TBAs enhanced role in maternal, child health delivery

They are simply selfless in their work to deliver new babies to mother earth. They are just dedicated and committed to what they do.

Although their roles are primarily voluntary and indispensable to health delivery, they are often sidelined and neglected. Yet they exist and work in inaccessible remote areas where the aura of orthodox medicine cannot reach.

That their existence predates the establishment of modern orthodox medical practice makes them a ready, quicker and trusted intermediaries people gladly visit, consult or count on, in terms of deliveries, especially in areas of unreliable means of transports, poor road networks and where the cost of transportation to the nearest health centre was beyond the means of the people.

The Traditional Birth Attendants (TBAs) are but a priceless human resources whose contributions are yet to be fully recognized, tapped and rewarded.

The depth of their understanding of delivery, their sense of urgency to act and their willingness to support mothers have resulted in the deliveries of many babies and the death of many potential leaders and women.

However, the recent training of some 140 TBAs in parts of the Brong Ahafo, Ashanti and the Northern Regions of Ghana has shown their readiness to learn and sharpen their skills as well as collaborate and complement effectively with efforts by health institutions to ensure safe deliveries of babies.

As a result of the training, the TBAs have been  stirred  to do more to improve upon maternal and child’s health in these areas.

The training programme, according to Mr. Peter K. Yeboah, Director of Health Services   in the Catholic Diocese of Goaso, was conducted by the National Catholic Health Service in partnership with some institutions of the Christian Health Association of Ghana (CHAG), and sponsored by  Cordaid-The Netherlands.

A recent study tour of some TBA training sites at Hwidiem and its catchment area in the Asutifi South District; Abease and Yeji and their environs in the Pru District, all in the Brong Ahafo Region, as well as Kayereso and Nalerigu in the East Gonja and East Mamprusi Districts respectively in the Northern Region, has shown the encouraging contributions the TBAs were making to skilled deliveries and reduction in maternal and child morbidities.

Available data at the collaborating health facilities the TBAs were working with indicates a sharp increase in the antenatal (ANC) and   postnatal (PNC) attendance, increased referrals from the TBAs and increased supervised deliveries, as well as a reduction in maternal and child mortalities.

Records at the St. Elizabeth Catholic Hospital, for instance, where the training programme was first conducted for 28 TBAs in 2009, shows a sharp increase in referrals of pregnant women to the hospitals, which has led to increases in ANC and PNC attendance and deliveries after 2009.

Background

It was observed between 2006 and 2007 that antenatal attendance at the St. Elizabeth Catholic Hospital has plummeted from 7000 to 6000, with amenable increases in maternal mortalities, at a time maternal healthcare services was available, accessible and affordable.

Mr. Yeboah said that the situation prompted a survey, which revealed that more pregnant women at the time were patronizing the services of TBAs, and noted that the problem had to do with cultural acceptability of the maternal health services.

It was further discovered that the TBAs who were barriers to, and gatekeepers of pregnant women accessing maternal services were for instance using their bare hands in deliveries and giving local oxytocin (toxic herbal concoctions) to pregnant women to induce labour, which were in a way contributing to more community maternal and infant morbidities.

Among some communities for instance, the belief that pregnant women should by all means be touched by TBAs before they gave birth or even go to the hospital created a barrier for pregnant women not to attend ANC at the hospitals even though the services rendered to them were free, accessible and affordable.

Mr. Yeboah said the Catholic Diocese of Goaso, based on social justice and equity principle of the Catholic Church’s Social Teaching and the geographical context the Diocese found itself, started the training for TBAs in 2009 as partners to help improve upon maternal health delivery, at a time Ghana Health Services had directed its facilities not to deal with the TBAs.

With variation in development index of the country the Director of Health Services noted that “we will never have a situation where midwives will be located in every village, so the TBA is relevant and will always be relevant,” adding that “they are needed as part of public health care to mobilise their community to take care of their own health”.

“The TBAs are local assets. They are change agents, that ought to be recognized, trained and repackaged very well and leveraged to improve maternal and child health,” he stressed.

A section of the TBAs including Madam Comfort Kwakye at Ata ne Ata and Madam Adjoa Pokua at Donkorkrom, in separate interviews confirmed the important lessons the training programme offered them and thanked organisers for presenting them with the TBA emergency delivery kits. Papa Dogo, ‘class prefect of the TBAs’ at Aportoyoawa near Goaso, reechoed the desire for the extension of the programme to cover more TBAs in the country. 

After the training for the 28 TBAs, Madam Princila Asor Frimpong, Public Health Midwife, in-charge of the Reproductive Child Health (RCH) Unit at the St. Elizabeth Catholic Hospital reports of the remarkable improvement in the numbers of referrals from the TBAs to the Hospitals and also commended their supportive role to pregnant women.

She acknowledged their dedication, commitment and sacrifices they were making to help improve on maternal and child health in their communities, noting the sacrifices  they make, to the extent of accompanying expectant mothers in labour to the hospitals as well as stay with them for the number of days they (pregnant women in labour) had to be at the hospital.

Administrator of the St. Elizabeth Catholic Hospital, Rev. Sr. Comfort Apedzi, also praising the general collaboration between the hospital and the TBAs, stressed the need for continuous education and sensitization among communities to help improve maternal and child health.

Other project areas

With success of the training programme at Hwidiem and its environs, the programme was extended to Mathias Catholic Hospital-Yeji and the Abease Catholic Health Centre both in the Pru District and under the Catholic Diocese of Techiman, where TBAs operating in remote areas including villages and islands on the Volta Lake were targeted.

Interacting with TBAs at Fawoman, Damankwanta, Abease, Abease-Krobo, Kamanpa and Cherambo communities, expressed how happy they were to have received the training, which a number of them recounted has helped them stopped the administration of local oxytocin (herbs and concoctions) to induce labour among pregnant women.

They said the 14-day training has taught them a lot on how to care for pregnant mothers and they now appreciate the essence of skilled deliveries. They appealed for mobile handsets to enable them communicate with the midwife at Abeasein matters of emergencies and referrals.

Noting the increased TBA referral of pregnant women to the facility, Madam Comfort Konadu, Midwife at the Abease Health Centre, commended the collaborative role of the TBAs, noting the efforts many of them were making including Madam Juliana Mansah, a neatly dressed TBA attached to the Clinic as well as Madam Comfort Donkor and Felicia Agyewaa at Damankwanta to maternal and child health.

Sharing her over three decades experience Madam Mansah also called for the training of more TBAs who were not covered in the first training programme, noting that the training has really improved their knowledge and skills of deliveries.

“It is worth understanding the TBAs’ beliefs and long traditional practice of conducting deliveries”, says Madam Dorcas Zenabu Seidu, Midwife at the Mathias Catholic Hospital-Yeji, and main facilitator for the training programme last April. She expressed the need for closer working relations between Midwives, health professionals and the TBAs since the latter has a lot to offer in heath delivery, especially in inaccessible areas.

She noted the increased referrals from trained TBAs some from Accra-town an Island of about 45minutes boat-ride from Yeji, and said it was a good thing to replicate the training programme to TBAs in other areas.

At Kayereso in the East Gonja District, under the Catholic Archdiocese of Tamale, Madam Agatha Atia, Midwife in-charge of the Clinic, noted the significant referral and the supportive role the TBAs were playing. The TBAs expressed delight at being trained last April and thanked the organisers for the efforts.

Six of the 35 TBAs trained at Baptist Medical Centre, Nalerigu in the East Mamprusi District in the Northern Region, indicated how helpful the 14-day programme has been to them. Some of them including Madam Arizata Muntari, an over 80-year old TBA at Nalerigu who resisted all efforts by the Centre to train her, until the April training even acknowledged how it had enlighten them on the harmful effect the local oxytocin they administered to pregnant women were and have since stopped.

Mr. Nelson Manduaya,in-charge of the Public Health Centre at the Baptist Medical Centre noted how the training has improved upon the trust and cordiality of the TBAs with the health facility. This he said has helped enhanced their efforts to refer more pregnant women to the hospitals.

Challenges

Even with its high prospect of scalability in the country, Mr. Yeboah noted that there were both internal and external challenges in sustaining the programme.

From the visit, most of the TBAs related challenges they faced with regards to getting ready means to transport to pregnant women to hospitals.

Some other challenges has to do with getting support and incentives to work with. The TBAs around Kayereso, Nalerigu, Abease and Yeji as well as Hwidiem noted that some incentives they used to receive after performing deliveries in the past had ceased, because members of the communities they worked in, thought government was paying them after the training programme.    

Conclusion

The Traditional Birth Attendants are no doubt a priceless human resources in the health delivery system, whose contributions are yet to be fully recognized, tapped and rewarded.

For now their services to deliver babies into the world and also enhance the health of the mother and child, remains primarily voluntary and indispensable to health delivery. But that they exist and work in inaccessible remote areas of our country where the aura of orthodox medicine is yet to reach, means they must be identified, engaged, trained and empowered to help perform better in healthcare delivery.