Child Survival & Health Grants_Diana DuBois_10.14.11

Promotion of Skilled Birth Attendants: Lessons from the Wellshare Tanzania Child Survival Project

CORE Group Fall Meeting

October 14, 2011

Diana DuBois

Executive Director

WellShare’s Mission | To improve the health of women, children, and their communities around the world

Photo: Jolene Mullins

Background

Karatu District, Tanzania (2006-2011)Population: ~220,000MMR: 454/100,000 NMR: 32/1,000 live births

Intervention areas •Maternal and newborn care (35%)•Malaria (20%)•Family planning (15%)•Control of diarrheal diseases (15%)•Pneumonia (15%)

Some Common Perceived Barriers to Training TBAs

Traditional Birth Attendants…• Unwilling or uninterested in changing current practices• Will lose income or status if they refer pregnant women

for health facility care and delivery• Not capable of learning and applying appropriate skills

due to limited education• Unable to work alongside health facility workers

WellShare found that none of these were true!

Child Survival Project

• Training of TBAs– Maternal and newborn care– Home-based lifesaving skills (some)– Adult education facilitation – Providing referrals

• Roles of TBAs – Reproductive & child health education

and counseling– Promotion of antenatal care and health

facility delivery– Maternal advocacy – Post partum follow up – Post partum family planning promotion

including partner counseling– Survive and Thrive Group facilitation– Pregnancy vital statistics data collection

(Village Pregnancy Register)

*Statistically significant at 95% confidence level

KPC ResultsIndicator Baseline Final % of children whose births were attended by a skilled health provider.

70 82*

% of mother of children 0-23 months who received AMTSL during the birth of her youngest child.

28 56*

% of children 0-23 months who were dried and wrapped with a warm cloth or blanket immediately after birth.

37 86*

% of mothers who received PPC within 72 hours of their most recent delivery.

20 83*

% of non-pregnant mothers of children 0-23 months who desire no children in the next two years OR are not sure AND who are using a modern method of child spacing.

31 65*

Lessons Learned

Traditional Birth Attendants…• Typically more eager than health workers to learn new skills• Competent and resourceful • Provide many kinds of support to women in their communities • Well-respected by the community (including by men)

– Can discuss sensitive topics– Can promote healthy household and relationship behaviors

• Do not actually want to deliver babies• Do not see a decrease in income or status when they do not

deliver babies• Capable of assisting deliveries at health facilities • Function best working in a supportive group settings with a leader

Enabling Factors• Supportive environment for TBAs

– Presidential support

– District health management team

• Constructed and staffed 6 new health facilities (MCH) during the life of project

• Set tone by conducting initial TBA trainings

• Supported TBA / health facility linkages

• Trained groups of TBAs (5-10 per village) and developed TBA leadership

• Participation in village health activities

• Community support to TBA activities

Recommendations

• Wider use of trained TBAs to:– Provide health education – Provide referrals– Fill gaps in maternal and neonatal health

services• Use of TBAs as “maternal advocates”

– Can lobby for construction/staffing of health facilities

– Provision of family counseling • e.g., Family planning, prevention of mother-to-child

transmission (integrate MNC and FP)

– Raise awareness of MCH issues

Conclusions

• TBAs are the primary maternal advocate in developing communities

• Trained TBAs do contribute to the overall health of their communities, reaching government maternal and newborn care targets, and helping to achieve MDGs 4 & 5

WellShare-trained Traditional Birth Attendant with Village Pregnancy

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