Background:
Between 2009 and 2012, Health Poverty Action (HPA) implemented an EU funded program in Somaliland entitled ‘Improving the Reproductive and Sexual Health of Internally Displaced People, Maroodi Jeex, Somaliland’.
A unique aspect of the program was Traditional Birth Attendant (TBA) training and incentivization to change TBAs from practicing as providers of maternal health services, including deliveries in the home, to health promoters and birth companions. As health promoters and birth companions, TBAs were expected to refer and or escort women during labour or childbirth complications to MCH facilities within their domains. This was intended to improve institutional delivery in Somaliland, enhance skilled birth attendance at delivery and ultimately contribute to improvements in maternal and newborn health in Somaliland.
The project ended in December 2012 and LSTM assisted HPA in carrying out a study on how the TBA training and incentivization project has worked and its effects on the target communities.
Objective:
The project ended in December 2012 and CMNH assisted HPA in carrying out a study on how the TBA training and incentivization project had worked and its effects on the target communities. Eight Key Informant Interviews (KII) and 10 Focus Group Discussions (FGD) were conducted, involving 32 TBAs and 32 mothers. A framework approach was used to analyse the data.
Results:
TBAs adopted their new role easily. Instead of conducting home births and referring at onset of complications, they accompanied or referred mothers to a nearby MCHCF for delivery, antenatal or postnatal care. Mothers accepted the new role of the TBA leading to more deliveries at health facility level and a decrease in home births. Facilitating factors included the creation of an enabling environment at the health facilities, acceptance of the TBA by the SBA and monetary incentivization.
Conclusion
Changing the role of the TBAs is acceptable and can lead to increased institutional delivery. Further research is needed to see if this can be scaled up.
Contract Value:
€127,961 from November 2011 - December 2012
