The Ugandan government has implemented a ban on the services offered by Traditional Birth Attendants (TBAs), attributing the decision to the TBAs’ lack of advanced skills in managing complications that may arise during pregnancy, which have led to a high rate of maternal and newborn deaths.
According to the issued directive, those who defy the ban and continue to provide TBA services will face serious repercussions, especially if their actions result in maternal or newborn fatalities.
This ban has been communicated through a letter authored by Dr. Henry Mwebesa, the Director General of Health Services at the Ugandan Ministry of Health, and dispatched to various district authorities, including Chief Administrative Officers, Resident District Commissioners, and District Health Officers.
Dr. Mwebesa’s letter details the government’s dedication to the cessation of preventable maternal and newborn deaths by 2030 and acknowledges the historical significance of TBAs in supporting maternity care. However, he states that their current abilities fall short in recognizing and managing complications associated with pregnancy, contributing negatively to maternal and newborn health.
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The recent incident in Buliisa, where a mother lost her life due to prolonged bleeding under a TBA’s care, is used to underscore the risks involved with TBA services.
The directive not only aims to halt TBA services but also encourages district leaders to redirect TBAs into new roles, such as community referral agents, guiding expectant mothers to seek assistance from certified healthcare facilities.
Highlighting the issue further, Dr. Richard Mugahi, the Acting Commissioner for Reproductive and Child Health at the Ministry of Health, expressed concern over hygiene issues and the propagation of infections, problems frequently associated with TBAs.
On the optimistic front, Dr. Mugahi noted that over 80% of health centre IIIs in Uganda are now fully functional, with healthcare facilities accessible within a five-kilometre range for the majority of the population.
IPAS Africa Alliance’s Director, Dr. Angela Akol emphasized understanding why women may prefer TBAs, such as aversion to the treatment received in conventional health facilities. Lessons from previous unsuccessful bans, including one in 2008, show that without addressing such root causes, prohibiting TBAs might not be effective.
Dr. Akol advocates for enhancements in the quality and compassion of healthcare services to foster trust within the community.
The ongoing reliance on TBAs, despite a 2010 ban and persistent gaps in the healthcare system, reflects the need to combat the high maternal and child mortality rates that plague Uganda, with a daily toll reaching 191 deaths due to limited access to healthcare and a significant disease burden.
Nevertheless, Dr. Mwebesa points to substantive strides in ameliorating maternal and newborn healthcare, underscoring a commitment to improving survivability rates.
