ESSENTIAL NEWBORN CARE CORPSRebranding Sierra Leone’s Traditional Birth Attendants as Health Promoters and Social Entrepreneurs

For nearly 50 years, Concern Worldwide has worked with the world’s poorest people to transform their lives. We reach 7.4 million people in 29 countries, working in emergency response, health and nutrition, climate resilience and more. Innovations for Maternal, Newborn & Child Health, an initiative of Concern Worldwide U.S., pilots creative solutions for improving the survival and health of women, babies and children. Innovations is supported by the Bill & Melinda Gates Foundation.

for maternal, newborn& child health

The presence of a skilled birth attendant at delivery is key to averting maternal and neonatal mortality and morbidity. Sierra Leone, where many women give birth at home with the assistance of a traditional birth attendant (TBA), faces one of the highest maternal and newborn death rates in the world.

A TBA assists mothers during childbearing, often in exchange for a small fee, and initially acquired her skills by assisting other TBAs or through brief government-sponsored training. With aims of improving health outcomes for women and children, the Government of Sierra Leone made health care free in 2010 for pregnant women and young children and discouraged TBAs from performing home deliveries.

Like many developing countries, Sierra Leone faces a critical question: How can TBAs be reoriented away from assisting births and be incorporated into the health care system to ensure that women and children receive essential care?

About the Program

Recognizing TBAs as a crucial yet overlooked maternal and newborn health resource in their communities, Concern Worldwide’s Innovations for Maternal Newborn & Child Health initiative (Innovations) launched the Essential Newborn Care Corps (ENCC) in Bo District, Sierra Leone. This two-year pilot explores the potential in training TBAs to have new roles as Maternal and Newborn Health Promoters (MNHPs).

These health promoters perform two critical roles: first, they make home visits, educating pregnant women about caring for themselves and their babies and checking for health complications; and second, they refer women to government health facilities for antenatal care, delivery, postnatal care, maternal and newborn complications and family planning.

The ENCC pilot targets 200 TBAs,

rebranded as health promoters, in the catchment areas of 18 peripheral health units, serving seven chiefdoms and 344 villages. Health Poverty Action implements the program with support from the Bo District Health Management Team.

The ENCC pilot is generating evidence on how non-literate TBAs can successfully fill roles in the maternal, newborn and child health (MNCH) continuum of care, similar to community health workers.

In addition, ENCC uses a quasi-experimental research design to explore how creating a sustainable source of income might incentivize and support the health promoters’ new roles. At the start of the project, half received a loan in the form of a start-up basket of health and baby products, valued at approximately USD30, to sell during their home visits.

ABOUT ESSENTIAL NEWBORN CARE CORPS

Expected Outcomes ENCC aims to increase use of the government’s maternal and newborn health services and improve coverage of essential care among pregnant women and newborns by formalizing the roles of TBAs as health promoters and creating a community-based referral system, while contributing to their livelihoods.

The project also aims to improve relationships between health facility staff and the former TBAs and to enlist community support for their new roles in the formal health system.

Learnings Thus Far Since the pilot began in March 2014, project monitoring has already shown positive changes. Growing numbers of women referred by the health promoters are visiting clinics, which receive 2,100 referrals on average each month. Health promoters in the business and non-business arms of the project have shown eagerness to participate, with nearly 100 percent retention. And support from health facility staff, community stakeholders and district health officials has been consistently high.

Of those in the social enterprise arm of the pilot, almost all have made their monthly loan repayments on time and in full. They continue to buy additional health and baby products to sell in their communities.

Incorporating Ebola Response

The recent Ebola outbreak posed new challenges in providing MNCH care throughout West Africa. As trusted members of their communities, the

health promoters were uniquely positioned to increase attendance at health facilities and carry key Ebola messages to people in remote areas.

After a suspension of activities from July to December 2014 due to Ebola, the resumed pilot expanded the health promoters’ roles to incorporate social mobilization for Ebola response into their work. All 200 health promoters were trained in the National Community Health Worker “No Touch” Guidelines for home visits. Thereafter, they educated community members on the disease and referred suspected Ebola patients to health facilities.

Policy Significance

Various efforts are underway in Sierra Leone to redefine the role of TBAs, such as the Free Health Care Initiative, the Basic Package of Essential Health Ser-vices (both passed in 2010) and, more recently, the National Community Health Worker Policy. While TBAs have demon-strated potential to be important health resources in addressing non-delivery care needs in the community, shifting TBAs away from their roles as birth attendants has had limited success due in part to the lack of alternate sources of income among TBAs and their desire to maintain status in their villages.

Through the new roles developed by this pilot, TBAs are now empowered and equipped to fill critical gaps in the health system, leading to improved MNCH cov-erage. This approach could easily inform others both in Sierra Leone and globally who seek to establish complementary roles for TBAs.

ABOUT ESSENTIAL NEWBORN CARE CORPS

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355 Lexington Ave. 16th Floor New York, NY 10017

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