Repositioning traditional birth attendants to provide improved maternal healthcare services in rural Ghana

Abstract

Summary Following the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community‐level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the health sector in Ghana, improving maternal healthcare in rural communities will require harnessing all locally available human resources. This cannot be achieved by “throwing out” a critical group of actors who have been involved in health‐care provision for many decades. We propose a win‐win approach that involve retraining of TBAs, partnership with health practitioners, and task shifting.

“From Experts to Locals Hands” Healthcare services Planning in Sub-Saharan Africa: Insight from the Integrated Community Case Management of Ghana

“…The qualitative approach was useful in exploring key variables postulated in the Spider-gram, framework on community participation in healthcare services planning [16]. To adequately situate the framework with the result of the study, we reviewed related literature from articles on community participation in healthcare planning in Sub-Saharan Africa [35,36,40,41], and health policy documents, reports and articles in Ghana [3,12,14,25,33,38]. We then collected qualitative data on Community health, the actors involved, the conduct of the need's assessment, the selection of the CBHVs, and how that influenced community-driven monitoring of the process, resources mobilization and leadership for sustainability.…”

“…Though this seems a reminiscence of the pre-colonial and traditional health care practices of African society, it is evolving as a novel view. Besides, it is generating unending conflict between the mainstream modern medical practitioners and that of the local health actors [14]. This longstanding conflict can be deduced from the following; Firstly, the perceived invasion of the roles of one another.…”

“…Another study attributed the above to earlier efforts made by the World Health Organization (WHO) towards banning the operations of local health actors, particularly, Traditional Birth Attendants (TBAs) and Traditional healers in several rural Sub-Saharan Africa by the opinion of incompetency, unlawful and harmful nature of their operations [14]. The call contributed to limiting the operational activities of local health practitioners and lowered modernist interests for local health services in their respective jurisdictions [14].…”

“…Another study attributed the above to earlier efforts made by the World Health Organization (WHO) towards banning the operations of local health actors, particularly, Traditional Birth Attendants (TBAs) and Traditional healers in several rural Sub-Saharan Africa by the opinion of incompetency, unlawful and harmful nature of their operations [14]. The call contributed to limiting the operational activities of local health practitioners and lowered modernist interests for local health services in their respective jurisdictions [14]. However, contemporary challenges in access to health care services including inadequate health facilities, deficient health care services, a poor road network in rural communities resulted in the regained interest, especially with the Integrated Community Case Management program [14,15].…”

“…However, effective supervision and self-initiative are key to success. In Ghana, studies on the capabilities of the Traditional Birth Attendants (TBAs), showcase the need for partnership between local actors and modern healthcare practitioners towards addressing rural health needs [14]. Others demonstrated how the existing fractions between local healthcare actors and the experts, play a role in providing basic healthcare [15].…”