Enhancing Integration of TBAs Into Modern Primary Health Care System in Oyo State: Lessons from A Community-Based Intervention for Maternal Child Health Services in Nigeria
Abstract:
Traditional Birth
Attendants (TBAs) have long played a crucial role in child birthing within
African communities, adhering to traditional birthing protocols before the introduction
of stern medicine. Highly respected and trusted, TBAs were integral to
home-birthing practices. The 1978 United Nations meeting at Alma Ata validated
their role and recommended their training in orthodox practices until the WHO’s
Safe Motherhood Initiative in 1997 called for their replacement with skilled
birth attendants. Despite this, 27 years later, a critical shortage of skilled
birth attendants persists, particularly in rural and underserved areas. Women
of reproductive age (WRA) often choose TBAs for their availability,
accessibility, and affordability. This study assesses the capabilities of TBAs
in providing services along the continuum of care from prenatal to postnatal
periods to explore their potential integration into the Primary Health Care
(PHC) system in Oyo State. A quasi-experimental and cross-sectional survey captured
quantitative data from 274 WRAs utilizing both formal and informal attendants
for maternal childcare in four LGAs of Ibadan Metropolis. Additionally, 187
TBAs practising in these LGAs received interventions on maternal and child
health (MCH) risk factors. The study also gathered perceptions from 24
experienced TBAs and 12 policymakers. The end-line data demonstrated
significant improvements, leading to the rejection of the null hypotheses. The
findings support exploring the integration of TBA services into the PHC system
to enhance maternal mortality reduction and achieve UHC.
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