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Traditional birth attendants in Zaire.


 Since 1982, more than 100 traditional birth attendants (TBAs) in the rural Ubangi Mongala region of northwest Zaire have been trained in improved delivery practices, learning to identify and refer women at high risk of pregnancy complications to the hospital in Karawa for obstetric care. They also have learned to collect data on maternal and child health, reporting on all deliveries they attend in their villages. This effort to integrate TBAs into the existing primary health care system began with 3 assumptions: that maternal and child health care can be improved; that to effect the improvements, health policy makers need community-based information on births; and that because there are so few medical professionals, more use must be made of TBAs. In most African countries, most women depend on TBAs for obstetric care, in part because few trained health care providers are available. The data collection system developed in Zaire, where the TBAs are illiterate, was designed to take advantage of the strong oral tradition in the area. Trained TBAs participating in the study report all births they attend to the health worker in their village, who records data in a "birth registry" about the health of mothers and newborns, complications of pregnancy or labor, and previous pregnancy outcomes. Each month or so, TBAs and village health workers travel to the hospital in Karawa or are visited by a hospital staff member to register information on deliveries since their last visit. Involving the TBAs in the development of the data collection system, training them well, and carefully monitoring their data collection activities works to improve the results obtained from TBA data collection programs.
