Human Resources for Health in Maternal, Neonatal and - HRH ...

Figure 12 Relationship between service provision, the health system and HRH
Essential
Obstetric
function
District Hospital
Health Centre
Midwifery
TBA
Health Post
Community
(WHO 1990)
Traditional Birth Attendants (TBAs)
The practice of TBAs is based on the socio-cultural and religious context of the communities
in which they work. Their practice is imbued in the prevalent beliefs concerning health,
illness, disability and its aetiology. Traditional or cultural practitioners are independent of the
health system and considered alternative or complementary to Western medicine. TBAs are
not formally employed but receive direct payment from their clients in the community. This
may include money as well as various goods and services. In addition TBAs are not-formally
trained but they may undertake short training courses from NGOs or other agencies including
the Ministry of Health. The proportion of births that TBAs attend varies and it has been
estimated that they assist in approximately 24% of births in resource poor settings (Lewin
2008).
TBAs have been described as ―aperson who assists the mother during childbirth and who
initially acquired her skills by delivering babies herself or by working with other TBAs‖
(Leedam 1985). They tend to be older women and their status may vary depending on the
community. TBAs may be the only worker that women in poor villages may access or they
may prefer to see TBAs in line with social and cultural expectations. Different countries may
have particular names for TBAs as shown in Table 8.
Table 8 Designations of traditional birth attendants in the Asia Pacific Region
Country Designation Reference
Pakistan Dais (Bhutta, Memon et al. 2008)
Bangladesh Dais (Rozario 1995)
Fiji yalewa vuku (Morse 1981)
Philippines Hilots (Mangay-Angara 1981)
Malaysia Biden Kampung (Chen 1976)
Indonesia Dunkun Bayi (Chen 1976)
Thailand Mohtamyae (Chen 1976)
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