How a Training Program Is Transforming the Role of Traditional Birth Attendants from Cultural Practitioners to Unique Health-care Providers: A Community Case Study in Rural Guatemala

Abstract

In low- and middle-income countries (LMICs), where the rates of maternal mortality continue to be inappropriately high, there has been recognition of the importance of training traditional birth attendants (TBAs) to help improve outcomes during pregnancy and childbirth. In Guatemala, there is no national comprehensive training program in place despite the fact that the majority of women rely on TBAs during pregnancy and childbirth. This community case study presents a unique education program led by TBAs for TBAs in rural Guatemala. Discussion of this training program focuses on programming implementation, curriculum development, sustainable methodology, and how an educational partnership with the current national health-care system can increase access to health care for women in LMICs. Recent modifications to this training model are also discussed including how a change in the clinical curriculum is further integrating TBAs into the national health infrastructure. The training program has demonstrated that Guatemalan TBAs are able to improve their basic obstetrical knowledge, are capable of identifying and referring early complications of pregnancy and labor, and can deliver basic prenatal care that would otherwise not be provided. This training model is helping transform the role of the TBA from a sole cultural practitioner to a validated health-care provider within the health-care infrastructure of Guatemala and has the potential to do the same in other LMICs.

Perspective of Traditional Birth Attendants on Their Experiences and Roles in Maternal Health Care in Rural Areas of Northern Ghana

“…Skilled birth attendants should foster collaboration with TBAs in the rural communities to ensure that some refresher training is given to TBAs with regular monitoring and supportive supervision to ensure that they work within their limits and those that are beyond their level are quickly referred to health facilities for expert management. The training of TBAs is found in literature to be an effective way of enhancing their roles in rural areas [ 22 ].…”

Bottlenecks and barriers to effective coverage of early childhood health and development interventions in Guatemala: A scoping review

“…First, as evidenced by the existing national multisectoral working group on ECHD, as well as the available ECHD public policy, we noted a strong political interest and commitment by the Government of Guatemala, presenting the opportunity for continued leadership, not only with regard to ECHD, but also to measuring and addressing health inequities using a life course approach (6). Second, we noted the strong presence of community health networks composed of local volunteers, facilitators, and practitioners who are readily accepted by the community, fluent in the native language(s), and geographically proximal, e.g., the comadronas (24,25). These networks should be empowered and treated as partners to leverage their ties to hard-to-reach communities.…”

Impact of Standardized Prenatal Clinical Training for Traditional Birth Attendants in Rural Guatemala

“…One of the biggest challenges that TBA training programs face is successfully measuring and reporting the outcomes of their didactic and clinical curriculum. We have previously published on the details of our 14-week School of POWHER training program [ 17 ]. With this present study, we focus on the standardization of our clinical curriculum and measuring its impact on PCS of our participant with a prenatal skills checklist.…”

“…The initial development of our prenatal skills checklist occurred from November 2016 through March 2017. Our own School of POWHER curriculum [ 17 ], WHO healthcare practices for birth attendants [ 15 ], and current guidelines for TBAs from the Guatemalan Ministry of Health [ 16 ] were consulted. By using this checklist to both standardize our clinical curriculum and measure PCS over time, we were able to report on a promising improvement of PCS during home visits.…”

“…Each woman that completes the School of POWHER training program receives a stethoscope, blood pressure equipment, a fetal Doppler, prenatal vitamins, and safe birthing kits. In total, the training program, now a one hundred percent sustainable program as current School of POWHER staff are TBAs who are past graduates of our program, has trained 60 TBAs in southwest Guatemala in focused maternal healthcare with appropriate obstetric referrals as the key to decreasing maternal death and complications in the region [ 17 ].…”