Lagos TBAs account for over 14,536 deliveries in 2015

As PATHS2 canvasses proper monitoring, referral system, others

No fewer than 14,536 deliveries were reported by about 342 registered Traditional Birth Attendants (TBAs), in Lagos, for year 2015.

The figure, which is contained in a new report, again underscores the continuous relevance of TBAs in communities and the imperative of improved monitoring, training and referral system to better the lot of maternal health in the State.

The report, courtesy of Partnership for Transforming Health Systems II (PATHS2), in collaboration with the Traditional Medicine Board (TMB), Lagos State College of Health Technology (LASCOHET) and the Primary Health Care Board (PHCB), shows that birth attendants, who assist in community deliveries and in faith-based organisations, reported a total of 14,536 deliveries at 42 per cent reporting rate.

The figures were much higher in 2014 data that were generated from 809 registered traditional birth attendants. A total of 23,229 deliveries and 23,500 live births were reported by traditional birth attendants for the period of January to December 2014.

From the 2014 data, Ikorodu has the highest number of registered TBAs (134) and deliveries (4059). Ikeja was reported as having the least number of TBAs put at four.

The study noted that only 342 TBAs actually registered or renewed their practicing license and reported data to the Traditional Medicine Board in 2015 unlike the preceding year where data was received from 809 TBAs.

Contrary to past estimates that suggested more number of deliveries were taken at the TBAs, the report showed that more deliveries were taken in public and private facilities than at the TBAs.

In 2014, private facilities reported a total of 67,168 deliveries at 62 per cent reporting rate, while public facilities had 26,297 at 77 per cent reporting rate. In 2015, both sector reported 64,048 apiece at 72 per cent and 86 per cent reporting rate respectively.

But with the drop in registered TBAs statistics between 2014 and 2015, the report among others, recommended the need to strengthen the regulation and monitoring of TBAs statewide.

“The TMB, as a regulatory agency is expected to make rules, administer them impartially and should be immune to negative external and internal influence. It should act in the public interest and actively engage stakeholders in interpreting and implementing the rules as well as promote an enabling regulatory environment.

“However, TMB is not adequately equipped to effectively regulate over 4820 trado-medical practitioners. The agency requires technical support, capacity development and resources both financial and human to perform optimally as a regulatory authority,” the report stated in part.

Strong regulatory and monitoring systems need to be in place to ensure accreditation, registration and license renewals; improve quality of service delivery and identify those who practice a mix of traditional and/or faith healing with orthodox medicine and opt for registration with the Traditional Medicine Board to avoid the more stringent requirements of HEFAMAA in terms of infrastructure and health personnel.

State Team Leader of the United Kingdom DFID funded agency, Dr. Ibironke Dada noted that PATHS2 is working with the PHC Board and Traditional Medicine Board to expand the monitoring and supervision of TBAs to community groups such as Ward Health Committees and Community Development Associations.

A scoping exercise was conducted in four focal LGAs (Amuwo-Odofin, Alimosho, Ikorodu and Kosofe) to identify already existing, legitimate, interested and respected groups within the community to provide oversight functions to informal health providers namely the TBAs and Patent Medicine Vendors (PMVs).

“These community groups were trained on how to work with CBA/TBAs to improve the quality of their services and engage with the users of the services by receiving complaints and providing feedback to them and the providers. As part of the training, the groups developed action plans on how to support the TBAs to deliver better services to their communities,” she said.

The report noted that strengthening referral linkages between the informal and formal sectors is a crucial strategy to reduce maternal and child health morbidity and mortality. This would be expanded beyond referrals from TBAs to public health facilities to include accredited private health facilities nearest TBAs.

Through the General Hospital’s Immersion programme, it was observed, referral linkages have been established and strengthened likewise referrals to public health facilities for HIV screening, family planning, immunisation and intermittent prophylactic therapy for malaria.

“Primary healthcare workers also provide services such as HIV testing and counseling, immunisation within TBA premises to reduce missed opportunities. TBAs routinely refer pregnant women for ultrasound scans to ascertain the positioning and wellbeing of the foetus.

“Each local government in Lagos has one state-owned secondary health facility. These are inadequate to effectively meet the health care needs of the huge population of 21 million.

“PATHS2 is advocating the expansion of the network of referral centres to include accredited private health facilities able to provide comprehensive emergency obstetric care nearest the TBA to avoid the second delay. Therefore, government needs to define the process of identification, accreditation and engagement of private health facilities to expand the referral network.”

It was further observed that the highest proportion of under-five deaths occurs in neonates (42 per cent) in Lagos. The major causes of neonatal deaths are pre-term births (39 per cent), asphyxia (23 per cent), infection (22 per cent) and congenital abnormalities (nine per cent).

“Beyond training TBAs on infection control and universal precautions, a key infection prevention measure is the use of chlorhexidine gel for neonatal cord care. In 2015, PATHS2 procured 12000 units of chlorhexidine gel for distribution to TBAs in Lagos. In addition, the project is facilitating linkages with community pharmacies (CPs) and Patent Medicine Vendors (PMVs) to improve access to two essential health commodities – chlorhexidine gel for cord care and Zn Oral Rehydration Salts for diarrhoea in four focal LGAs (Alimosho, Ibeju-Lekki, Amuwo-Odofin, Kosofe and Ikorodu).

“PATHS2 in conjunction with Clinton Health Access Initiative (CHAI) trained TBAs on the management of diarrhoea. PATHS2 through CHOs (PHCB) also trained TBAs across the state on the use of chlorhexidine gel for cord care. PATHS2 is advocating for a state-wide program to improve access to these life-saving health commodities.

“To effectively reduce maternal and child mortality in Lagos, there must be strong linkages to orthodox practitioners both private and public. It is expected that operations research will provide further evidence on the impact of each approach towards strengthening this category of healthcare providers.”