Traditional birth attendant training programs in low resource countries: an integrative literature review

Pregnant women continue to die from preventable causes, the greatest number in low-resource countries, where neglect of Traditional Birth Attendant [TBA] training is adversely affecting women with the least access to family planning or a Skilled Birth Attendant. Consideration for TBAs role to strengthen maternity care in low resource settings is recommended. The scope of the TBA role, appropriate training and supervision remains a challenge.

This integrative literature review analysed publications about TBA training programs in low-resource countries.

A search strategy was implemented incorporating a five-step framework utilising electronic databases. Twenty- five publications were reviewed. Four themes and eleven sub-themes were identified about "TBA training programs in low-resource countries": (1) Variance in role of TBAs affecting training including subthemes of variance in role, scope and title of TBAs, appointment and remuneration, and articulation of TBA work; (2) Training influenced by where TBAs provide services including areas of high Maternal and Neonatal Mortality, and with low access to health; (3) Educational needs of TBAs, including lack of consensus around specific knowledge and skills, need for culturally appropriate educational needs assessment and importance of education about role of health facilities and referral process; (4) Training and teaching TBAs, including methods, cultural contexts and resources.

There is global confusion about TBA's role within maternity services in low-resource countries, including their title, scope of practice, remuneration, specific training needs and required clinical skills. Community engagement to ensure a culturally applicable role for TBAs, appropriate training information and materials is imperative to ensure sustainability and effectiveness. A gap in knowledge exists around measurable outcomes related to training programs. Recommendations are offered to incorporate TBAs into the maternity healthcare system for low resource settings.