The Ministry of Health has indicated that it has no intentions of training Traditional Birth Attendants (TBAs) both in rural and urban areas of the country.
Ministry spokesperson Kamoto Mbewe said the idea of training TBAs was not good because certain situations which expectant mothers faced required the attention of qualified medical personnel.
Dr. Mbewe told ZANIS in Lusaka today that conditions such as excessive bleeding must be attended to by qualified medical personnel.
He charged that TBAs contributed to high levels of maternal mortality rate in the country hence the need for expectant mothers to deliver from health centres.
He emphasised that the Ministry of Health was carrying out massive sensitisation campaigns to women on dangers of delivering from home.
Dr. Mbewe explained that these campaigns were being done through safe motherhood action groups.
He said the role of TBAs has shifted to holding workshops with expectant mothers and educating them on benefits of delivering from health centres where all their complications could be handled by qualified medical personnel.
Dr. Mbewe said it was therefore imperative for all expectant mothers to deliver from health centres for their safety and their babies.
He called on all expectant mothers attending workshops with the TBAs to adhere to what they learn and regard the material as important material.
ZANIS
so whats wrong with training the tbas? i do not, for the life of me, think this action will discourage those women bent on delivering at home ( of whom their is a sizeable population in the rural areas) from continuing with their practice
in such situations positive reinforcement and risk reduction strategies have be found to have more effect than this negative thing you are proposing kamoto
i think continuing to train these tbas is still the way to go but take away their mandate to carry out deliveries at home, for those who still want to practice their trade and the patients who prefer to be delivered by their own tbas, they can be allowed to do deliveries under supervision at the health care centers. both ways you will still achieve your goal of reducing home deliveries, the only
difference is that with this approach, you recognise that whatever you do, you will always have home deliveries happening but have put forward measures to mitigate against bad outcomes vis a viz continue training the tbas for where there is no midwife
but again, i may not fully understand your system works, in which case i might be talking about nothing but wind!
Or go Lueti RHC where the sole “medical” personnel is a casual worker!
TBAs are ‘untrainable’, they provide an understandable compromise where there are no health workers to do a proper job. I hope ministry of health have done their home work and are sure we have reached a stage where we can finally tell them to get lost. As the move is not backed with figures, it may be premature and may cause resentment in well meaning TBAs.
This is a stu.pid *****!! I live in England and there are people that choose to give birth from home!!! There is nothing primitive about that iwe Chi Mbewe ubupuba!!! Your parents were born in the same way you are now despising!!! Ati ba Doctor ba mafi!!!
In England you can opt for a home delivery, however it is attended by a fully qualified midwife. If things go wrong an ambulance can readily be called. No TBAs in England at all, just like all other developed countries.
kamoto whom i been to school with and know is a decent, well mannered and pleasant personality. #5, please argue or insult the policy and not the man. can’t you see that you are the odd one out with irrational insults? i am saying this of course with risk of attracting insults to myself from people like you!
one last thing, do not compare apples with oranges; we have all lived in these countries where there is the luxury of choice of birthing methods, but remember all these patients have an obsterician who has been looking after the woman pre natally and who okays the type of birthing that can be allowed based on the risk profile of the pregnancy
WE DO NOT HAVE THESE LUXURIES IN ZAMBIA, so argue with respect to our context
Once again you nailed it Dr Mbewe. This is an excellent policy. Every time I see news from Ministry of Health I’m so proud of you and our foundation we got from UTH back in the day. May you be very very successful leadership at the ministry sir.
The statement that the TBAs contribute to high levels of mortality rate is not true, this doctor is not appreciating the positives that these TBAs have contributed especially in rural areas. As long as trained doctors like him remain in offices and stop attending to patients, there will never be enough trained medical personnel he is dreaming about. There are so many doctors sitting in offices in the name of management when patients are dying. In developed countries you find Health Care Assistants (HCA) but in Zambia you want to have only trained people to attend to patients, that is why there will always be higher deaths. What is required is to retrain or having refresher courses yearly for the TBAs. However, Mr spokesperson do not apportion increased maternal death rates to the TBAs.
# 6 and 7 You have missed the point here!!! How many doctors do you have in Zambia? If you cut off the basic training what is gonna happen to those people that depend on Traditional Birth Attendants? And oh, while women are giving Birth in the streets you are just gonna charge them with pornographic offences? You people are stupi.d!!
What you throw away is what other people are embracing!! Pregnant women’s water break unexpected and babies can come at any time and if it does, at least you expect the people present to be able to handle it. But not in Zambia, cut off the training so that they give birth in the woods with the help of a charcoal burner passin.
This is like saying you have cut off first Aid because you need people to be rushed to the clinic.
Ala mulifipuba pa Zambia!!!
I guess Zambian doctors do not want anyone doing their jobs of killing babies and delivering some. While they are at it, they are at it, they might as well barn unapproved traditional medicines and ‘topings’.
…GRZ will send you a manda-manda before they send you a mobile clinic since they have more manda-mandas than mobile clinics.
#10, Kashimani I totally agree with you. What is needed is retraining the TBA’ s as often as possible. In most cases the women that are attended to by TBA’s have never ever been to ante-natal clinics not because of their liking but because Health centers are long distance away from their villages. These women don’t even have a clue as to when they will be giving birth and when labor strikes, most of the times the women can’t make it to the health center. And even if they did make it to the health center the clinical officer is not readily availabe 99% of the time.
Ba Doctor it does not work like that, home deliveries will automatically reduce when we have enough health centres. Its like saying that we are burning the use of bicycles cause they are risky we want to encourage people to use motor vehicles….how!!!!!! I hope that man sitting next to you is not confusing you.
As with many above, this maybe a retrogressive step! We have no figures to attribute the increased mortality.We should remember that the reason TBA’s were established, remains the same reason they will be needed. We have a Health system that is hardly coping, yet we want to do away with TBA’s that cost almost nothing to the system, but are a valid resource to the many women out of reach of health centres!! Maternal morbidity & mortality remain high in Africa!!
If TBA’s are truly responsible for such mortality & morbidity, we should be looking at how we train them, IT IS ACTUALLY A REFLECTION ON THE SYSTEM THAT HAS TRAINED THEM, i.e INADEQUATELY!!
What we have to remember is that unnecessary intervention may not always give positive outcomes!
A well trained TBA should be able to pick up the tell-tale signs of a difficult labour, thus what should be emphasized is early referral & a RESPONSIVE NETWORK should be in place avert morbidity & mortality!!
We shouldn’t deceive women into believing that TBA’s are a danger to them – it is a very wrong if not dangerous message!! I know Mbewe, but I guess this has not been his individual decision, MOH will have to rethink this one through!!!
What they need in Zambia is a Think Tank.An organization by which the Zambian government should run some of these ideas by before they implement them.Take this idea there.Is it beneficial for the country to stop the training of TBAs or not? Some other past decisions they should revisit; Has the country benefited by our decision to cut off night school and adult education? Has the country benefited from sending pregnant girls out of school or even colleges (has this one changed,I heard something some years back)? Readers add some more decisions they should revisit.
Thanks bloggers, you have indeed educated me on this matter. indeed TBA just like First Aid must be well known in our societies. knowledge is good. You can train people and then urge them to assess the condition before referals are done. in every aspect of life now, globally people are appreciating the traditional knowledge and embracing it with scientfic knowledge. these TBA have great experience that you can just throw away. they can as well to asked to be working part-time at hospitals. I agree with the blogger who said that the biggest problem we have in Zed is rushing to make decisions before turning the coin on both sides. how many do we have in rura health centres? what are the distances that people cover? these are critical issuess for some areas the practice should continue
Among the most common causes of maternal mortality in Zambia is inadequate facilities and staff. I believe TBAs play an important role in filling the gaps left by inadequate staff. All they need is training and retraining.
#10 Zambia is not the only country were Doctors manage hospitals. All we need to do is to train more of them and give them good conditions of service then they will stay in the country. The few Doctors in management positions won’t make a difference if they went to the wards, because the deficit is simply too big. Zambia currently has only half the health workers that it needs.
#21 I did not say that zambia is the only country that where doctors manage hospitals, that was your statement. We need doctors who can be in manage hospitals and also find time to attend to patients. We have a cartel in Zambia where there are so many doctors occupying offices at the Ministry of Health at the expense of patient care. These are same doctors who are coming up with false statements that TBAs contribute to high mortality rate when them can not go in rural areas to conduct deliveries. They are not longer in touch with reality on the ground but just rubbing shoulders with funders/donors. You know that we shall never train enough doctors so let us just use the available resources and make TBAs proud. We must change the word Traditional to more dignified one.
I think the word “Traditional” is sending a wrong message to some people. They start believing that these people are using some tradional methods of delivering. They are trained to deliever in a house or home using facilities they are given by the Ministry of Health. What is contributing to high mortality rate a bad policies of the MMD, the party that has been in power for a long time but failed to improve the health services in the country. They retrenched health workers around 1998 under the voluntary seperation scheme. why not condeming such policies, the learned managers at MOH have targeted the innocent TBAs. We lost skilled man power during VS and the mines also retrenched many workers who have now left the country. the are contributing factors to maternal mortality rate, period.
I live in a very rural setup and I work with some of the poorest people Zambia has and the worl d at large has. I can only say Dr. Kamoto Mbewe is a joker. The opposed about his statement on TBA’s is true. We have one doctor at our District Hospital and this person spends the whole year out for workshops. I just wonder what they go to learn that they are never allowed time to come and implement. It took me a year to meet him and I visit the hospital very often. Our services are far from good for us to disregard what our poor women are doing for their fellows and children.
If they are not trained, what alternative is there? This GRZ amazes me. It says it is fighting corruption, but on the other hand it remove clauses that help fight corruption.
This is ill timed move, if at it it is true! I was in Lundazi recently where expectant mothers walk more than 20 km to nearest health centre. They spoke highly about the TBAs that by then were being trained by an NGO. Unless the reason is lack of resources to train the TBAs, then I strongly feel that the move is ill concieved idea and a danger to millions of pregnant mothers especially in rural areas.
This guy is making decisions without feet on the ground. It is like RB buying Mobile Hospitals when we do not have any roads to accommodate them. When are we going to have well balanced leaders and managers in our institutions to make sound decisions?
Min of Health is doing the right thing. The outcome of the deliveries and general care of TBAs has been disastrous. this is based on overwhelming evidence that has been collected over time not only in zambia but most countries of simillar setting. it has nothing to do with primitivity. this TBA idea is being abadoned by many country because of the overwhelming evidence.
one things this episode shows is that there are no short cuts to training medical/health personnel. The TBA idea was a short cut to training a nurse. the idea was thought to be serving money.
I THINK THIS IS A MISPLACED PRIORITIES,remember govt policy is having a health centre af atleast 12km apart,nw coming to rural areas where health centres a more than 20km wat happens?tbas are very important dat we shud not forget naimwe ba Kamoto.be a wise doctor and advise appropriate..Will give u a precise example of where i kum frm–
Lubwe hospital in samfya District is centrally located in chief Chitembo’s village,people frm as far as Kasaba,ku masonde streching to musaila kum to this hospital which is more than 25km apart and being a finished gravel road u no wat that means and u hv an xpectant mother en things a so serious teti afyalila munshila,bt wen tba a around things wil be quickened period….misplaced priority indeed
Matuka Mwansa No 29 i sympathise with you, but what you should be asking for is qualified health workers with whom robust evidence has shown that they are safe practitioners eg Nurses to run clinics/health posts that should be placed near communities.TBAs ARE A DANGER with respect to the role they were playing. there are no short cuts to this
#30 TBA’s are not a term nor a role created as a stop gap to man power shortage, this has been a role since the beginning of man!! ask your grannies, there were always older women in villages who went out to help when an expectant mother was delivering, and am sure in your mother tongue you have aterm for them. TBA was a term coined to recognise them. Midwives are the next step up, difference being, these are trained nurses! Thus TBA have always been recognised & trained within structures in MOH & NGO’s.
If you analyse morbidity & mortality data, & factors contributing, top of list will Transport/distance to specialised care, & NOT A TBA PERSISTENTLY TRYING TO DELIVER A DIFFICULT LABOR, inspite having specialised help at hand!! I challenge you to show that this is the case!!
No 31 you have never worked in any health related organisation, you have never read anything writen on TBAs. you have never seen actual stastitics about the impact of TBAs on health care in any of the our region. and by the yes some one has always taken the role of todays TBA 100 years ago. but you have no idea about the current dynamics. for example 100yrs back pregnant women were traditionally forbid from eating nutritrious foods this resulted in them giving birth to underweight children this made deliveries easy hence those TBAs delivied easy. compare with todays world where lifestyle has changed babies are bigger.
how can you say they perform well then when no records where kept from which to accurately analyse
#32 you see how you lack insight to analyse?? You claim no records are kept in you last sentence yet your second sentence you claim to have actual statistics. This leaves me wondering what you are using to think – i.e. is it your head or your bottom??
YOUR FIRST SENTENCE IS ACTUALLY MIND BLOWING!! Better be careful how you speak with such temerity, I might have just delivered you as a “squeaky wee one”, whilst I was at it!!
Yes babies may get bigger, do you even understand why?? Over-nourishment is just as bad as under-nourishment, hence both are referred to as malnourishment or malnutrition!! -i.e. putting it for you in the simple terms that you are familiar with!