Development of a framework for collaboration between midwives and traditional birth attendants at a selected province in South Africa

Abstract

Background: The World health Organization (WHO) has identified collaboration between traditional health practitioners (Traditional birth attendants [TBAs]) and skilled birth attendants (midwives) as an essential strategy towards the reduction of maternal and neonatal mortality and morbidity rate (MNMR) especially in low- and middle-income countries (LMICS). In South Africa, the traditional birth attendants' care is often performed in a reticent manner. Nevertheless, the reality remains in South Africa, there is no collaboration existing between western health practitioners and traditional healthcare practitioners. Aim: The study aimed at developing a framework for collaboration between midwives and traditional birth attendants as part of the re-engineering of maternal Primary Health Care services in selected provinces in South Africa. Methods: The study was conducted in two phases and was guided by the Structure-ProcessOutcome (SPO) Donabedian framework (1986). Phase 1 was a convergent parallel mixed methods design including concurrent data collection from quantitative and qualitative research design. The findings of phase 1 were analysed and merged to inform the next phase. Phase 2: a consensus method nominal group technique (NGT) held with various stakeholders was employed in the study. Results and findings: Subphase 1-Quantitative study. Overall Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants for maternal and neonatal healthcare. In terms of attitude, the midwives displayed a negative attitude towards collaboration for maternity care (mean=46.8, SD=2.1). Midwives (70.4%, n = 183) only agreed to collaborate for antenatal care. In addition, there was a significant relationship (p<0.05) between the level of education and attitude toward collaboration. However, on issues of collaborating for re-engineering of primary maternal healthcare services, the midwives displayed positive results (mean = 63,8, SD=2.4). Subphase 2, from empirical study findings eight themes emanated. In the nominal group technique, the stakeholders reached a consensus on the seven fundamental themes to be included in the framework for collaboration. Front matter v Conclusion: The findings of the study indicate that both the Traditional birth attendant and midwives form the entry point to healthcare services for childbearing women. However, the traditional birth attendants facilitate access of women to maternity care services through a “non-organised and non-regulated framework” in most resource limited settings globally. Thus, the adoption and implementing the collaborative framework will strengthen provision of antenatal care services, prevention of complications including early identification of complications including referrals to modern health care services as recommended by WHO which in turn contributes to reduction on maternal morbidity and mortality through collaborative efforts between TBAs and midwives. Key words: Collaboration, Framework, Midwives, Traditional birth attendants, Re-engineering of primary healthcare, maternal and neonatal health care