Walking Together: Towards a Collaborative Model for Maternal Health Care in Pastoralist Communities of Laikipia and Samburu, Kenya

Abstract

Purpose In 2009 the Kenyan Government introduced health system reforms to address persistently high maternal and newborn mortality including deployment of skilled birth attendants (SBAs) to health facilities in remote areas, and proscription of births attended by traditional birth attendants (TBAs). Despite these initiatives, uptake of SBA services remains low and inequitably distributed. This paper describes the development of an SBA/TBA collaborative model of maternal health care for pastoralist communities in Laikipia and Samburu. Description A range of approaches were used to generate a comprehensive understanding of the maternal and child health issues affecting these pastoralist communities including community and government consultations, creation of a booklet and film recognising the contributions of both TBAs and SBAs that formed the basis of subsequent discussions, and mixed methods research projects. Based on the knowledge and understanding collectively generated by these approaches we developed an evidence-based, locally acceptable and feasible model for SBA/TBA collaborative care of women during pregnancy and childbirth. Assessment The proposed collaborative care model includes: antenatal and post-natal care delivered by both SBAs and TBAs; TBAs as birth companions who support women and SBAs; training TBAs in recognition of birth complications, nutrition during pregnancy and following birth, referral processes, and family planning; training SBAs in respectful maternity care; and affordable, feasible redesign of health facility infrastructure and services so they better meet the identified needs of pastoralist women and their families. Conclusion The transition from births predominantly attended by TBAs to births attended by SBAs is likely to be a gradual one, and an interim SBA/TBA collaborative model of care has the potential to maximise the safety of pastoralist women and babies during the transition phase, and may even accelerate the transition itself.

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

“…There is ample empirical evidence from countries like Kenya, Somalia, Tanzania, and Uganda for task shifting and reorientation of TBAs to help improve maternal and child healthcare. For instance, studies that have assessed the impact of reorienting TBAs from conducting deliveries themselves to promoting SBA‐assisted deliveries at health facilities suggest that such reorientation approaches can lead to increased uptake of supervised delivery . In countries where TBAs were trained to identify high‐risk pregnancies, this led to an increase in facility level obstetric health care .…”

“…For instance, studies that have assessed the impact of reorienting TBAs from conducting deliveries themselves to promoting SBA-assisted deliveries at health facilities suggest that such reorientation approaches can lead to increased uptake of supervised delivery. 1,25 In countries where TBAs were trained to identify high-risk pregnancies, this led to an increase in facility level obstetric health care. 37,38 A systematic review of the effect of linking TBAs with formal health workers on the outcomes of SBA frequency, referrals, and facility deliveries showed a positive effect.…”

“…Persistently high maternal and neonatal mortality in many low‐ and middle‐income countries remains a challenge for policy makers . Supervised delivery is promoted as the optimal strategy for reducing maternal and neonatal mortality .…”

“…These prevailing role conflicts are ironic given that the Community‐based Health Planning and Services (CHPS) policy which sanctioned the deployment of community health nurses to rural areas, envisaged a cordial, complementary, and collaborative relationship between CHPS operatives and all other local community stakeholders . This is because evidence suggests that collaborative healthcare delivery models that integrate SBAs, TBAs, and communities have the potential to improve the quality of maternal healthcare and the utilization of health services . The fundamental question that remains unanswered is: how can biomedical health personnel and traditional health practitioners work together effectively to deliver efficient, cost effective, safe, and timely maternal health care to deprived rural communities?…”

“…10-12 This is because evidence suggests that collaborative healthcare delivery models that integrate SBAs, TBAs, and communities have the potential to improve the quality of maternal healthcare and the utilization of health services. 1,13,14 The fundamental question that remains unanswered is: how can biomedical health personnel and traditional health practitioners work together effectively to deliver efficient, cost effective, safe, and timely maternal health care to deprived rural communities? Drawing insights from studies across the developing world, we propose a threestep approach to guide the repositioning of TBAs to promote improved maternal health delivery in developing countries.…”