Stakeholder views on the incorporation of traditional birth attendants into the formal health systems of low-and middle-income countries: a qualitative analysis of the HIFA2015 and CHILD2015 email discussion forums

Onikepe Oluwadamilola Owolabi,Claire Glenton,Simon Lewin,Neil Pakenham-Walsh

doi:10.1186/1471-2393-14-118

Abstract

BackgroundHealth workforce shortages are key obstacles to the achievement of the health-related Millennium Development Goals. Task shifting is seen as a way to improve access to pregnancy and childbirth care. However, the role of traditional birth attendants (TBAs) within task shifting initiatives remains contested. The objective of this study was to explore stakeholder views and justifications regarding the incorporation of TBAs into formal health systems.MethodsData were drawn from messages submitted to the HIFA2015 and CHILD2015 email discussion forums. The forums focus on the healthcare information needs of frontline health workers and citizens in low - and middle-income countries, and how these needs can be met, and also include discussion of diverse aspects of health systems. Messages about TBAs submitted between 2007-2011 were analysed thematically.ResultsWe identified 658 messages about TBAs from a total of 193 participants. Most participants supported the incorporation of trained TBAs into primary care systems to some degree, although their justifications for doing so varied. Participant viewpoints were influenced by the degree to which TBA involvement was seen as a long-term or short-term solution and by the tasks undertaken by TBAs.ConclusionsMany forum members indicated that they were supportive of trained TBAs being involved in the provision of pregnancy care. Members noted that TBAs were already frequently used by women and that alternative options were lacking. However, a substantial minority regarded doing so as a threat to the quality and equity of healthcare. The extent of TBA involvement needs to be context-specific and should be based on evidence on effectiveness as well as evidence on need, acceptability and feasibility.

Highlights

Health workforce shortages are key obstacles to the achievement of the health-related Millennium Development Goals
The World Health Organization (WHO) defines a Traditional Birth Attendant (TBA) as “a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBAs” [6]
Study participants The discussions about TBAs were the most active in the history of HIFA2015 and CHILD2015–we included and analysed 658 messages posted by 193 participants

Summary

Introduction

Health workforce shortages are key obstacles to the achievement of the health-related Millennium Development Goals. The role of traditional birth attendants (TBAs) within task shifting initiatives remains contested. The World Health Organization (WHO) defines a Traditional Birth Attendant (TBA) as “a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBAs” [6]. TBA training for these tasks became more widely available, estimates in 1990 indicated that maternal mortality rates had not improved [8]. At a 1997 technical consultation of the Safe Motherhood Interagency Group, TBAs were formally excluded from the definition of skilled birth attendants [7], i.e. they were no longer included among the list of recognized health professionals (such as midwives, nurses and doctors) who had the necessary accredited skills to manage pregnancy, childbirth and postnatal care [9]. A single global target was set: 90% of births would be supervised by skilled birth attendants by 2015 [10]

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