Evaluation of a programme to train traditional birth attendants in Ghana.

A 4-year evaluation of a program to train traditional birth attendants (TBAs) in Danfa, Ghana covered a district containing about 60,000 people living in 307 villages. The fertility rate was 220/1,000 women aged 15-44, and the population growth rate was about 3.2% annually. In the 3 study areas of the project, 237 TBAs and 26 assistants were registered in 1972; they were about 1/2 male, had a mean age of 62, and averaged 6 deliveries/year. TBAs were to acquire, over 8 3-hour sessions held every 2 weeks, knowledge of pregnancy and its care and monitoring, referral of high-risk patients to skilled care, safe deliveries, umbilical cord care, and improved maternal and child health practices and family planning. Community education and program promotion were carried on at the same time. Where before the training 75% of TBAs almost never referred pregnant females for prenatal visits, after the training program, 91% were referred for at least 1 prenatal visit during the pregnancy. An increase was reported in the use of sterile blades provided in midwifery kits, for umbilical cord cutting: from 42% in 1974 to 68% in 1976. In other childbirth practice evaluations, female generally scored higher than male TBAs; there was no correlation between quality of care and age. The program was estimated to have have had a cost of US$6.07/birth in this area, including the cost of promoting contraception. It may be cost effective to concentrate resources on the most active TBAs in future. Keeping villagers informed of the training program made them aware of the value being built into the TBAs' services and more willing to pay for services perceived as better-quality.