Skilled Birth Attendants: Who is Who? A Descriptive Study of Definitions and Roles from Nine Sub Saharan African Countries

Abstract

BackgroundAvailability of a Skilled Birth Attendant (SBA) during childbirth is a key indicator for MDG5 and a strategy for reducing maternal and neonatal mortality in Africa. There is limited information on how SBAs and their functions are defined. The aim of this study was to map the cadres of health providers considered SBAs in Sub Saharan Africa (SSA); to describe which signal functions of Essential Obstetric Care (EmOC) they perform and assess whether they are legislated to perform these functions.Methods and FindingsKey personnel in the Ministries of Health, teaching institutions, referral, regional and district hospitals completed structured questionnaires in nine SSA countries in 2009–2011. A total of 21 different cadres of health care providers (HCP) were reported to be SBA. Type and number of EmOC signal functions reported to be provided, varied substantially between cadres and countries. Parenteral antibiotics, uterotonic drugs and anticonvulsants were provided by most SBAs. Removal of retained products of conception and assisted vaginal delivery were the least provided signal functions. Except for the cadres of obstetricians, medical doctors and registered nurse-midwives, there was lack of clarity regarding signal functions reported to be performed and whether they were legislated to perform these. This was particularly for manual removal of placenta, removal of retained products and assisted vaginal delivery. In some countries, cadres not considered SBA performed deliveries and provided EmOC signal functions. In other settings, cadres reported to be SBA were able to but not legislated to perform key EmOC signal functions.ConclusionsComparison of cadres of HCPs reported to be SBA across countries is difficult because of lack of standardization in names, training, and functions performed. There is a need for countries to develop clear guidelines defining who is a SBA and which EmOC signal functions each cadre of HCP is expected to provide.

The Inverse Equity Hypothesis: Analyses of Institutional Deliveries in 286 National Surveys

“…Past research has suggested that such inequalities are associated with the geographical concentration of facilities in wealthier and urban areas, cultural and educational barriers to accessing facility delivery, and out-ofpocket costs incurred with transportation and user fees. 34,35,[43][44][45] Several initiatives have been launched since the 1980s to address these barriers faced by poor and rural women in low-and middle-income countries, such as increased access to institutional deliveries for poor women, home delivery by skilled attendants, training of traditional birth attendants, and vouchers for delivery in a health facility, among others. [46][47][48][49] Although some of these initiatives were successful at local or national level, they were not sufficiently scaled up to have an impact at global level.…”

“…34, 35 We were unable to locate studies that directly validated the institutional delivery indicator. However, in a study from Mozambique with observation of obstetric care in facilities followed by a questionnaire applied at home 8 to 10 months later, the indicator with the highest validity (sensitivity and specificity around 80%) was whether the woman had delivered in a hospital versus a health center.…”

Factors Affecting Prenatal Care Utilization in East Wollega Zone, Oromia Regional State, Ethiopia

“…There was agreement, signed by 179 country representatives, set a goal of 40% of all births to be assisted by a skilled attendant by 2005, with 50% coverage by 2010 and 60% by 2015 among countries with very high maternal mortality. However Oromia, skilled health professionals attend very few births (Mehari, 2013;Adegoke and Broek, 2009;Crowe et al 2012;Adegoke et al, 2012).…”

“…However identifying the main predictors and challenges in the implementation of this strategy which if addressed will help progress towards the achievement (Adegoke, et al, 2012).…”

“…However, trends documenting the change in the proportion of births accompanied by prenatal care and skilled attendant over the last 15-20 years offer no indication that adequate change is imminent. To improve maternal health rapidly in regions where births in the home without skilled birth attendants are common, governments and communitybased organizations could implement a cost-effective strategy (Prata et al 2011;Adegoke et al, 2012).…”