Govt to enforce ban on Traditional Birth Attendants

A Traditional Birth Attendant attends to expectant mothers in a rural setting. FILE | PHOTO

What you need to know:

  • Officials say traditional birth attendants have inadequate skills in managing pregnancy-related complications, which has led to numerous maternal and newborn deaths

Government has moved to enforce the ban on services offered by the Traditional Birth Attendants (TBAs) across the country, warning that those who persist in offering such services will face severe consequences, including being held accountable for maternal and newborn deaths.

The directive was outlined in a letter from Dr Henry Mwebesa, the director general of Health Services at the Ministry of Health, addressed to Chief Administrative Officers, Resident District Commissioners, and District Health Officers.

Dr Mwebesa said TBAs lack the necessary skills to manage pregnancy-related complications, which has led to numerous fatalities among pregnant women and newborns.

The latest victim is a mother in Buliisa, who bled for over eight hours while in the care of a traditional birth attendant.

“The government of Uganda, through the Ministry of Health, is committed to ending preventable maternal and new-born deaths by 2030. While we appreciate the historical role TBAs have played in assisting pregnant mothers within our communities, their knowledge and skills cannot adequately identify and manage pregnancy-related complications. This significantly, contributes to negative maternal and new-born health outcomes,” Dr Mwebesa’s April 15 letter reads in part.

It added: “The purpose of this communication is to request all district leaders nationwide to be part of this campaign aimed at ending preventable maternal and new-born deaths by stopping TBAs from delivering pregnant mothers.”

Dr Mwebesa also proposed repurposing TBAs as referral agents to guide pregnant women to recognised health centres

Speaking to Daily Monitor on Tuesday during a regional dialogue on post-abortion care and maternal health organised by IPAS, a civil society organisation, Dr Richard Mugahi, the Acting Commissioner for Reproductive and Child in the Ministry of Health, discussed the ongoing challenges posed by TBAs. He explained that these challenges have necessitated the government’s decision to enforce a ban on TBA operations.

“Some of the TBAs are infected and don’t even use gloves and likewise, some mothers are infected and this contributes to the spread of diseases. So, as the government, we are moving to ban them. We are now over 80 percent in terms of coverage of health centre IIIs where deliveries are happening. More than 80 percent of our population can access health services in a distance of less than five kilometres,” he said.

Addressing the gaps

But Dr Angela Akol, the director of IPAS Africa Alliance, stressed the need to address the underlying reasons why many women prefer TBAs, including the negative attitudes and abuse faced by expectant mothers in some health facilities.

“This is not the first time the government is banning TBAs, I believe it dates far back as 2008. The ministry directed that TBAs be rolled into the VHTs structure. The fact that they are talking about it now in 2024, it shows that it failed,” Dr Akol said.

“You have to understand why TBAs are still successful and why we are still banning them. It is because communities have trust in the TBAs than they do in our health facilities. So the only successful way of banning TBAs out of business is to build the quality of services, and build the friendliness of our health services. As long as we continue to offer substandard services, women, we are rational, we shall go to the TBAs,”  she said.

Despite the previous ban in 2010, many women still turn to TBAs due to inconsistencies and gaps in the healthcare system. Uganda continues to face high maternal and child mortality rates, with up to 191 deaths daily attributed to inadequate healthcare access and the high disease burden.

Dr Mwebesa noted that the Health ministry has made significant progress in improving access to quality maternal and newborn healthcare services, resulting in increased survival rates.