It is my wish that expecting mothers here in Malawi should deliver at health clinics at all cost in order to have a safe delivery. For this to be achieved, there are a number of factors that need to be taken into account by all stakeholders, including government, the civil society and traditional leaders.
As a community development worker, I have been working with poor people on the ground and I really appreciate the role of the alternative health-care providers in the rural communities, including traditional birth attendants (TBA’s). These people have been supplementing the work of government by helping villagers who could not travel long distances to hospitals, for example.
Banning the TBA’s from carrying out their services will result in more maternal deaths than is the case now because there are other people who are very far from health centres and there are some who are living in hard-to-reach areas with no health facilities. It is in these areas where TBA’s come in to supplement government’s efforts.
In my view, it is totally wrong to blame the growing number of maternal deaths to TBA’s. As a nation, do we have enough trained health workers to match our growing population? Do we have the required infrastructure and beds to accommodate the expectant mothers in the said waiting shelters?
Government should come up with an alternative ways of working hand in hand with the TBA’s rather than just banning them. Government can train the TBA’s and give them resources to communicate to nearby health facilities whenever they encounter cases which need further medical attention.
There are a number of research findings on the importance of the role alternative health-care providers are playing in complementing the government efforts. The TB Control Programme engaged traditional healers to identify those people suspected to have TB. These traditional healers were provided with referral letters to the hospital to give to those people who frequently visit the traditional healers with problem of coughing.
The REACH Trust also carried out a similar research, but they engaged shop keepers. These shop keepers were provided with registers of customers who frequently go to their shops to buy cough syrup and Panado. Those who visited the shop to buy Panado almost daily were given referral letters to get tested for malaria at a nearby health facility and those who were buying cough syrup were given referral letters to get tested for TB. This worked out very well and those who tested positive for malaria and TB started getting the treatment before they got very sick.
In the same way, TBA’s should have been trained to enable them to refer complicated cases to hospital. This training should be continuous. Currently, hospitals and other health facilities are overwhelmed as a result of this directive and very soon our health workers will start complaining of heavy workload.
The coming in of male nurses trained in midwifery is another factor which is obstructing expectant mothers from the village to deliver at the health facilities because of their beliefs.
It is my plea that government revisits this decision and puts aside the issue of politics on this matter. Think of Mayi Nayele of Nanjili, who has been delivering babies for over 20 years. Is it worth it for her to completely stop providing her services to expectant mothers when she has such vast knowledge and experience?
Let us all work together with alternative health-care providers to achieve health for all by 2020.
—The author is management speacialist focusing on community development.