Elochukwu Benjamin
Awka
The Anambra State Government has commenced moves to integrate Traditional Birth Attendants (TBAs) into the formal healthcare system through a structured referral network aimed at reducing maternal and infant deaths across the state.
The initiative formed the focus of a multi-stakeholder dialogue organised under the Strengthening Public Accountability for Results and Knowledge (SPARK 2) project, where government officials, healthcare managers, civil society organisations and traditional birth attendants agreed that TBAs remain vital in many communities but should no longer operate in isolation.
The meeting, supported by the International Budget Partnership (IBP), brought together representatives of the Ministry of Health, local government authorities, Primary Healthcare Centres (PHCs), traditional birth attendants and civil society organisations to develop a referral framework that will ensure pregnant women with complications receive prompt medical attention from skilled health professionals.
Participants acknowledged that traditional birth attendants continue to enjoy public confidence because they are affordable, accessible and deeply rooted in local communities, often providing more personalised care than conventional health facilities.
However, they stressed that complicated pregnancies should be promptly referred to healthcare facilities rather than being managed beyond the capacity of TBAs.
Speaking at the meeting, the Director of Justice Development and Peace Caritas (JDPC) Nnewi, Rev. Fr. Benedict Okolo, said the goal was not to abolish traditional birth attendants but to integrate them into a safer maternal healthcare system.
According to him, government health facilities alone cannot meet the healthcare needs of every community, making the role of TBAs important, particularly in rural and underserved areas.
“We know you are filling a gap, but things have to be done properly. Government facilities cannot do everything, which is why this conversation is necessary,” he said.
Presenting findings from consultations with traditional birth attendants, Executive Director of the Social and Integral Development Centre (SIDEC), Mrs. Ugochi Ehiahuruike, revealed that referrals by TBAs are currently informal and inconsistent, relying largely on personal judgment rather than an organised healthcare system.
She identified delayed recognition of pregnancy complications, poor communication between TBAs and Primary Healthcare Centres, inadequate use of skilled birth attendants and weak linkage of pregnant women to health insurance as major challenges contributing to poor maternal health outcomes.
Ehiahuruike recommended creating a comprehensive database of TBAs, regular capacity-building programmes, referral monitoring mechanisms and incentive packages that would encourage traditional birth attendants to refer complicated cases early.
“When TBAs refer complicated cases, they often lose their customers. Government should therefore develop incentive packages that encourage referrals rather than discourage them,” she said.
Executive Director of Civil Rights Concern (CRC), Mr. Okey Onyeka, said the dialogue was fundamentally about saving lives through stronger collaboration between government and traditional birth attendants.
“We need to understand the level of coordination between government and traditional birth attendants and how that relationship can be strengthened to save more mothers and children,” he said.
Also speaking, Chairman of the Community Empowerment Network (COMEN), Ide Godwin Eze, said the objective was to ensure that women experience safe pregnancies and deliveries.
He urged TBAs to recognise danger signs during pregnancy and promptly refer expectant mothers to appropriate health facilities for specialised care.
Programme Manager of JDPC Nnewi, Mr. Onyekachi Ololo, described delayed referrals as one of the leading causes of poor maternal health outcomes among women who patronise traditional birth attendants.
He noted that many expectant mothers continue to prefer TBAs because they are more accessible, affordable and perceived to be friendlier than some government health facilities.
Ololo added that poor interpersonal relationships in some public hospitals also discourage women from seeking skilled medical care.
According to him, the proposed referral pathway will strengthen collaboration between TBAs and Primary Healthcare Centres while ensuring that pregnant women benefit from government interventions, including health insurance schemes.
The Permanent Secretary, Anambra State Ministry of Health, Dr. Obiageli Uchebo, commended the contributions of traditional birth attendants but insisted that they must register with the government and upgrade their skills.
She explained that the state was working towards a healthcare system where every traditional birth attendant would operate under the supervision of a skilled birth attendant.
“Anambra State does not want TBAs to continue practising the way they currently do. We want all TBAs to register with the government and work with skilled birth attendants while continuing their traditional roles,” she said.
Uchebo encouraged TBAs to acquire formal training or sponsor their children to become skilled birth attendants, assuring them that registration would enable them to benefit from government programmes.
As part of the initiative, SPARK 2 community structures, including the Community Empowerment Network (COMEN) and Ward Development Committees (WDCs), are expected to commence community sensitisation campaigns in August to educate residents on maternal healthcare services available at government health facilities.
Stakeholders expressed optimism that integrating traditional birth attendants into the state’s healthcare referral system would significantly reduce delays in emergency obstetric care and improve maternal and child health outcomes across Anambra State.
