The role of traditional birth attendants in the prevention of mother to child transmission: a case study of the New Community Health Worker National Strategy of Zambia
Singal, Robert L
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Background The Ministry of Health in Zambia is implementing a National Community Health Worker Strategy to improve health care access using a new cadre of community health assistants (CHAs). The strategy does not include traditional birth attendants (TBAs), an existing health care resource in the community. This case study examined how TBAs can work with CHAs to provide prevention of mother-to-child transmission (PMTCT) services to pregnant women and infants in rural areas within this new health worker strategy. Methods Using the case study methodology, this study analyzed multiple sources of data including published and unpublished literature, program documents and key informant interviews. Thirteen semi-structured interviews were conducted with policy makers and community field workers involved with TBAs and community health workers providing PMTCT services in rural Zambia. Methodological triangulation was used to synthesize information and compare themes across different sources to gather various perspectives and provide additional insights into the topic. Results In the absence of trained facility-based health care workers, TBAs often provide antenatal and delivery services. Acknowledging the limited provision of care for pregnant women in the CHA Strategy, respondents pointed to the potential role of CHAs in assisting with deliveries. Emphasis was placed on the importance of TBAs to reduce barriers between the home and the formal health system. TBAs and CHAs have complementary skills that can be used in partnership to provide PMTCT services. Conclusions With standardized trainings, TBAs can play a supportive role in providing PMTCT services within the new community health structure. TBAs and CHAs can assist with deliveries and provide PMTCT services at the health facility and at home. TBAs can accompany CHAs to navigate family and gender dynamics and provide home-based adherence, breastfeeding education and support, and referrals. A new incentives model for TBAs has the potential to increase facility births and engage the volunteer cadre in playing a supportive role to the CHAs. This task-shifting and sharing model, using TBAs and CHAs, can improve maternal health services by strengthening the link between the community and the facility and integrating, rather than excluding the traditional health care system.
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