Over the years, the role of Traditional Birth Attendants (TBAs) in most African communities has often been regarded as one operated outside of the formal healthcare delivery structure.
In view of this, the World Health Organisation (WHO) defines TBA as “a person who assists the mother during childbirth and initially acquired her skills by delivering babies herself or through apprenticeship to other TBAs”.
TBAs are integral members of their communities and provide an important window to local customs, traditions, and perceptions regarding childbirth and new-born care.
The role of TBAs in improving maternal health has been heavily debated, especially within the context of a renewed focus on Millennium Development Goal (MDG) 5.
While trained TBAs are not considered skilled birth attendants (SBAs), their potential contribution has been recognised in diagnosing labour, ensuring clean delivery, detecting and referring maternal complications, providing hygienic cord-care and ensuring warmth of the new-born, supporting early exclusive breastfeeding, and providing advice on a number of issues.
While in most African settings a TBA is viewed as a traditional midwife, community midwife or lay midwife, who is a pregnancy or childbirth care provider, but they may also function within specific communities in developed countries too.
It is within this context that a Switzerland-based healthcare group, SUPPORT, decided to support health projects in West Africa, starting from Nigeria.”
Makoko/Iwaya Waterfront community is a marginalised sprawling century-old informal fishing neighbourhood on the lagoon of Lagos, Nigeria. The community accommodates upwards of 50,000 inhabitants comprising five ethnic groups coexisting in a peaceful manner.
The majority lives on wooden stilt-houses on the Lagoon. They have no access to basic infrastructure, reliable clean drinking water, electricity, sewage and other waste disposal, and conventional health care services.
The community repeatedly decries its high MMR and infant death, besides the prevalence of malaria, pneumonia, measles & HIV/Aids and frequent outbreaks of water borne diseases due to the congestive living and very poor hygienic conditions.
Members of the community have to go to healthcare centers outside the plan coverage area, what few seldom do. Most inhabitants rely on traditional healers (TH) and traditional birth attendants (TBA) for their healthcare needs.
SUPPORT came to Makoko/Iwaya Waterfront communities four years ago on the request from the Community for Assistance to implement aspects of its own “Makoko/Iwaya Waterfront Regeneration Plan”, to see how it could help contain and improve upon the non-existent healthcare services in this slum community.
According to Dr. Vincent da-Silva, President and founding Member of SUPPORT of Switzerland and Nigeria, the move aims at “helping to improve health conditions of the women, men and children with limited or no access to basic medical care in West Africa” such as those in Makoko-Iwaya.
So, the organisation came out with an innovative development project of integrated medical health project that brings Makoko-Iwaya’s Traditional Healers, (THs), TBAs and conventional medical health practitioners together to enable the communities achieve self-supporting and sustainable solutions to the problems in the local health care systems.
According to SUPPORT, “Help to self-help is central to our projects, because we believe that the essentials of solutions to regional problems should be sought after, primarily in local resources. That is why SUPPORT advocates local health projects and initiatives.”
Thus, the group collaborating with a newly formed local NGO, IROHES, embarked on a three-legged Project Proposal of Integrated Primary Healthcare System of Traditional Medicine and conventional Medicine. They would achieve this:
First, by Empowerment and Capacity building in Health Literacy through the Help of so called “Health Champions” who after Training, enlighten and acquaint the community members through regular Home visits, in the workings of conventional medicine. Secondly, the Target group of TBAs and THs who undergo a total of 4 Training Modules in which they are equipped with basic theoretical Knowledge and know-how of conventional medicine.
Secondly, a system of eight Community Health Posts – one in every subunit of the community (one doctor/5,000patients!) to cater for minor health needs and for counselling on health matters.
Thirdly, erection and operation of a functioning PHC as the Platform for the integrative healthcare service delivery.
Similarly, 20 young people were selected from the communities to be trained as health champions. These are youth leaders.
The project began in Nov.2016 with the Training of the TBAs and THs with the main themes of personal and environmental hygiene and pregnancy (in difference to the dire hygienic conditions in the community) as well as a number of common health issues.
They were instructed on a number of health issues and general healthcare. The training included issues like nutrition, immunisation, common diseases like Malaria and Diarrhoea and how to keep themselves safe from HIV infection.
The second and third modules of training workshops took place in May and September this year and lasted three days each for the THs and TBAs who constitute the target groups of SUPPORT to deliver and operate within the primary healthcare system.
The training sessions this time focused again on ‘Basics of microbiology and hygiene as well as challenges to waste disposal and Management in Makoko/Iwaya Waterfront Community, infection control, including the spread of diseases, standard precautions, water treatment, wounds and care.
On the other hand, the themes on pregnancy involved the anatomy and physiology of pregnancy, nutrition and care during pregnancy as well as management of complications of pregnancy.
A special group of youths of the community also began training for the first time to become “Health Champions”.
They are youth leaders who must have at least high school education and have not had formal education in health related matters but are well embedded within the community. They will be tasked with going into their communities at least twice monthly to educate and instruct their people on health matters.
Prior to this they were taught the art of effective communication with people during a two-day training workshop.
The main facilitators for the September trainings were Ms Chris Mohr, on Hygiene and infection Control and Ms Eliane Hinderling on pregnancy and Management/(Referral) of Complications. They are both from Cantonal Teaching Hospital, Aarau Switzerland.
Others were Mr. Rahman Adigun, traditional medicine, Lagos State Traditional Medicine Board (LSTMB) and Dr. Ismail Morayo, Primary Health Care, Medical Officer of Health, Yaba, Lagos.
Following the September 18 to 22 training workshops, an outreach programme was organised in Maokoko/Iwaya each on land and on water that included doctors, nurses and other medical professionals, including Laboratory technicians.
They examined Hundreds of people, among whom were nursing mothers who brought in their babies for immunisation as well as general examinations that included weight/length and body mass index (BMI). Adults were tested for hypertension among other things, and those who consented took tests for HIV.
It was during these tests that four HIV persons tested positive and later referred. These patients now undergo treatment after counselling. Those with pathological findings were referred to hospitals immediately for further assessment and treatment.
It was not surprising, therefore, that by the end of the September training, both the Lagos State government, and the Yaba Local government where Maroko/Iwaya are located, became fully supportive of the project that is being implemented by Iroko Healthcare Support (IROHES).
IROHES are partners of the Swiss SUPPORT group in Africa. The communities have allocated land for the erection of a Primary Healthcare Centre of their own, and the Primary Healthcare Centre formerly operated by the Medicines Sans Frontiers (MSF) was also offered to IROHES. But the building abandoned after the MSF left, needs extensive refurbishment.
da Silva said: “This is a positive development and an encouraging one for that matter”, while also stating that the building will be renovated by next year in order to house the Integrated Primary Healthcare Centre. This will enable the THs, TBAs, as well as the conventional medical practitioners operate under one roof.
Treatment at this centre will not attract any extra charges and will make it possible for patients to choose where they want to be treated.
One of the advantages of this setup is that the traditional practitioner that will encounter any complication with patients could easily seek conventional medical attention. They would thus also share their experiences.
Speaking to Africa Link, da Silva said SUPPORT is not a charitable organisation. “We believe in developmental aid, whereby the beneficiaries – in this case Makoko/Iwaya communities-and IROHES, have to work together.
Each has its own responsibilities and commitments to deliver in every transaction such as the land and structure for the centre, which meant that, “Makoko/Iwaya owned the project, and together we formulated the operational conditions.”
He said IROHES had started to work with the local and state governments on the conditions of handing over the building at Aiyetoro to the organisation.
He added: “We want the governments to renovate it, after which we will furnish, equip and operate it. We hope to fund the personnel for a while. This collaborative effort would be an example of private, public, partnership (PPP) in Healthcare.”
The minimal fees that patients will pay for services will help cushion the running costs. The fees that patients pay for both services –traditional health services and conventional health care delivery – will be the same.
The trainings will be completed next year before the envisaged Integrated Primary Health Centre (PHC) is ready.
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