Local practice helped achieve MDGs, the lessons in Bangladesh

Background: Gonoshasthaya Kendra (GK), a non-governmental organization in Bangladesh, was one of the world's pioneers and best practices in integrated primary health care (PHC). In addition to its innovative adoption of women paramedics, traditional birth attendants (TBAs) complimented its performance.

Objectives: To understand how TBAs contributed to achieving Millennium Development Goals (MDGs) and identify the consequences of ignoring them.

Methods: Information was obtained through multiple methods, including literature review, in-depth interviews and participatory observations in rural healthcare settings.

Results: Case study of GK revealed that trained TBAs played multi-faceted functions in achieving MDGs more than maternal and child health. Inclusion of TBAs in GK's PHC referral mechanism was a pragmatic approach to address the shortage of skilled manpower at rural level, utilize lay knowledge and local wisdom, enhance gender equity and empower women (MDG 3), as well as prevent HIV/AIDS (MDG 6). However, medicalization of birthing and commercialization of health services resulted in denouncing TBAs. It might lead to (1) undermining the community's social capital; (2) further marginalizing the poor in accessing and affording health services; (3) inducing demand for and cost of healthcare, and (4) alienating the grassroots from participation in their health activities, thus widening the gap between people and health providers.

Conclusion and implications: Health workers in collaboration with TBAs could enhance health system in terms of delivery and promotion. Attention should be redirected from facilities and health commodities to adequate utilization of local resources.