursing manager at Abwenzi Pa Za Umoyo, as Partners In Health is known in Malawi, was among those health workers.

“Everyone was not safe,” he recalls. “Being a public place, everywhere you stood was a potential risk of contracting the virus. But we knew we had to help in saving lives. So, we continued doing our work.”

Even as case counts rose, along with uncertainty, Mphande led Abwenzi Pa Za Umoyo’s team of 19 nurses through the COVID-19 response, providing the medical care and social support that define PIH’s work around the world.

This year, he is one of 10 recipients of PIH’s Global Nurse Executive Fellowship—a program launched in 2017 to equip nursing and midwifery leaders at PIH’s clinical sites with the knowledge and skills to respond to global health challenges and transform health systems, from the ground up.

A Commitment to Service

Nearly 50% of the world’s health workers are nurses and midwives.

Yet, nurses and midwives are systemically undervalued compared to doctors and health care management, receiving lower pay and fewer leadership opportunities. And when they are placed in leadership roles, they don’t receive the necessary tools, skills, or support to be successful. That’s a reality that the fellowship aims to change.

Each year, 10 awardees are selected from among senior and executive nurse leaders at PIH’s clinical sites around the world. Mphande was chosen for the year-long program following his outstanding leadership in response to COVID-19. The program includes three, weeklong intensive bootcamps, a yearlong executive-style curriculum, and a capstone project which seeks to improve patient outcomes and care delivery.

Originally from Mzimba, a district in the northern region of Malawi, Mphande holds a Bachelor of Science in Nursing and Master of Science in Midwifery from Kamuzu University of Health Sciences in Blantyre, Malawi. He first began working as a nurse in December 2008 at Chitipa District Hospital.

He joined Abwenzi Pa Za Umoyo in September 2018, drawn to its mission.

“I love PIH because of the commitment to serve people who live in challenging situations,” he says.

Now, as primary care nursing manager, he supervises a team of 19 nurses in rural Neno District, where he manages clinical care, making sure patients are supported from screening to outpatient services, and mentors Abwenzi Pa Za Umoyo’s nurses, midwives, and support staff, investing in their professional development.

Abwenzi Pa Za Umoyo has worked in Malawi since 2007 in partnership with the Ministry of Health and has expanded to support two hospitals, 12 health centers, and a network of about 1,300 community health workers. Its clinical programs include HIV, malnutrition, and mental health.

In an area where more than half of families live below the poverty line, Abwenzi Pa Za Umoyo provides food and housing assistance to more than 4,500 patients each year, tackling the structural barriers that prevent patients from accessing health care.

It’s work that Mphande finds fulfilling on a personal and professional level. But it’s not without hurdles.

“The biggest challenge is resource constraints in the environment where we work,” he says. “We have few staff members and not enough medications or supplies.”

Another obstacle, he says, are poor roads in Neno, which can lead to delays in medical supplies reaching the health centers as well as for patients seeking referrals for advanced care.

Nurses as Leaders

When COVID-19 struck, those challenges were compounded—fearful of coming to the clinic, patients canceled their check-ups and attendance dropped, even among pregnant women, leading to complications in maternal care, including some that persist to this day.

But Mphande and his team were determined to respond as fast and as comprehensively as they could, despite limited resources and a staffing shortage. Over the course of the year, with Mphande’s support, Abwenzi Pa Za Umoyo trained more than 1,225 community health workers to educate the public about COVID-19, continued its health services for thousands of patients, and provided key insights that informed the Ministry of Health’s nationwide pandemic response.

That work has continued to this day.

As wealthy nations hoard vaccines and COVID-19 puts patients’ lives at risk in Malawi and other low- and middle-income countries, Mphande is continuing to press forward with the pandemic response, strengthening Neno’s health system and leading his team by example, as a nurse and midwife—leadership that he hopes to see more of.

“There are more nurses practicing in health facilities [now] compared to the time I started working as a nurse,” he says. “I hope to get more nurses into leadership roles at PIH.”