Focus whom they shared the same religion. The TBAs

Focus group discussions


Two focus group discussions (FGDs) were
carried out, each group comprising a different contributors:

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1) Three TBAs with no training; 2) Two TBAs
who were trained; 3) four women who gave birth at a health care facility and;
4) four women who had given birth at home. Data from FGDs comprising of untrained
TBAs suggested that their daily operations were mostly influenced by their
religious beliefs. Most of the women who approached them for services were women
with whom they shared the same religion. The TBAs said that they mostly
assisted those women that had not had not had difficult births previously, also
those women who faced challenges with transport and money to go and deliver at
formal health centres. As confirmed by all participants, high cost of living has
forced a lot of women to seek assistance during delivery outside health care
facilities, as conveyed by the statement below:


life is difficult. Who can give the United States Dollars that are being
charged at the clinics when one wants to give birth?”


was sighted by TBAs as one of the reason why women come to them for deliveries.


It is during emergencies only when trained
TBAs have confirmed that they double up as delivery assistants at the health care
centres, when the woman fails to get to the health facility that provides
maternity services.

In a lot of instances,
TBAs would rather encourage women to register their pregnancies at a health
care facility so as to receive ANC services, rather than providing assistance
to these women before delivery. This was alluded to by one TBA who explained:


“If and when a
pregnant woman comes to me and there is still time till delivery, and there
exist no distress related to pregnancy, I will encourage her to visit a health
centre, in most cases I even accompany them.” “In cases where I also
feel that there is a risk for the woman delivering along the way before
reaching the health facility I accompany her so that I can assist if need be.”

That was one TBA
explaining some of the duties she carries out with expectant mothers.


Previous complications
during pregnancy, including women who are pregnant for the first time were
indicated as contraindication for a TBA to deliver such women. Booking
pregnancies early was a way that TBAs felt women could better prepare
themselves for any problems that may arise during pregnancies and at delivery
time. With regards to knowledge related to basic HIV/AIDS issues, TBAs that
were interviewed expressed enlightenment on the existence of HIV, even though
not all of them had heard about PMTCT. In most cases they would never suspect
if a woman was HIV-positive, they would only know about it later after the
woman fell sick and had died. They indicated that their attitude towards
assisting HIV-positive women would not change and they would welcome and
appreciate any assistance rendered to them by health centres with such sundries
as gloves for their optimum protection during deliveries.

These community health cadres expressed
their readiness to be involved in PMTCT interventions but were quick to pick
the importance of training, so that an agreement on what services would be dispensed
and the requirement to be somehow acknowledged by the health workforce to
counteract any difficulties when delivering PMTCT services.

Deliberations with women who had delivered
at a health facility brought out an idea that they had probably done so as a
result of their choice to receive antenatal care at a health facility since medication
is supplied there. Such women would go back to health facilities for their children
to be immunized, they are also aware of the PMTCT services available to them at
the health centres, however, discrimination and stigmatization presented a
source fear of being tested for HIV. When it comes to the involvement of TBAs
in PMTCT, these women are of the idea that not all TBAs would be able to effectively
conduct the services, even if training was provided to them, a negative factor
being old age in most of the TBAs.

In the group of women
who were assisted to deliver by a TBA, qualitative data indicates that the main
the reason for doing so was lack of transport means to the health centres
during an emergency delivery. Most of these women would have received ANC at the
health centres but somehow felt that the relationship that existed between the
health personnel and themselves was not conducive enough for them to go back
there for maternal services. One of the women expressed:

personnel do not have time listen to our concerns as they may be too busy to do
so during our visits to the health centre, whereas TBA always have time to
discuss our issues”


When it comes to the TBAs’
involvement in PMTCT endeavours, these women are of the idea that TBAs are
talented enough to conduct these services only if they receive training,
however they also doubted the TBAs’ capability to perform blood test for HIV.
Furthermore, the women’s concern lay on the ability of the TBA to withhold
women’s HIV-sero-status classified. A woman who was assisted to deliver by a
TBA alluded:


“It therefore
relies on the TBA’s ability to keep a secret if I reveal to them my HIV-positive
status. I would not be comfortable with a situation where every-one in the
community is aware of my HIV-positive status. “At the clinic, in most
cases the nurse does not know you so she is not tempted to tell anyone, that
way my status stays a secret,”