28 October 2008

Zambia: Experience of a Traditional Birth Attendant

Martha Akalimikwa, aged 45 and a mother of three - two girls and a boy, decided to take up the voluntary profession of traditional birth attendant after she underwent a difficult labour herself and delivered at home.

Unfortunately her baby, a beautiful girl did not survive. She died upon arrival at the district hospital. The circumstances that led to Ms Akalimikwa delivering at home are not strange to anyone living in a rural district like Lukulu.

Lukulu is one of the seven districts in the western part of Zambia. The district has a population of about 68,373. Women make up the majority of the population and also suffer the burden of poverty, disease and unemployment.

Ms Akalimikwa has been a traditional birth attendant (TBA) for the past 23 years. Her work is valued and appreciated by community members that benefit from her services.

In the absence of maternal health services as close to the household as possible, the role of Ms Akalimikwa and many other TBAs in providing health care services is critical.

Catherine Mwambwa, also a TBA in Lukulu and aged 53, decided to take up this noble profession because she wanted to assist women like Ms Akalimikwa and others in her community.

She describes this as a life of sacrifice.

Ms Mwambwa was selected by members of her community because she is respected, mature and as such expected to uphold the principles of confidentiality.

In addition to her job in the community, Ms Mwambwa is in charge of the primary health care unit (PHCU) in Kankwilimba community in Simakamba area. This is an occupation valued and appreciated by community members that benefit from her services.

"I am on duty 24 hours. When an expectant mother is in labour, I am informed immediately by her husband or family members. When that happens, I have to stop attending to any other house chores, rush to where my services are needed and stay there until the woman delivers," Ms Mwambwa explained.

The health of mothers is at risk in most rural districts. And in Lukulu, the situation is even worse with only 11 Government and two mission health facilities serving a large population.

The situation is compounded by inaccessible roads and long distances to health facilities, which make the status of women's health even more precarious. The uneven distribution of the homesteads makes it difficult for the people to access the available health facilities.

The point to note and appreciate is that the life and work environment of a TBA is not an easy one. It is very challenging, especially in situations where the TBA lacks basic requirements such as clean water, razor blades and cotton wool to ease their work.

In an effort to assist TBAs, the Government, through the Ministry of Health, has been implementing a package of interventions by providing delivery kits - bicycles to assist TBAs reach hard-to-reach areas and training.

These deliberate efforts have made it easier and manageable for TBAs to conduct their noble work of providing safe maternal health services to women in localities riddled with high poverty levels prevailing in the area.

The poverty situation disadvantages the women even more and makes it difficult for them to access transport and get to a health facility.

Ms Akalimikwa and Ms Mwambwa's spirit of voluntarism, dedication and passion have contributed significantly to the country's improved maternal, newborn and child health situation.

And the Government has made huge investments in the provision of maternal health services.

Some of the measures being implemented by the Ministry of Health include the following:

-Provision of free maternal health services during antenatal clinics (Family Planning, Voluntary Counselling and Testing, Intermittent Preventive Treatment)

-Formation of the Maternal, Newborn and Child Health (MNCH) partnership

-Provision of Mother-to-Child Transmission of HIV (PMTCT) services in 678 health facilities countrywide

-Implementation of comprehensive emergency obstetric care in 30 districts in the country

-Implementation of the annual child health week activities by all the 72 districts

-Provision of Insecticide Treated Mosquito Nets (ITNs) to pregnant women, children under five and the chronically ill persons, and

-Annual training for TBAs.

The contribution by the Government and its partners is commendable but more needs to be done. The district health office ensures that it conducts annual training for TBAs to keep them abreast with the requirements of their work and maintain the number of trained TBAs.

Mr Mark Mutozi, officer in-charge and health promotions focal person at Simakamba rural health centre, feels the number of trained TBAs is not adequate though training is conducted every year.

"We conduct training every year but we still need more because some of the trained TBAs got married and have moved to other areas, while others move when their spouses are transferred to other towns or districts," Mr Mutozi said.

Asked about what type of assistance TBAs like herself would require, Ms Mwambwa requested for delivery beds, beddings and lighting devices and commodities such as lamps, torches and paraffin at the PHCU level. She also appealed to the Government to provide TBAs with bicycles suitable for females and delivery-kit items.

The community in areas like Lukulu have been helpful and supportive. In Ms Mwambwa's case, the community supports her by harvesting and cultivating her field, donating food and sometimes even performing household chores such as fetching water and sweeping.

Perhaps what is striking about Ms Mwambwa is that she understands the need for reliable and effective communication in her line of duty.

"We have been advised by the DHMT that when complications arise and we are unable to deliver, a note should be written and quickly sent to the rural health centre," she explains.

And in this era of advanced communication technologies, Ms Mwambwa advises that TBAs must be equipped with communication gadgets such as mobile phones. She is confident that her community would support her by providing talk-time.

Although Ms Mwambwa's and Ms Akalimikwa's contributions in an urban setting may seem insignificant, their role in contributing to delivery services in the country is vital for some communities.

With only half of the deliveries in the country occurring in health facilities, we may be a long way from having our ideal of having every delivery attended by a skilled health worker. TBAs such as these offer us a stopgap measure with their great passion and dedication.

Therefore, holding the first-ever Zambia Countdown to 2015 conference gives implementers and other stakeholders an opportunity to assess progress towards the attainment of the two health-related MDGs - four and five - that are aimed at reducing child mortality and improving maternal health, respectively.

Dr Victor Mukonka, director of public health and research in the Ministry of Health, is hopeful that the two health-related MDGs will be attained.

"There is need to sustain the gains and continue with more efforts to further improve maternal, newborn and child health," Dr Mukonka says.

Reports show that Zambia has performed remarkably well. However, implementers should not relent in their efforts.

The onus is on the Ministry of Health, partners and the community to reduce child and maternal deaths by two-thirds and three-quarters, respectively by 2015.

In areas like Lukulu and many other rural places in the country, the role of TBAs is important in contributing to delivery services in Zambia.

Yes, volunteers like Ms Mwambwa and Ms Akalimikwa need respect, recognition, motivation, and above all, everybody's support.

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