Dear HIFA members
Referring to the topic of TBA, I would like to share my experience working TBAs, as is the case in many developing countries, TBAs are the health providers for delivery. They are part of the local culture, important and respected by the community where they live. Unfortunately many are semiliterate and unresponsive to new medical technology. The reasons why the Ministry pf Health recommend to eliminate all TBA’s to replace with Midwives. Pro and contra of TBAs services is not new. Many governments put pressure to eliminate all TBA’s training and services considered useless and risky due their characteristics and difficulty to change. This is however not easy, especially in situation as Indonesia with more than 17.000 islands, in rural and remote areas TBAs still provide delivery care due to lack of health personnel.
A qualitative study on TBA’S reveal, that previous training TBA’s did not consider their cultural background level and habits. Lack of supervision, refreshing and guidance is also lacking. It was for this reason that I started developing equipment, recording forms based on appropriate technology principles. Tools, acceptable, applicable, easy to use and effective need be provided for TBAs. Some intervention studies were carried out using those equipment and tools, reveal, that better training and using appropriate equipment’s and tools can improve TBA’s their knowledge and skill that could have a positive effect on maternal and neonatal indicators.
My experience showed that applying appropriate training and tools, TBA’s could improve skills and delivery services in rural and remote areas. But it will not have a significant result unless a working referral system is available. Improve communication between health- providers (midwives) and TBAS, working in partnership, where TBA’s role as emotional provider and midwives have the role as technical provider. respect each other role and responsibility is also important. TBA’s will disappear naturally if rural women are more educated and can make choices. But putting pressure to eliminate all TBAs will probably not result in improve MCH program immediately especially in rural and remote areas if the referral system is not ready.
With best wishes
HIFA profile: Anna Alisjahbana is Professor Emeritus, Pediatrician, Neonatologist with SuryaKanti Foundation, Indonesia. Professional interests: Neonatology, Development and Behavioral Pediatrics. alisjahbana.anna AT gmail.com