Curbing Needless Maternal Deaths – A case for TBAs and Public Health Nurses

BY EDMUND SMITH-ASANTE

Nana Akyereba III

Nana Akyereba III, Queenmother, Efrim Traditional Area, Sekondi, Ghana, has charged the  country’s health authorities to better equip traditional birth attendants (TBAs), as they are the ones assisting with child delivery in the remotest parts of the nation.

She stated that though the TBAs are often tagged as illiterates, they are the ones saving the lives of Ghana’s women folk at the countryside, cottages and hamlets who do not have access to clinics and hospitals.

“TBAs are classified as illiterates and sometimes tagged as illegal,” she said.

Nana Akyereba, also a member of the Pathfinders Outreach Ministry, was contributing at a dialogue on maternal healthcare organised for religious bodies and opinion leaders, by international non-governmental organisation, Oxfam and partners in Accra, last week.

She also lamented that although there are only few old midwives and maternal healthcare personnel who are often based in the big towns and cities, nurses who fail their midwifery theory examinations are not made use of, but left to continue with mainstream nursing.

“Use nurses who fail midwifery exams, as proficiency midwives who can assist TBAs instead of discarding them,” she suggested as the way forward.

Arguing that if TBAs who have not received formal education can effectively assist pregnant women, then formally trained nurses could even do better, Nana Akyereba III stated, “Their practical knowledge can be of immense use in remote areas which are inaccessible for vehicles.”

She cited an instance when during a field monitoring exercise for malaria in the Volta Region, her team came across a male TBA in a very remote area “doing a very wonderful work” assisting women in labour in his area, who otherwise would have to trek for a very long distance before they reach the health facility in Akatsi, by which time they would already have put to bed.

Adding that malaria contributes to about 60% of maternal deaths, the queenmother recommended that TBAs be trained in administering sulphadoxine-pyrimethamine (SPs) to rural women, who though find them trustworthy, mostly disclose they are with child when their pregnancy is four months old.

SP is known to be a drug effective in preventing maternal and placental malaria as well as improving pregnancy outcomes among women.

Commenting on the invaluable contributions public health nurses could make to maternal healthcare, Nana Akyereba said “Even in the country’s nursing sector, public health nurses are not recognised or classified as nurses. The public health nurses who can go to remote areas - they look down upon them. It’s not a hidden secret, it’s an open secret so we have to look at all these things.”

When the question was posed by a participant, Regina Boakye of the Opportunities Industrialisation Centre International (OICI) on how Ghana is mitigating and integrating HIV/AIDS issues with maternal healthcare, Rev. Mrs. Anna Bretuo, CEO, Mission of Grace Ministry, proffered that “Government must educate medical personnel to handle all patients, including those with HIV/AIDS,” while enough protection is needed for nurses and other personnel.

For her part, Rosemary Akolaa, Oxfam, facilitator of the dialogue, bewailed the change in the status of free maternal healthcare, which has negatively impacted on ante-natal and post-natal attendance.

“Free maternal healthcare made attendance 90% but it has now reduced to about 50% due to frustrations. Now pregnant women have to register with the NHIS, paying GH¢ 20 for a card before they can access the facility, whilst when it began it was absolutely free,” she said.

Touching on the rampant maternal deaths while setting the tone for the discussion, she quizzed; “Giving birth is a natural process and having a child is a right, and if a woman chooses to have a child why should she die?”