Primary Impact meets Success in Malawi

The hour-long walk through acres of cornfields and dusty dirt roads was very familiar to Angelina Yona. The 19-year old Malawian was expecting her first child, and regularly made the trip from her home in Gawamadzi Village to Chiwamba Health Center, where she attended ante-natal visits. During each visit, a nurse would check her vital signs, weigh her to monitor the baby’s growth, and counsel her about danger signs that could mean an emergency situation for her or her baby. As Angelina approached her due date, the nurse also counseled her to prepare cash for any unexpected expenses.

One day, when she was just 37 weeks pregnant, Angelina started to bleed. She immediately recognized one of the signs that the nurse had warned her about, and knew that she needed to get to the health center, and fast. Bleeding in late pregnancy can be a sign of placental abruption — a potentially life-threatening condition for both the mother and baby.

Angelina used some of the money she had set aside to hire a taxi to take her to Chiwamba, covering the rough, dirt road much more quickly than usual. At Chiwamba, the midwife on duty stabilized Angelina, and called an ambulance to take her to the district hospital 30 miles away. Within an hour, the ambulance arrived, and Angelina was on her way to Bwaila District Hospital, where doctors were waiting for her. 

For more than 40 years, the U.S. government has partnered with local governments in countries like Malawi to strengthen health systems so that women like Angelina can access high-quality maternity care, and other primary health care services. Through the U.S. Agency for International Development (USAID), the United States works with the Malawi government to provide training and mentoring to health care workers, deliver commodities and equipment so they can manage obstetric emergencies, and carry-out community awareness activities to foster health seeking behavior. 

These USAID investments have helped improve health outcomes for mothers, children, and infants. Malawi is one of the few countries on track to achieve Sustainable Development Goal 3.2 — ending preventable deaths of newborns and children under-five years of age – and has experienced incredible reductions in both maternal and child mortality in the past 10 years, from 675 to 439 and 77 to 42 deaths per 1,000 live births, respectively.

During a recent visit to Chiwamba Health Center, USAID’s Assistant Administrator for Global Health, Dr. Atul Gawande, described how USAID plans to build upon these successes through the Agency’s new effort, Primary Impact, which aims to strengthen primary health care across seven focus countries, including Malawi.

"Through Primary Impact, we are driving a radical reorientation of country health systems toward primary health care so they are better equipped to handle a person’s health needs across their lifetime and ready to respond to health emergencies," said Assistant Administrator Gawande. "USAID investments in Malawi's primary health care system helped to protect both Angelina and her daughter's lives."

After arriving at Bwaila District Hospital, doctors decided to induce Angelina’s labor. A few hours later, she gave birth to a healthy, five-pound baby girl who she named Success. As Success slept peacefully on her mother’s lap a week later, her mother smiled. Despite her scary start, Success now has every opportunity to enjoy a healthy, happy, and productive future.  


A man in a suit kneels down to speak eye to eye with a young mother holding a newborn baby on her lap.
During a visit to Chiwamba Health Center in Malawi, USAID’s Assistant Administrator for Global Health, Dr. Atul Gawande met Angelina Yona and her newborn daughter, Success.
Photo by Kelvin Before Gumbi for USAID
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