Introduction
The traditional Birth Attendants (TBAs) have been the bastions of maternal care in most communities especially in low-resource communities. With all the progress in the modern medicine, TBAs still traditionally help millions of women to get through the pregnancy, the birthing process and the after pregnancy care. Their practice is however on many occasions not under formal health systems and therefore issues around its safety and regulation besides concurrence with national health objectives are of concern.
TBAs have become popular and the governments all around the world are seeing what TBAs could do in reducing the infant and maternal mortality. Countries are incorporating TBAs in their national health approaches through formulated strategy of policy reform, registration programs, supervision, and incentive based partnerships.
The chapter is an examination of the way that countries such as Nigeria, Bangladesh and Kenya are developing such policy routes. It assesses achievements, disadvantages, and the repercussions of TBAs policy reform in the attainment of safer and equity maternal health.
Why Policy Reform is Essential for TBA Integration
Bridging Traditional and Modern Practices
TBAs have a vast social leverage particularly in rural areas and among marginalized people where they appear as the initial point of contact and even the sole point of contact when it comes to maternal care. Nevertheless, cultural practices which are practiced in a traditional manner can incorporate harmful practices, they do not employ sterile methods, and they dawdle in referring the complexities.
Policy reform seeks to shift TBAs out of a self-sufficient mode to a more cooperative position by re-integrating TBAs into official health systems. It will allow TBAs to maintain their cultural credibility and at the same time be assured that the way they provide maternal and newborn care is in accordance with modern medical practice.
Elements of Successful TBA Integration Policies
Registration and Accreditation
The business of formal registration of TBAs has a number of benefits:
- Recognition: It legalizes the existence of TBAs in the health workforce.
- Tracking: The authorities are capable of tracking the circulation and distribution of TBAs.
- Training: TBAs who are registered can be trained and monitored in an orderly manner.
- Accountability: Practice standards are made enforceable.
Other nations that incorporate the registration system tend to establish an association by way of the capability of TBA to practice with the compulsory training program which, in turn, enhances safety and quality.
Structured Training Programs
Good policies focus on training so as to arm TBAs with the following:
- Delivery clean techniques
- Identification of the danger signs of obstetrics
- Safer care practices for newborns
- Counselling under family planning
- Emergency referral protocols
Training will convert TBAs into grassroots health advocates as opposed to independent traditional practitioners.
Supervision and Monitoring
The frequent monitoring of TBAs will make sure that they:
- Comply to ensuring safe practices
- Need to update their skills once in a while
- Be associated with the formal health care services
- Keep up well recorded maternal and newborn outcomes
This responsibility contributes towards longer -lasting quality initiatives.
Incentive Based Partnerships
Certain governments use a financial reward, free medical materials, or awards as recognition to a TBA when she:
- Refer women to health institutions
- Work in official training
- Care about the nationwide maternal health programs
Rewards create bonding and motivate the TBAs to work towards the national health targets.
Nigeria: From Prohibition to Collaboration
Historical Background
The ratio of maternal mortality in Nigeria is one of the worst in the world. In Nigeria, the policy in the early 2000s was first skewed as to all-out ban of TBAs in an effort to channel all births to health facilities. Nevertheless, cultural norms and logistical issues ensured that most women still opted to use the services of the TBA in some secrecy.
Shifting Toward Integration
Nigeria shifted to integration in view of seeing the ineffectiveness of prohibition. A good example is the Lagos State. Through its reform on TBAs policy reform, Lagos established its initiatives on:
- Register TBAs
- Have them trained at current methods of delivery
- Put up clear referral procedures
- Monitor their activities by having periodic check ups
TBAs are no longer considered as competitors or mortal enemies. They are trained on identifying high-risk pregnancy cases and advised to refer to the health facilities where complicated cases may be received.
Achievements and Challenges
Successes:
- Traditional birth attendants are included in referral in regions that experience expansion of zone-level facility deliveries
- Increased awareness of communities concerning maternal health
- Enhanced connection between the modern and traditional health system
Challenges:
- Sustainability in finances of trainings
- Regional policy executive variability
- The opposition by older TBAs who are not willing to change their ways
The case of Kenya points to the criticality of both national and community involvement as a prerequisite to effective policy.
Comparative Analysis: Nigeria, Bangladesh, and Kenya
Shared Success Factors
In all the three countries, there are few things in common:
- Registration: Assists the governments to monitor, educate and control TBAs.
- Training: Provides TBAs with knowledge to be able to deliver safer services.
- Supervision: Keeps standards and responsibility.
- Incentives: Motivate TBAs to follow up complex cases to the health facilities.
Such elements of policy help to turn TBAs into an appendage of the formal system of health care.
Unique Challenges
- Nigeria: The health system is so decentralized as to create disparities in policy operation among the states.
- Bangladesh: Traditional dependency on TBAs is very deep-rooted and good care must be taken not to offend the traditions.
- Kenya: In some isolated areas, geographical obstacles present logistic difficulties on the way of supervision and training.
Benefits of Policy Driven Integration
Health Outcomes
- TBAs integration leads to:
- Decrease in deaths of mothers and neonatal deaths
- Facility based deliveries Increased
- Reduced anti-social traditional ways
System Efficiency
TBAs become shouldering the eyes and ears of the community by knowing the high risk pregnancies and advising the women to seek timely care. This minimizes the wastages in accessing the services, which is a leading cause of maternal mortality.
Community Trust
These policies have earned the confidence of the formal health systems when they are respectful and embracive to TBAs. The TBAs will help in closing the modern medicine with the beliefs of the community and thus the health interventions are more acceptable.
Ongoing Policy Gaps and Future Directions
Funding Sustainability
Although integration policies give a positive future, many of the programs remain dependent on donor financing. National governments have to spend funds on:
- Keep maintaining training programs
- Supplies with TBs provided
- Sustaining supervisory platforms
Data and Monitoring
It is necessary to monitor the contribution of TBA. Governments should have good data systems so that they are able to:
- Keeping track on TBA activities
- Roundup outcomes
- Notify adjustment of policies
Balancing Modern Medicine and Tradition
There are sensitive politics of culture to be observed by policymakers. Although trust and access are offered by TBAs, certain traditional practices are not safe. Respectful dialogue has to be encouraged by policies, and alternatives should be offered that preserve culture, but do not threaten safety.
Policy Recommendations
On the basis of Nigeria, Bangladesh, and Kenya lessons, the following recommendations come out:
- Institutionalize Registration: Any of the practicing TBAs must be registered and mapped.
- Mandate Regular Training: Train abilities so that in case TBAs need to adhere to the medical practices.
- Link TBAs to Referral Systems: Promote the use of handoffs to competent workers in time.
- Offer Incentives: encourage TBAs through public recognition or supplies
- Engage Communities: Engage the community leaders in the development of integration policies.
- Invest in Data Systems: monitor TBA adding for evidence based making of policy
Conclusion
Incorporating TBAs into national health systems via the consideration of policy change is not only a tactic, but a necessary process of strategy to minimize morbidity and mortality in the birth of mothers and babies in underserved areas. Nigeria, Bangladesh, and Kenya are demonstrating that, when trained, supported, and rewarded, TBAs can be hugely effective health partners in meeting national health targets.
Although there are still difficulties to overcome, especially the issues of sustainable funding, data tracking, and cultural dynamics, the positive impact of the inclusive policies is hugely greater than the dangers. With governments perfecting their health strategies, the future is achieving a balance between the modern standards of medicine and community confidence in the form of TBAs.
Finally, the remodelling of TBAs policy reform is a demonstration of the efficiency of culturally competent, evidence-based policymaking that has introduced life and healthier communities.
