Recent outbreaks of crop pests such as fall armyworm and desert locusts are threatening food security and have spurred increased use of pesticides in sub-Saharan Africa. While pesticides can prevent crop losses, they can also have adverse effects on human health and the environment, if not used judiciously. In this article, we examine whether plant clinics―an innovative extension approach of providing plant health diagnostic and advisory services to smallholder farmers―can enhance judicious use of pesticides, measured by intensity of pesticide use, adoption of alternative and more environmentally friendly pest management practices, safe pesticide use practices, and incidence of pesticide-related illness. We use data from a sample of 1474 farm households in Rwanda and Zambia. Propensity score matching estimates suggest that although plant clinic participants exhibit a higher probability of opting for pesticides for pest control, they do not use pesticides intensively and are more likely to adopt alternatives to chemical pest control. On the other hand, plant clinic users and non-users are equally likely to use restricted pesticides and inappropriate methods of disposing of pesticide wastes, which can lead to pesticide poisoning. Overall, our results imply that the plant clinic extension approach can promote sustainable pest management in smallholder agriculture, but additional training of plant clinic staff and clients on pesticide safety would be necessary.