Traditional Birth Attendants (TBAs) in Anambra State may soon become part of a formal maternal healthcare referral network as government officials, civil society organisations and healthcare managers seek to end the long-standing practice of isolated childbirth services that has been blamed for delayed emergency care and preventable maternal deaths.
The move emerged at a multi-stakeholder dialogue convened under the Strengthening Public Accountability for Results and Knowledge (SPARK 2) project, where participants agreed that while TBAs remain indispensable in many communities, they should no longer operate without a structured relationship with Primary Healthcare Centres (PHCs).
Supported by the International Budget Partnership (IBP), the meeting brought together representatives of the Anambra State Ministry of Health, local government authorities, primary healthcare managers, traditional birth attendants and civil society organisations to begin developing a referral framework that will ensure women experiencing pregnancy complications receive timely skilled medical attention.
Stakeholders observed that TBAs continue to enjoy widespread patronage because they are deeply rooted in communities, charge affordable fees, are easily accessible and often provide more personalised care than many public health facilities.
However, they warned that these advantages should not encourage TBAs to manage high-risk pregnancies beyond their competence.
Director of Justice Development and Peace Caritas (JDPC) Nnewi, Rev. Fr. Benedict Okolo, said the objective was not to eliminate traditional birth attendants but to integrate them into a safer maternal healthcare system.
“We know you are filling a gap, but things have to be done properly. Government facilities cannot do everything, which is why this conversation is necessary,” he said.
Also speaking, Executive Director of Social and Integral Development Centre (SIDEC), Mrs. Ugochi Ehiahuruike, disclosed that referrals by TBAs currently depend largely on individual judgment rather than a coordinated system.
She identified delayed recognition of danger signs during pregnancy, poor communication between TBAs and Primary Healthcare Centres, inadequate use of skilled birth attendants and weak enrolment of pregnant women into health insurance schemes as major gaps requiring urgent attention.
In a paper presentation, Ehiahuruike proposed the establishment of a comprehensive database of traditional birth attendants, continuous training, referral monitoring mechanisms and incentive packages to encourage TBAs to refer complicated cases instead of attempting risky deliveries.
“When TBAs refer complicated cases, they often lose their customers. Government should therefore develop incentive packages that encourage referrals rather than discourage them,” she said.
Executive Director of Civil Rights Concern (CRC), Mr. Okey Onyeka, noted that the discussion was essentially about saving lives through stronger collaboration.
“We need to understand the level of coordination between government and traditional birth attendants and how that relationship can be strengthened to save more mothers and children,” Onyeka stated.
Programme Manager of JDPC Nnewi, Mr. Onyekachi Ololo, said delayed referrals remain one of the biggest contributors to poor maternal health outcomes among women who rely on TBAs.
He explained that many women continue to avoid government facilities because TBAs are closer to them, more affordable and generally perceived as friendlier.
Mr. Ololo also observed that poor interpersonal relationships in some public health facilities contribute to the continued preference for TBAs. He said the new referral pathway being developed would create a stronger partnership between TBAs and Primary Healthcare Centres while ensuring that women benefit from government health programmes, including health insurance.
As part of the initiative, SPARK 2 community structures such as Community Empowerment Network (COMEN) and Ward Development Committees (WDCs) will begin community sensitisation campaigns in August to educate residents on maternal health services available in government facilities.
Permanent Secretary of the Anambra State Ministry of Health, Dr. Obiageli Uchebo, assured participants that government values the contributions of TBAs but insisted that maternal healthcare must comply with established professional standards.
She urged TBAs to register with government, engage qualified personnel and promptly transfer complicated cases to health facilities equipped to handle them.
“We appreciate your work, but you must upgrade yourselves and you will benefit more from government programmes,” she said.
Former Acting Executive Secretary of the Anambra State Primary Health Care Development Agency, Dr. Ngozi Okeke, and State Health Educator, Mrs. Uju Onwuegbusina, encouraged TBAs to establish close working relationships with nearby Primary Healthcare Centres, describing collaboration as essential to improving maternal and child health outcomes.
Beyond safe delivery, State Immunisation Officer, Mrs. Edith Onwuka, urged traditional birth attendants to become advocates for immunisation, family planning and the elimination of female genital mutilation within their communities.
During the interactive session, the TBAs defended their practices while acknowledging the importance of referrals in complicated pregnancies.
Mrs. Cordelia Anwasia, popularly known as Nye Adamu, said she often corrected what she considered abnormal fetal positions before delivery, while another practitioner, Benedeth Odu, popularly called Nurse Imo, recounted how she recently referred a pregnant woman whose condition appeared too risky to manage.
Another participant, Mrs. Dorathy Opalaji from Nnokwa, said she routinely carried out blood pressure checks, HIV screening and referred women for ultrasound scans when necessary.
The meeting also highlighted broader challenges confronting maternal healthcare, including inadequate staffing, poor infrastructure and insufficient investment in Primary Healthcare Centres.
Participants concluded that strengthening collaboration between government health facilities and traditional birth attendants rather than treating them as competitors offers one of the most practical pathways to reducing delays in emergency obstetric care and lowering maternal and newborn deaths across Anambra State.
Angel Network News (ANN) reports that
the SPARK 2 project is being implemented in Anambra by JDPC Nnewi, Social and Integral Development Centre (SIDEC), Civil Rights Concern (CRC), and Community Empowerment Network (COMEN) with support from the International Budget Partnership.
