Department of Social, Political and Historical Studies, Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana.
Department of Geography, University of Western Ontario, London, Canada.
Int J Health Plann Manage. 2019 Apr;34(2):e987-e994. doi: 10.1002/hpm.2779. Epub 2019 Apr 4.
Following the World Health Organization's recommendation for developing countries to discontinue the use of Traditional Birth Attendants (TBAs) in rural areas, the government of Ghana banned TBAs from offering maternal health care services. Since this ban, community-level conflicts have intensified between TBAs, (who still see themselves as legitimate culturally mandated traditional midwives) and nurses. In this articles, we propose a partnership model for a sustainable resolution of these conflicts. This article emanates from the apparent ideological discontent between people from mainstream medical practice who advocate for the complete elimination of TBAs in the maternal health service space and individuals who argue for the inclusion of TBAs in the health sector given the shortage of skilled birth attendants and continued patronage of their services by rural women even in context where nurses are available. In the context of the longstanding manpower deficit in the health sector in Ghana, improving maternal healthcare in rural communities will require harnessing all locally available human resources. This cannot be achieved by "throwing out" a critical group of actors who have been involved in health-care provision for many decades. We propose a win-win approach that involve retraining of TBAs, partnership with health practitioners, and task shifting.
世界卫生组织建议发展中国家停止在农村地区使用传统接生员(TBA),加纳政府随后禁止 TBA 提供产妇保健服务。自该禁令实施以来,TBA(他们仍然认为自己是合法的、具有文化授权的传统助产士)和护士之间的社区层面冲突加剧。在本文中,我们提出了一种伙伴关系模式,以可持续地解决这些冲突。本文源于主流医疗实践人员与那些主张在产妇保健服务领域完全淘汰 TBA 的人之间明显的意识形态不满,以及那些主张将 TBA 纳入卫生部门的人之间的分歧,因为熟练的接生员短缺,而且农村妇女即使在有护士的情况下仍然继续光顾他们的服务。在加纳卫生部门长期人力短缺的情况下,要改善农村社区的产妇保健,就需要利用所有当地现有的人力资源。这不能通过“抛弃”一个在医疗保健领域工作了几十年的关键群体来实现。我们提出了一种双赢的方法,包括 TBA 的再培训、与卫生从业者的合作以及任务转移。