MCH Providers: Who Are They?

1. MCH Providers:Who Are They?

2. Session Learning Objectives • List the range of HCWs in MCH programs and describe their roles • Define SBA • State the % of births worldwide that are attended by a SBA • Define TBA • Describe trends in recommendations regarding TBAs and explain evidence regarding effectiveness of TBA training on maternal and neonatal health outcomes

3. Ghana 2 Teaching Hospitals, 7 other Regional Hospitals 78 District Hospitals 558 Health Centers/Clinics 1085 Community Clinics Source: Mercen M. International Public Health. GP’s & non-MD providers deliver 98% of child health care in Ghana

4. MCH Providers: Who Are They? Source: International Labour Organization. International Standard Classification of Occupations.

5. Mid Level Providers (MLPs) Variable availability and responsibilities • Medical Assistants (Ghana) • Clinical Officers (Tanzania) • Técnicos (Mozambique) • In Mozambique 92% of caesarean sections at the district hospital level were carried out by técnicos

6. Mid Level Providers (MLPs) Source: Mullens F. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007.

7. Mid Level Providers (MLPs) continued Source: Mullens F. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007.

8. WHO Definition of CHW • should be members of the communities where they work, • should be selected by the communities, • should be answerable to the communities for their activities, • should be supported by the health system but not necessarily a part of its organization, • and have shorter training than professional workers.

10. continued

11. Countries have differing policies on CHWs’ roles, responsibilities, and qualifications.

12. Traditional Birth Attendants (TBA): WHO Definition A person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBAs.

13. Informal Sector • Traditional healers • Pharmacy shops • Vendors

14. Skilled Birth Attendants (SBAs) Accredited health professionals including midwifes, doctors, or nurses that have been trained to manage normal pregnancies, childbirth, and the immediate postnatal period and can identify, manage, and refer complications in women and newborns.

15. SBAs and Neonatal and Maternal Mortality Source WHO World Health Report 2005: Making Every Mother and Child Count

16. Skilled Birth Attendance: An Indicator being Used to Monitor Progress Toward MDG5

17. One reason for low coverage: Shortage of SBAs 57 countries have critical shortage of professional HCWs necessary to attain SBA at minimum 80% of delivers • 36 of these countries are in SSA • 2.4 million more doctors, midwives and nurses needed • In absolute terms, largest need is in SE Asia • Bangladesh, India, Indonesia

18. Other reasons for low coverage of skilled birth attendance: • Lack of access due to poverty • Lack of transportation • Cultural beliefs/traditions • Perceived and real beliefs about quality of care • Lack of knowledge about benefits of SBA • Low status of women

19. What is the role of TBAs?