Back: Nkhoma Safe Motherhood Program - Overview

Introduction

Current national policy discourages women to deliver at the TBA and promotes delivery at health facilities under supervision of a skilled birth attendance. There is good evidence that skilled birth attendance gives better maternal and neonatal outcomes. The majority of women deliver in the community though, often assisted by a traditional birth attendant (TBA). There are differences of opinion in the public health community how this issue should be addressed.

Community projects like the Mangochi Safe Motherhood Project try to take a middle road. TBA's are instructed to refer higher risk deliveries (teenager, primigravida). A mother that has delivered earlier without complications can be delivered by the TBA. The TBA can also do the follow up visits for antenatal care (ANC) after the first visit has taken place in the health facility. There is an incentive scheme in place where TBA's receive a reimbursement for a proper and timely referral. It was observed that the TBA's were not motivated by the monetary reimbursement, because their status depends on delivering. A system was put in place where TBA's are acknowledged in the community for good referrals, which has resulted in an increase of referrals.

Activities

The Nathenje Safe Motherhood Project would like to follow a similar approach. It should be stressed that in line with national policy the project will encourage women to access skilled birth attendance at health facilities (see also activity 1.2, 1.3 and 1.5.) and build capacity in health centres to increase the availability of bemoc services.

Activity 2.1 Organise refresher training for registered TBA's

The Government of Malawi has a certification for TBA's. The Nathenje Health delivery counts 68 registered TBA's. Registered TBA's have been trained by the Government and they have the required equipment (proper delivery room, gloves).

We propose to organise a refresher training for registered TBAs.

Activity 2.2 Implement a referral system that encourages TBA's to refer to health facilities

In the refresher course TBA's will be instructed to refer high risk deliveries to a health facility. TBA's that timely refer a client will receive a small financial incentive. Village Health Committees will receive feedback from health facilities on succesful referrals, which allows them to publicly acknowledge the contribution of the TBA to a healthy delivery.   

Activity 2.3 Provide equipment & supplies to registered TBA's

TBA's need supplies for a safe delivery. These supplies include gloves and desinfectant. The project will provide these supplies on a three monthly basis.

Back: Nkhoma Safe Motherhood Program - Overview