30 Traditional Birth Attendants (TBAs) will be trained in two rural communities with a population of 42,000 in North West Frontier Province, Pakistan. One TBA will be trained for every 200 households. Interactive workshops in practice and theory will be held in two-week long courses for three groups of ten participants each. Trainers will include midwives who are Master Trainers and female physicians working for Frontier Primary Health Care (FPHC). A short Training of Trainers course will be organized for the trainers which focuses on supportive supervision and participatory training skills.
Following training, the Trained Traditional Birth Attendants (TTBAs) will be provided with a certificate, a basic delivery kit, one year’s supply of birth kits for mothers and assistance in setting up a revolving fund for provision of birth kits. Regular monthly supervision of TTBAs will be done during monthly meetings organized by the midwives from the local health center. Postnatal visits by midwives in the village which are done in the company of TBA provide an additional opportunity for ongoing teaching and review. Record collection of deliveries and referrals will be done during monthly meetings.
As selection of TBAs by their communities is an integral part of the project and takes takes considerable time, the project will take place over 3- 5 months. .
Background
Ismaila and Wardaga are rural communities in North West Frontier Province, Pakistan served by Frontier Primary Health Care (FPHC). Most (60-70%) of the 42,000 people in these communities (30,000 in Ismaila and 12,000 in Wardaga) still rely on traditional birth attendants (TBAs) to delivery women in their homes. FPHC has been involved in training and supervising Traditional Birth Attendants (TBAs) since 1997, however lack of funding has postponed regular upgrades..
The 26 TBAs trained by FPHC in Ismaila in 1997 were instrumental in helping to reduce maternal and newborn morbidity and mortality as they were able to reach women in their homes. They have also been active in referring women and infants to the health center for immunization and care. In Nov 2007, a basic emergency obstetrical center (EmOC) providing 24-hour labour care was established in Ismaila. The EMOC is staffed by three nurses, one assistant nurse and four dais. Retraining of TBAs was done at this time although only five of the original group remained active so a further 12 TBAs were trained. About half (8-10) of this second group of TBAs trained are currently active in Ismailia.
Of the 20 TBAs trained in Wardaga area in 1997, barely 4 - 6 remain active. Attrition of TBAs has occurred from a number of factors including ill health, death, changing priorities and migration.
Spurred on by the success of the community labour room for their neighbours in Ismaila, the people in Wardaga, with FPHC assistance, established a day time labour room in June 2008. The Wardaga community labour room is staffed by two nurses and three dais.
Approximately 1500 births occur annually in the two communities, 1100 in Ismaila and 400 in Wardaga. Retraining of TBAs and ongoing supervision is needed to ensure quality care continues to be provided and they remain motivated. In both communities, new TBAs need to be identified and trained. A total of 30 TBAs are needed to ensure one TBA for every 200 homes, or an average of each TBA doing one delivery per week.
Two weeks of training in both theory and practice are needed and will be done in three workshops. TBA selection is a more lengthy process which will be done by village clusters so that each cluster of approximately 200 homes will have one TBA who lives within their neighbourhood that they have participated in selecting. Candidates must be female, mature, in good health and committed to provision of maternal services. Most importantly they must be acceptable to the community, which means they must be respected, responsible and have good communication skills. Male and female members of community- based organizations (CBO), Jirgas, local groups and FPHC staff members from nearby health centres will be involved in identification and selection of candidates. The total project, including selection of TBAs will take 3-5 months.
The project is supported by the Hillman Medical Education Fund, through Rose Charities Canada
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