Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #117056

Eugene Twahirwa, MS, Rwanda Child Survival Program, International Rescue Committee, BP 2961, Kigali, Rwanda and Emmanuel D'Harcourt, MD, MPH, Health Unit, International Rescue Committee, IRC, 122 East 42nd street, New york city, NY 10168, 212-551-3178, harcourt@aya.yale.edu.

BACKGROUND: The use of TBAs in developing country maternal health programs is widespread but controversial. Proponents argue they provide services where none would be available, whereas critics cite the lack of effectiveness data and concerns that TBAs are inadequate substitutes for real obstetric care. We present here the results from a large TBA support program in South-Eastern Rwanda. METHODS: The IRC and its local partners have been documenting TBA performance and obstetric outcomes since 1999 though a community reporting system, clinic and hospital data, and quality assurance investigations. The current system supports over 400 TBAs for a population of approximately 700,000. The TBAs provide prenatal, delivery, referral, and post-natal services under the supervision of health center staff. RESULTS: The proportion of TBA deliveries referred to health centers has steadily increased from 6% in early 2000 to 18% in late 2004. During the same period, the proportion of women delivering in clinics has increased from 16% to 25%, and the proportion of women receiving cesarean sections has increased from 1% to 2.3%. TB As provide a number of other services, including bringing women for prenatal care and providing post-natal care for mother and baby. CONCLUSIONS: TBAs can have a positive impact on emergency obstetric care as measured by key UN process indicators. However, getting these results requires a long-term commitment and may divert resources towards improve infrastructure or quality at health facilities.

Learning Objectives:

• At the end of the session, participants attending this session will be able to
• Name 2 potential benefits and 2 potential drawbacks of using TBAs to improve access to EmOC
• Name 3 positive and negative results of the reliance of TBAs in rural Rwanda
• Assess the pros and cons of working with TBAs in his or her work area.

Keywords: International Reproductive Health, Community-Based Health Care

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.