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.
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