The plan named, the TBA referral voucher system, involves giving a monetary incentive to every TBA who accompanies a woman to a health facility for delivery.
Kabarole district has introduced a financial incentive to stop the work of Traditional Birth Attendants (TBAs). TBAs are community resource persons who assist women in deliveries especially in rural areas where there is limited or no access to formal health services. The plan named, the TBA referral voucher system, involves giving a monetary incentive to every TBA who accompanies a woman to a health facility for delivery.
When the TBA takes the woman to the facility, she is given a cash voucher of shillings 20,000 by the nurse on duty or the in-charge of the facility and takes it to the health department for cashing. The plan was devised by the district health department after the department carried out a survey in March and discovered that 75% of the TBAs operate in unhygienic places and lack the necessary equipments used in deliveries.
Dr. Richard Mugahi, the district health officer Kabarole says the move to disband the TBAs also comes after the death of three women in Kijura at the hands of TBAs. According to Mugahi, some TBAs lack medical knowledge and often use traditional practices which can be risky to women. He says that the TBAs are given monetary incentive, because the TBAs earn an income through deliveries.
//Cue in: “we have put a small incentive…
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Mugahi says that the referral voucher system is a gradual process, which they hope will have an impact in the next one year. However there are mixed reactions from some TBAs and members of the community, in areas where the initiative is being implemented. Gorreti Mugenyi, a resident of Rwengaju in Busoro Sub County says that the plan will not work, because they have trust and confidence in the TBAs.
She says TBAs are easily accessible and are not rude like health workers. She also says that if the TBAs are disbanded, it won’t have any impact, unless measures are taken to improve access to health services. Mugenyi says that the district should instead offer training to the TBAs and not disband their activities.
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Janet Baguma, a TBA in Rwengaju says that although she welcomes the plan by the district she will not stop attending to women who come to her for help. Baguma says that she has tried to accompany women to the health centre on various occasions but many of them rejected the offer. In 2010, the then minister of health, Steven Malinga, said that TBAs had done nothing to reduce the rates of maternal and infant mortality in the country.
Malinga also warned NGOs from offering TBAs training, saying that TBAs should be incorporated into the work of the village health teams (VHT), which offer only advice on basic healthcare.
traditional birth attendants
minsitry of health
dr. richard mugahi