Background
Methods
Results
Author | Study design | Setting | Description of intervention |
---|---|---|---|
Fauveau et al., 1991 [6] | Pre and post intervention study | BANGLADESH, rural Matlab | Nurse-midwives posted in outposts of programme area. The nurse-midwives’ duties included working with CHWs and TBAs to ensure that they were called during labour. |
Frankenberg et al., 2009 [4] | Longitudinal panel survey | INDONESIA | A village midwife programme where midwives were trained and placed in poor communities far from health centres. Responsibilities included developing collaborative relationships with traditional village midwives. |
Gabrysch et al., 2009 [19] | Pre and post comparative study | PERU, Ayacucho rural Santillana district | A culturally appropriate childbirth care model developed with Quechua communities and health professionals. Key features included a rope and bench for vertical delivery position, inclusion of family and TBAs, use of the Quechua language and health professionals that were respectful of culture. |
Mullany et al., 2010 [7] | A pre and post intervention study (2-stage cluster-sampling surveys before and after programme implementation) | MYANMAR, Shan, Mon, Karen, and Karenni regions | A community-based project, collaboration to improve coverage of maternal health services in vulnerable communities. Strategy of a 3-tiered network of community-based providers: TBAs created links between community member and senior workers, HWs strengthened links between TBAs and lead health workers, and MHWs, who oversaw the work of TBAs and other HWs. |
Purdin et al., 2009 [13] | Programme evaluation using health information system/retrospective pre-post analysis | PAKISTAN, Hangu district, Afghan refugee camp | Male involvement interventions relating to safe motherhood, services established, and training provided to different community actors including TBAs to raise awareness of services and reproductive health issues. Outreach and community input. Each refugee camp has a health committee with community representatives and health service staff that meet bi-monthly to discuss project activities and provide feedback to health workers on health services provided. Basic emergency obstetric care facilities, community-based education provided to key community representatives including CHWs, female health workers, women of reproductive age, men, health committee members (all men), teachers, religious leaders and private practitioners. |
Ronsmans et al., 2001 [5] | A pre and post intervention study, including mixed methods | INDONESIA, three districts in South Kalimantan | A midwife placed in each village and at least one doctor with obstetric skills in each district. Financial access was facilitated for the poor. Village midwives were encouraged to work side by side with TBAs. TBAs supported to refer women with a complication and to work in collaboration with village midwives. |
Additional sources | |||
Andemichael et al., 2009 [25] | Published article – rapid assessment | ERITREA | Improve access to services: addressing geographical barriers. New role for TBA: accompanying women to health services. |
Braine, T. 2008 [11] | Published article - opinion | MEXICO | New role for TBA: Doctor + TBA partnership. Cultural adaptation of institutional childbirth. |
Davis-Floyd, R. 2001 [30] | Published article – qualitative research | MEXICO | Improve access to services: addressing geographical barriers. New role for TBA: midwife + TBA partnership. |
Fonseca-Becker et al., 2004 [27] | Published (online) report | GUATEMALA | New roles for TBA as a key component of newly established health committee. Recognises TBAs importance as a (culturally acceptable) bridge between pregnant women and the health system. TBAs incorporated into activities in health facilities as part of MNH. TBA giving emotional support and coaching during labour, passing instruments to SBA and acting as interpreter. |
Koblinsky et al., 1999 [28] | Published article – review paper | MULTIPLE COUNTRIES | Improve access to services: addressing geographical and financial barriers. New role for TBA: support at childbirth with health workers. |
Murigi, S.F. 2010 [26] | Newspaper article | UGANDA | TBAs prohibited for childbirth. New role for TBA: community advocacy and accompanying women to health services |
Onuki, D. 2002 [29] | Published article - opinion | BOLIVIA | New role for TBA: paid to refer pregnant women to health services. Cultural adaptation of institutional childbirth. |
Ministry of Health, Myanmar 2010 | Personal communication | MYANMAR | Improve access to services: addressing geographical barriers. New roles for TBA: community advocacy; health services + TBA partnership. |
Ministry of Health, Nigeria, 2010 | Unpublished concept note | NIGERIA | New role for TBA: community advocacy, accompanying women to services, support for women during labour and childbirth, paid to refer or accompany women to health services, provide a link between women and families and health services. |
Ministry of Health, Southern Sudan, 2009 | Unpublished report | SOUTH SUDAN | New role for TBA: accompany women to health services, financial incentives to TBAs, midwife + TBA partnership. |
Save the Children, 2008 | Unpublished report | AFGHANISTAN | Human resources development and deployment Policies to increase access to services, quality of the services, community participation and midwife + TBA partnership |
UNICEF Indonesia, 2010 [21] | Published (online) report | INDONESIA | New role for TBA: midwife + TBA partnership. |
Weber, M. 2010 | Innovation ‘letter to a friend’ (‘surat dari sahabat’). Also described in reference [21] | INDONESIA | New role for TBA: midwife + TBA partnership. Community advocacy. |
World Bank, 2010 [22] | Published (online) report | INDONESIA | Human resources development and deployment Improve access to services: addressing geographical and financial barriers. New role for TBA: midwife + TBA partnership. |
Stakeholder experiences of partnerships and new roles for TBAs
TBA, community-based SBAs, and facility-based staff experiences
Women service users, family members and wider community experiences
Barriers and facilitators to implementation of new roles for TBAs
Changing traditional TBA roles and practices
Working relationships between TBAs and other health workers
Rewards and incentives for TBAs in new roles
Discussion
What factors are critical to the success of TBA interventions?
Studies from systematic review that report overall improvement in care seeking outcomes | Findings from synthesis of factors influencing implementation | ||
---|---|---|---|
Author, year | Country, setting | Facilitating factors critical to successful outcomes | Barriers to successful outcomes |
Fauveau et al., 1991 [6] | BANGLADESH, rural Matlab | Collaborative working between trained midwives, nurse-midwives, CHW’s and TBAs - Integration of TBAs into a ‘referral chain’ working with skilled personnel | - Continued adherence to traditionalism and traditional practices - Men as main decision-makers in the family may be unwilling to seek external assistance |
Frankenberg et al., 2009 [4] | INDONESIA | - Collaborative relationships with TBAs identified as a duty of trained midwives posted in villages | - Greater degree of traditionalism in some villages where trained midwife posted |
Gabrysch et al., 2009 [19] | PERU, Ayacucho rural Santillana district | - Adopting a participatory approach including TBAs and family members to design culturally appropriate childbirth services - TBAs accommodated as birth companions to help with pushing and giving drinks and to provide a culturally appropriate facility birth - TBAs involved in capacity building workshops with other health workers | - Providers continuing to ascribe high levels of home births as due to ‘cultural preference’ or ‘ignorance’ rather than offering culturally accessible services |
Mullany et al., 2010 [7] | MYANMAR, Shan, Mon, Karen, and Karenni regions | - Integration of TBA into a 3 tiered network of community based providers - Training of HWs and TBAs to strengthen their working relationship - TBAs used to create links between community members and senior health workers - TBAs used to provide improved ANC - Supervision of TBA role a responsibility of MHWs | |
Purdin et al., 2009 [13] | PAKISTAN, Hangu district, Afghan refugee camp | - TBAs provided with reproductive health (RH) training along with other community members - TBAs active in awareness raising, including RH | |
Ronsmans et al., 2001 [5] | INDONESIA, three districts in South Kalimantan | - Village midwives encouraged to strengthen their relationships with TBAs - TBAs identified as one of several ‘key decision-makers’ - TBAs involved in accessing information, education and communication (IEC) materials for community use |