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"It is disheartening that 60% of girls in Nigeria get married before age 18.In my community in the south-eastern part of Nigeria, girls are still getting married at an early marriage either due to teenage pregnancy or because their parents are poor and see marriage as an alternative to the girl’s education.." - Onyeka Akunna
Without considerable improvements in access to quality maternal, newborn and child health care (“MNCH”), preventing HIV/AIDS mother to child transmission will continue to be elusive. It is widely acknowledged that a major barrier to increasing coverage and quality of MNCH and PMTCT is lack of skilled health care professionals to provide essential services and deliver women of babies in a risk free environment. This acute shortage of skilled heath workers has fueled a debate on the role of traditional birth attendants (‘’TBAs’’) in many countries and among members of the global health community; many argue that TBAs have the potential to reduce gaps in human resources and play a key role in HIV/AIDS prevention especially PMTCT.
South Saharan Social Development Organization tested this in Enugu State through its prevention of mother to child transmission and sexual reproductive health programme in which TBAs are being trained on PMTCT. The programme which started in 2012 is strengthening TBAs and maternity homes in Enugu State with skill and knowledge to provide PMTCT education, conduct HTC and make referral to improve loss to follow-up and provide SRH education to women of reproductive age to prevent unintended pregnancies. So far 300 of the 500 targeted TBAs have been trained in 35 communities and 4 local government areas of the state in such areas as Hygiene, Umbilical cord care, Female reproductive health, Nutrition in pregnancy, Danger sign in pregnancy, Danger sign after delivery, Overview of HIV/AIDS, prevention of mother to child transmission of HIV/AIDS (PMTCT), referrals, family planning, infant care and breast examination.
Through these trainings, the quality of care provided by TBAs has greatly improved both in PMTCT and other areas required by pregnant and nursing mothers. Furthermore, TBAs have become trained HIV/AIDS counselors and boosting the numbers of HIV/AIDS counselors and testers at the community level and the access to counseling and testing for local communities. Pregnant women who visit TBAs now routinely receive antenatal care, health talks and HIV/AIDS testing with their sex partners. In addition, TBAs have been linked to properly accredited health centers and maternity centers where they refer and follow up HIV positive pregnant women for antenatal and delivery. This has greatly reduced HIV infections, transmission from mother to child as well as maternal and infant mortality as the TBAs no longer try to deliver women with complication SSDO has established mobile PMTCT groups which go to TBAs facilities on their antenatal days to provide health talks and HCT assistance without stigmatization to pregnant women.
Testimonial from patients of TBAs demonstrate the marked improvement in the services now provided by TBAs following the trainings. Ogochukwu Amadi from Okpatu who had previously deliver two children was pleasantly surprised by the changes and new skills her TBA now demonstrated. She noted that she received counseling and testing for HIV/AID for the first time as well as ante natal and health talks. She said she now feels more confident refer other women to the TBA. While the focus of this programme has been on building the nonetheless involved community enlightenment programmes, many people now know their HIV status as over 2,000 people have received counseling and testing for HIV/AIDS. In addition, stigmatization of HIV positive people has reduced through consistent anti- stigmatization messages that a delivered at rallies and are through text messages. This programme has demonstrated that with adequate training and mentorship, TBAs can bridge the skills gap for healthcare professional experienced at the community level.
TBAs are better placed to do this, because they come from the communities and, therefore, deeply care for the members, many of whom they know intimately. TBAs are known and respected by the women who patronize them and are active citizens in the communities at large. Furthermore, TBA services are willing to spread payments and even receive their fees in kind (food stuff, labour etc). Based on the success of this program, we recommend that TBAs be co- opted into other community healthcare schemes such as routine immunization, birth registration, hygiene education, etc. this is also the prayer of many of the women we interviewed who receive services at the TBA centers. SSDO is also advocating for the institutionalization of TCBAs in Enugu State through the provision of a separate TBA cadre in healthcare. Through this, a certificate progrmme will be developed for TBAs where all the necessary training they require to support pregnant women can be provided. This will also give TBAs the respect they need in the healthcare profession and health professional the confidence to work with TBAs. We are delighted that some of our advocacy efforts are yielding fruits as the State Ministry of Health has endorsed the institutionalization of TBA and currently support TBAs alliance within 6 LGA of Enugu State to provide quality Service Delivery in their various health facilities.
Despite the above, we recognize that TBAs are dealing with women at a very delicate stage in their lives, therefore, also advocate for a register of all TBAs in Enugu State at the ministry of health as well as the development of a state and local government regulatory framework, monitoring and supervisory system. TBAs can help reduce HIV/AIDS infection, PMTCT and save lives. The time to institutionalize them is now!