Scaling the Frontier: Traditional Birth Attendant practices and possible involvement in PMTCT service delivery

In South Sudan almost 89% of expectant mothers deliver outside health facilities and are attended to by Traditional Birth Attendants (TBAs) with no form of modern midwifery training. Using formative interviews, we explored perceptions, roles, practices and social relationships of the TBAs in regards to their involvement in HIV prevention of mother-to-child transmission (PMTCT) programmes. Results from key interviews with 42 TBAs in Nzara County revealed outdated delivery practices; challenges in handling difficult obstetrical cases; low HIV knowledge among TBAs and their rural clients. Currently the 42 TBAs are undergoing training for the: provision of HIV/AIDS education to their clients, mobilization of women for VCT, referring and facilitating HIV positive mothers to access PMTCT, observing treatment for HIV+ mothers delivered at home and have received nevirapine, observing their infants to receive Nevirapine syrup. TBAs have demonstrated high motivation to follow the required obstetrical practices for HIV PMTCT. Process and impact evaluations are currently underway to assess the success of this TBA model. Conclusion: TBA's may significantly contribute to reaching women who strongly believe in the traditional system of delivering at home, outside health facilities designated for PMTCT service delivery. It is critical to support TBAs by adopting a training module that marks a step in “moving the TBAs and their clientele” closer to the recommended PMTCT service sites.