RESUMO
Three quarters of deliveries in Ghana are still attended by untrained personnel, including traditional birth attendants (TBA's), and maternal mortality remains high. The Ministry of Health is exploring ways of improving this situation. Recently, training traditional birth attendants to improve maternal and child health practices and promote family planning has been considered. Most TBA's in rural Ghana are elderly illiterate farmers. The Danfa Project has identified and trained 57 of these TBA's with the objective of developing a programme that might be replicated elsewhere in the country. This paper describes the design of the programme and problems encountered and makes recommendations to others who may be considering similar programmes in other countries.
PIP: 57 traditional birth attendants were identified and trained by the Danfa Project in rural Ghana in an effort to improve maternal and child health practices and promote family planning. A plan was also developed for follow-up and continuing education of these traditional birth attendants (TBAs). The Danfa Comprehensive Rural Health and Family Planning Project is a 9-year research, service, and teaching project undertaken jointly by the University of Ghana Medical School and the University of California at Los Angeles. The following objectives of the TBA training program were defined: 1) to motivate and train the TBAs to monitor women during the antepartum period and to recognize and refer high risk woman or those with serious complications of pregnancy or delivery; 2) to train the TBAs to perform safer deliveries; 3) to train the TBAs in the proper care of the cord; and 4) to enlist the aid of the TBA in the promotion of improved maternal and child health practices and family planning in their villages. The syllabus - outlined here - emphasizes the teaching skills which are needed to meet the stated objectives. The most important aspect of the training program is the continuing support and supervision of the trained TBAs. Problem areas of the program are related to supervision, transportation, non-participation, age of the TBAs, and remuneration. The following were included among the recommendations to those contemplating the training of TBAs in Africa: 1) training should be continuous; 2) emphasis should be on motivating the younger TBAs and those who perform the greatest number of deliveries; and 3) the training program should be simple and emphasize only those basic scientific midwifery skills which would help the TBAs gain self-confidence and make deliveries safer.
