A Study of Models of Partnership between Skilled and Traditional Birth Attendants in Reducing Maternal Mortality in Ile-Ife
This study aimed at examining the acceptability and feasibility of partnership models between skilled and traditional birth attendants in reducing maternal mortality in Ile-Ife. It further identified factors associated with the choice of birth attendants and assessed the attitude of TBAs and skilled attendants to each other. This was with a view to assessing the acceptability of various partnership models between skilled attendants and traditional birth attendants as well as the possible barriers and motivating factors. The study was conducted in Ife East Local Government Area of Osun State using a cross-sectional descriptive design. Both quantitative and qualitative data collection methods were employed. All categories of TBAs working in the LGAs were identified, through their local association and also by using a snowball sampling technique, and interviewed. Also, the most senior skilled attendants in the registered health facilities (public and private) were interviewed. Exit interviews were conducted for the most recent clients of both types of birth attendants. Focus group discussions were held with various target groups: TBAs, male and female community members, as well as in - depth interviews with the Director of Primary Health Care and skilled attendants. Data were presented using appropriate descriptive and inferential statistics, while qualitative analysis was through the use of alpha-text beta software. The results showed that the significant predictors of the utilization of skilled attendants in Ile-Ife were attendance at antenatal care [Odd Ratio = 11.09 (95% CI 3.47 – 35.45); p < 0.05], knowledge of obstetric complications [Odd Ratio = 2.51 (95% CI 1.20 – 5.25); p < 0.05] and husband's involvement in the choice of birth attendants [Odd Ratio = 2.78 (95% CI 1.26 – 6.09) ; p < 0.05]. With respect to attitude, majority (84.5%) of the TBAs had a good opinion of skilled attendants while 60% of skilled attendants commented unfavourably about the TBAs. Comparably greater proportions of TBAs (78.6%) than skilled attendants (53.8%) were in support of a partnership pact between themselves. The partnership models examined in this study were; the Expanded-Role Model, Referral – Supervision Model and the Link-Care Model. Referral – Supervision Model was the most acceptable, to both groups, of the three models of care. The Link care model was more acceptable to the skilled attendants than the TBAs (32.2% of TBAs versus 49.5% of SA). The barriers to a partnership model identified by skilled attendants and TBAs included interpersonal problems, operational differences among them, and lack of logistic support. The facilitating factors included an enabling government policy, availability of funds for monitoring and supervision, community support for the partnership and support of development partners. The study concluded that partnership model of care were a promising approach toward addressing maternal mortality and the Referral-Supervision Model will be more successfully implemented in our environment. The adoption of the Link-care Model, although technically sound, needs to be approached cautiously in view of its poor acceptability.