Dear Neil, and HIFA Colleagues,
Warm greetings from the United States. My response to your question that is possible to use TBAs as trained specialized CHWs for birth attendants? Is not only positive but necessary. To justify my answer, I would like to share our experiences of CHWs training in Iran in 1971. Our assumption was that the Bahvarz (CHW), during her training should attend and deliver at least 50 deliveries in District hospital and take care of the deliveries in addition to her primary health care tasks in the catchment areas of her Health House with a population of about 1500- 2500. The first batch of BEHVARZ were trained for the purpose. But soon we have realized that as far as the child Labour takes quite good amount of time, that they are not able to perform their PHC routine Tasks. Furthermore we have realized that the TBAs as community leaders tried to make campaign against BEHVARZ as young girls and un experienced health workers. Therefore people have refused to use the services of the CHWs (BEHVARZ). Soon we have realized that our PHC pilot project is going to be failed.
Therefore we had arranged a meeting with village leaders, TBAs and BEHVARZ of the Catchment areas of the relevant Khaneh Behdashts. And Frankly discussed with them and made an agreement with TBAs & Comunity leaders that BEHVARZ will not attend any delivery if TBAs exist in the village. But BEHVARZ will provide sterile equipments and antiseptics from the Health House to TBAs free of charge and will assist TBAs if she desired. Need less to say that we have trained BEHVARZ that when she is assisting TBAs in child Labour, she should indirectly with a perfect hand washing and provision of clean sheets and antiseptic, respectfully assist & train TBAs as her daughter or grand daughter. We have made a good cooperation with TBAs and deleted the child Labour from the Tasks Of BEHVARZ.
Also I would like to mention that in some countries like North Yemen that one or two families are living in top of the mountain the only person who assist during the delivery is a member of family who the family call her family midwife. Because no any skilled health worker is available in the mid night when most of the child birth is happening, nor any skilled health worker is accessible nearby. So I may say that TBAs as the first generation of health workers of the world, who assisted the delivery of billions of the men and women of my age in different parts of the world, is respectable and in a lot of remote areas of the LMIC is impossible to be replaced.
Respectfully. Dr. M.A. Barzegar.
HIFA profile: Mohammad Ali Barzegar is an initiator of Primary Health Care in Iran since 1971, and Representative of People's Health Movement (PHM) Iran. His interest include 45 years of national & international experiences on PHC, Sustainable Development and Public Health. barzgar89 AT yahoo.com