Background
Human resources crisis in Zambia and TBAs
Methods
Research design
Study site
Study population
Data collection
Key informant interviews
Focus group discussions
In-depth interviews
Data analysis
Ethical considerations
Results
Attributes of TBAs
Characteristics | Number of participants | |
---|---|---|
Age (TBAs) | (FTL) | |
30–34 | 4 | |
35–39 | 5 | |
40–44 | 6 | 3 |
45–49 | 2 | 1 |
50–54 | 2 | 1 |
55–59 | 1 | |
60–64 | 1 | 1 |
65+ | 1 | |
Total | 22 | 6 |
Years of experience | ||
1–5 | 3 | 2 |
6–10 | 7 | 2 |
11–15 | 5 | 1 |
16–20 | 4 | |
21–25 | 2 | 1 |
25+ | 1 | |
Total | 22 | 6 |
Perceived reasons for the ban
“I just thought that maybe it is because of this HIV/AIDS that has gone so much into the communities. Government was trying to reduce the spread of the disease from mothers to their babies during delivery because the people that used to conduct these deliveries were not fully knowledgeable on how to prevent the same disease. Otherwise it is just thinking we were not given any reasons why the decision was made” (Key Informant 5).“As traditional birth attendants we have no much knowledge on how to handle complicated cases like when the child is breech so at the clinic they know how to handle such cases. Sometimes the child maybe born with a disease like being born with a yellow skin and we don’t know what to do in such cases, all we know is how to deliver” (Respondent 2, FGD 1).“The reasons I was told were many including the need for reduction of infant and maternal deaths and many other complications that are common in the community” (30-year old tTBA).“We are trained but we do not think we have the skills like those of nurses and doctors and we don’t have the equipment to use except the foetoscopes” (Respondent 1, FGD 1).“Even when there is a complication some people delay to make decisions to take women to the hospital due to for example dependence on community deliveries….” (Respondent 6, FGD 1).
Positive effects of the ban
“If a complication arises while at the clinic it’s easier for someone to contact the hospital unlike in our homes because some of us come from distant places and our roads are very bad” (Respondent 4, FGD 1).“I think it has helped improve the hygiene in the community because when we were still delivering in the community we would just do it on the floor on a mat or sack with a plastic on top but at the clinic there are beds there and they clean those rooms better with chemicals. One time I delivered a woman from her kitchen outside because she was staying in a one room hut and the husband and other children were in the house at night. Now this is the same place where food is prepared so I think on that one it is a good idea to just go to the clinic.” (30-year old tTBA).“On one side I would say there are no women and babies dying in the community. In the past we would hear of women dying in the community during labor but because of that decision we don’t hear of such deaths…” (42-year old tTBA).“It helped us from criticisms from the community. For example, when a woman dies while in labor the community will just say that TBA never took good care of the woman besides why did she deliver someone who had complications she can’t handle. So government saved us very much”(Respondent 2, FGD 2).
Negative effects of the ban
“…because of the Safe Motherhood Action Groups (SMAGS) I do a lot of walking escorting women to clinics far away from here but once there I do nothing at all” (36-year old tTBA).“I don’t often go to the clinic though at first I would go frequently…pauses…..ah it’s like they don’t need us there anymore. Although the nurses don’t say it verbally but their actions show that am not needed. You can go there and they see you but they will just greet you and they get busy with whatever they are doing so I felt out of place most of the times and I stopped” (30-year tTBA).“It’s rather annoying because they damped us. But what is surprising is that when they want something from us like information in the community they come back to us. So they just want to use us when they are stuck” (Respondent 6, FGD 3).“I remember some time back people would organize themselves especially during the rainy season to come and cultivate the fields for me just as a way of appreciating what I used to do for their wives but since they heard that we were stopped by government they have stopped.” (42-year old tTBA).“Staying at the relatives’ shelter entails running two separate homes. Women have to share the little food between those that remain at home and those that go to the clinic and this is expensive for us in the community. So we don’t know how government thought on that one because it never came to the people to explain.” (Respondent 1, FGD 1).“…people that are not trained, the old women and relatives are the ones delivering in the community now.” (45-year old tTBA).