Perceived differences on the role of traditional birth attendants in rural Tanzania: a qualitative study

Beatrice Mwilike,Kana Shimoda,Frida E. Madeni,Satoe Miura,Yoko Shimpuku

doi:10.1186/s12884-021-03611-0

Abstract

BackgroundIn many low to middle income countries, traditional birth attendants (TBAs) play various roles (e.g., provision of health education, referral to hospitals, and delivery support) that can potentially improve women’s access to healthcare. In Tanzania, however, the formal healthcare systems have not acknowleded the role of the TBAs. TBAs’ contributions are limited and are not well described in policy documents. This study aimed to examine the perspectives of both TBAs and skilled birth attendants (SBAs) to clarify the role of TBAs and issues impacting their inclusion in rural Tanzania.MethodsWe used a qualitative descriptive design with triangulation of investigators, methods, and data sources. We conducted semi-structured interviews with 15 TBAs and focus group discussions with 21 SBAs in Kiswahili language to ask about TBAs’ activities and needs. The data obtained were recorded, transcribed, and translated into English. Two researchers conducted the content analysis.ResultsContent analysis of data from both groups revealed TBAs’ three primary roles: emergency delivery assistance, health education for the community, and referrals. Both TBAs and SBAs mentioned that one strength that the TBAs had was that they supported women based on the development of a close relationship with them. TBAs mentioned that, while they do not receive substantial remuneration, they experience joy/happiness in their role. SBAs indicated that TBAs sometimes did not refer women to the hospital for their own benefit. TBAs explained that the work issues they faced were mainly due to insufficient resources and unfavorable relationships with hospitals. SBAs were concerned that TBAs’ lacked formal medical training and their actions could interfere with SBAs’ professional work. Although there were no between-group interactions at the time of this study, both groups expressed willingness to collaborate/communicate to ensure the health and lives of mothers and babies.ConclusionsTBAs and SBAs have different perceptions of TBAs’ knowledge and skills, but agreed that TBAs need further training/inclusion. Such collaboration could help build trust, improve positive birth experiences of mothers in rural Tanzania, and promote nationwide universal access to maternal healthcare.

Highlights

In many low to middle income countries, traditional birth attendants (TBAs) play various roles that can potentially improve women’s access to healthcare
Despite fertility rates being higher in rural areas of Tanzania, health workers and facilities remain concentrated in urban areas
Data were collected through individual interviews with TBAs and focus group discussions with skilled birth attendants (SBAs) working in a district hospital in rural Tanzania

Summary

Introduction

In many low to middle income countries, traditional birth attendants (TBAs) play various roles (e.g., provision of health education, referral to hospitals, and delivery support) that can potentially improve women’s access to healthcare. In rural areas of Tanzania, nearly half the women still give birth outside health facilities, so these areas continue to experience a high MMR and raise the national MMR of 556/100,000 live births [2]. Despite fertility rates being higher in rural areas of Tanzania, health workers and facilities remain concentrated in urban areas. The health workforce of Tanzania relies heavily on practitioners who have received brief training courses, with nurses and midwives accounting for 27% of the total national healthcare workforce. This percentage is much lower than that of other African countries (about 50%) [3]

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