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A small-scale training programme for birth attendants in a remote area of Burkina Faso was evaluated two years after it had been started. The evaluation methods included interviews with trained birth attendants and the analysis of health service statistics and survey data. The findings showed that the programme had been moderately successful in imparting knowledge and overcoming cultural inhibitions about assisted deliveries. However, the effectiveness of the programme was severely curtailed by structural deficits in the health system, especially lack of skilled staff, supervision and transport. In deprived areas such as the Sahel, it is probably the health centre, the hospital and the referral system that should be the first priority for improvement, rather than grass-roots practices.This program evaluation pertains to a program initiated in 1990 for training of 18 traditional birth attendants (TBAs) from Fulani or Rimaibe villages in the department of Sebba in northern Burkina Faso. All were illiterate and most were another ethnic minority. Training was directed to performing safe birth procedures and the detection of high risk pregnancies. Techniques were taught for massaging the uterus in order to induce contractions, putting the baby to the breast immediately after delivery, and referral. Methods involved group discussions, practical demonstrations, and role playing. Pictorial cards were used for recording pregnancy information. TBAs received simple maternity kits. An ambulance was made available for emergency referral to the regional hospital. The area is served by two clinics and one medical center. Program evaluation occurred in 1992. Interviews were conducted among 17 TBAs, health service statistics were collected, and a health survey was conducted in the department (296 women of childbearing age from 21 villages). 397 deliveries occurred in the five years preceding the survey. 92% of deliveries were at either of the two clinics or at the Sebba medical center. 12% delivered without assistance. 39% had the assistance of a friend or relative. 24% had assistance from an older neighbor. 19% had assistance from untrained TBAs. 7% had health personnel assistance. TBAs were found to have retained most of the childbirth information, and 11 could correctly identify signs of high risk pregnancy. 14 correctly described hygienic practices. All 17 recognized chloroquine as an anti-malaria drug, and 12 knew the proper dosage of 3 tablets per week. Knowledge of postpartum hemorrhage was weak. The trained TBAs were seldom used in the two year period. Seven villages regularly used their services. Three correctly attended 35-50% of all births in their villages. 13 TBAs made a total of 36 referrals. Program success was not related to training activities or cultural obstacles. The entire health delivery system at the clinic level, the referral system, and health staff training rather than grass roots changes, were suggested improvements. Candidates for training should be selected more appropriately. |
