USAID / Malawi - Success Stories

CHAPS Project- Mangochi-USAID/Save the Children US.

Traditional Birth Attendants (TBAs) are well known for their complimentary role as Midwives at the community level. Considering that few villages have easy access to health facilities, community volunteers offering safe deliveries to expectant mothers is a crucial need for many.

But what does it take to be a TBA? This question was put to Mrs. Emily Dinala, a TBA at Nkuchila Village: "I am now 53 years old and started offering services as a TBA in my early twenties. I decided to help others to emulate the good services my elder sister was providing as a TBA. I started assisting her and learned how to conduct deliveries." Emily explained that since her village was far from any health facility, mothers were very pleased to get delivery services right where they were, in the village. After learning the trade from her sister, she began to conduct deliveries at her own house and in clients' homes when called upon. Initially, she did not receive any formal training. She recalls, "I faced many hardships at that time, such as insufficient knowledge on how to assess women before, during and after delivery. I also used bare hands to deliver children, not realizing the risk I was exposing myself to." There was no proper referral mechanisms put in place, such that mothers requiring urgent care would sometimes be left without proper attention from a doctor or registered nurse.

When the Mangochi Community Health Partnerships (CHAPS) project started its activities in the area, the community identified Mrs. Dinala as one of the TBAs to be trained. In June 1999, she, and 15 other TBAs, traveled to Mangochi Boma and participated in a one-month training organized by the Mangochi District Health Office. "At the end of the training," Mrs. Dinala continued, "each TBA was supplied with a 'TBA kit,' consisting of a plastic pail, a pair of receiving dishes, a mackintosh, hand towels, hand washing basin and a paraffin lamp. We were also provided with gloves, disinfectant, cord ligatures, iron tablets and cotton wool, which, we were informed, would be replenished periodically." Mrs. Dinala says the project-provided training has given her the capacity to provide a much better and safer service to her community. "I have acquired a lot of knowledge in how to refer mothers at risk: those who have had previous caesarian section, who are carrying their first children or who have had five or more deliveries. I also know how to identify women with problems and refer them to the health center or hospital in time." She also refers mothers for postnatal check ups, immunizations and family planning services.

According to the records Mrs. Dinala keeps, with assistance from the Project's supervisory team, she conducts about nine deliveries per month, referring about three women per month to the Mangochi Hospital.

"I am very thankful to the CHAPS Project for giving me an opportunity to participate in an Exclusive Breast feeding workshop which provided me with knowledge and skills to adequately advise and support mothers in changing their infant feeding practices to immediate and exclusive breast feeding", Mrs. Dinala continues. "The project has really been supportive, ensuring that I receive refresher training (in 2000) so that my knowledge and skills are kept up to date."

Mrs. Catherine Chimimba, another TBA met recently in a village 45 minutes north of Mangochi, confided that even though she had been practicing deliveries since the 1970's, the training she received from the CHAPS project in 1998 has enabled her to better perform her services. Since she has received the training, she has had no child or maternal deaths among her patients.

Traditional Birth Attendants tend to between 50 and 75% of the deliveries in the Mangochi area. This emphasizes the need for well-trained professionals. The CHAPS project has trained more than 200 TBAs in that particular district and provides refresher courses every year.

USAID/ Malawi- Success Stories