The usefulness of traditional birth attendants (TBAs) in contemporary times is a highly disputed subject. Many reasons have been given in support of TBAs and many against them.
Supporters argue that a “severe shortage of trained and skilled health workers” is the main cause for poor maternal and child health in Sub-Saharan Africa. They point out that the presence of TBAs with their limited skills is better than birth with no (skilled) person present altogether.
They argue that TBAs can be found in every village and are available around-the-clock to their patients. Thus, TBAs play a crucial role especially in rural areas, where many formally trained health workers do not like to work. In villages, a high number of births are home births attended by TBAs.
Moreover, TBAs belong to the same community as the pregnant women, understand their culture, speak their language, have a personal relationship with the women and are willing to visit the women at their homes. Another advantage is that TBAs tend to be flexible in regard to payment.
Opponents say that TBAs have no place in a modern healthcare system. They argue that TBAs endanger the lives of mothers and children, mainly due to their lack of formal training and a failure to refer patients to hospitals when they encounter complex cases.
However, many TBAs have expressed their wish to learn ‘Western’ medicine, while their supporters refer to studies, which show that training improves the healthcare practices of TBAs. As part of this training, emphasis on identifying and referring complex cases must have a high priority.
This is where the Seventh Day Adventist Hospital (SDAH) in Ile-Ife, Osun State, comes in. The hospital is running several community outreach programs. This includes activities specifically targeted at Traditional and Missionary Birth Attendants (TMBAs).
In Ile-Ife, not all births take place in a hospital as the Director of Nursing Services Chief Popoola and the Chief Medical Director Dr Obisanya tell me. They emphasize that every birth, even at home, needs to be attended by a health worker, in case of complications. They also tell me that, in Ile-Ife Traditional and Mission Birth Attendants (TMBAs) attend to many women who deliver at home.
However, some of the TMBAs have learnt the job from their parents and others have no training at all. Hence, they do not always know what to do when they encounter complex cases and do not always know when to refer a patient to the hospital.
This is why the SDAH wants to train TMBAs. It wants to enable them to take deliveries without complications at home, give them a delivery kit with tools for a safe delivery and instruct them on how to recognise cases that are beyond their abilities and have to be sent to the hospital.
So far, the TMBAs have been coming to the hospital for meetings but proper training did not take place until about two weeks ago, when the hospital started introductory lessons with about 20 TMBAs participating (see photo above).
Apart from the work with TMBAs, the hospital is also trying to enhance the skills of its existing staff. Later in the year, the hospital expects a team from the Perinatal Rescue Network (PRN) in the USA. The PRN team will expand the hospital’s programme by training doctors and nurses to become Master Trainers in Helping Mothers Survive and Helping Babies Breathe activities. TMBAs will also receive training from the PRN team.
While programmes like these can be of benefit in the short-term, the long term goal for Nigeria must be to increase the number of formally skilled health workers so that they can attend all births and to improve health equipment and staff motivation. How can these be achieved?
The political party that won the last presidential elections, the APC, in their manifesto promised to increase the numbers of physicians in Nigeria if elected. Now that General Buhari has become president-elect, will he share how his government plans to do that? What will the new government do to increase the numbers of nurses, midwives and other health workers? And what will they do to encourage health workers to accept placements in the rural areas where they are needed most?
At the moment, many women make use of antenatal, delivery and postnatal care provided by the SDAH. The hospital also provides Family Planning Services. However, women still have to pay for (some of) these services, e.g. an ultrasound to check if the unborn baby is doing well costs N800. Also, women have to bring to the hospital materials and medications that are needed for a delivery without complications.
Again, this will be a challenge for the incoming government, which promised free antenatal care for pregnant women. Similarly, we look forward to hearing their intentions in relation to free delivery, postnatal care and family planning.
It is true that we expect a lot from president-elect Buhari and the incoming government. That’s because reducing the current maternal mortality (576 deaths per 100,000 live births) by the 70% promised in the APC manifesto will not be easy. Nevertheless, improving the wellbeing of mothers and newborns is a goal worth striving for.
The Seventh Day Adventist Hospital is keen to hear from any individuals or organizations willing to support their training programme. For more information, please get in touch with the Director of Nursing Services Chief Popoola. The hospital will gladly welcome additional, qualified trainers, financial support as well as your words of encouragement.