Focus group discussions Two focus group discussions (FGDs) werecarried out, each group comprising a different contributors: 1) Three TBAs with no training; 2) Two TBAswho 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 untrainedTBAs suggested that their daily operations were mostly influenced by theirreligious beliefs. Most of the women who approached them for services were womenwith whom they shared the same religion. The TBAs said that they mostlyassisted those women that had not had not had difficult births previously, alsothose women who faced challenges with transport and money to go and deliver atformal health centres. As confirmed by all participants, high cost of living hasforced a lot of women to seek assistance during delivery outside health carefacilities, as conveyed by the statement below: “Nowadayslife is difficult. Who can give the United States Dollars that are beingcharged at the clinics when one wants to give birth?” Thiswas sighted by TBAs as one of the reason why women come to them for deliveries.
It is during emergencies only when trainedTBAs have confirmed that they double up as delivery assistants at the health carecentres, when the woman fails to get to the health facility that providesmaternity services.In a lot of instances,TBAs would rather encourage women to register their pregnancies at a healthcare facility so as to receive ANC services, rather than providing assistanceto these women before delivery. This was alluded to by one TBA who explained: “If and when apregnant woman comes to me and there is still time till delivery, and thereexist no distress related to pregnancy, I will encourage her to visit a healthcentre, in most cases I even accompany them.” “In cases where I alsofeel that there is a risk for the woman delivering along the way beforereaching the health facility I accompany her so that I can assist if need be.”That was one TBAexplaining some of the duties she carries out with expectant mothers. Previous complicationsduring pregnancy, including women who are pregnant for the first time wereindicated as contraindication for a TBA to deliver such women. Bookingpregnancies early was a way that TBAs felt women could better preparethemselves for any problems that may arise during pregnancies and at deliverytime.
With regards to knowledge related to basic HIV/AIDS issues, TBAs thatwere interviewed expressed enlightenment on the existence of HIV, even thoughnot all of them had heard about PMTCT. In most cases they would never suspectif a woman was HIV-positive, they would only know about it later after thewoman fell sick and had died. They indicated that their attitude towardsassisting HIV-positive women would not change and they would welcome andappreciate any assistance rendered to them by health centres with such sundriesas gloves for their optimum protection during deliveries. These community health cadres expressedtheir readiness to be involved in PMTCT interventions but were quick to pickthe importance of training, so that an agreement on what services would be dispensedand the requirement to be somehow acknowledged by the health workforce tocounteract any difficulties when delivering PMTCT services.
Deliberations with women who had deliveredat a health facility brought out an idea that they had probably done so as aresult of their choice to receive antenatal care at a health facility since medicationis supplied there. Such women would go back to health facilities for their childrento be immunized, they are also aware of the PMTCT services available to them atthe health centres, however, discrimination and stigmatization presented asource fear of being tested for HIV. When it comes to the involvement of TBAsin PMTCT, these women are of the idea that not all TBAs would be able to effectivelyconduct the services, even if training was provided to them, a negative factorbeing old age in most of the TBAs.In the group of womenwho were assisted to deliver by a TBA, qualitative data indicates that the mainthe reason for doing so was lack of transport means to the health centresduring an emergency delivery. Most of these women would have received ANC at thehealth centres but somehow felt that the relationship that existed between thehealth personnel and themselves was not conducive enough for them to go backthere for maternal services.
One of the women expressed:”Healthpersonnel do not have time listen to our concerns as they may be too busy to doso during our visits to the health centre, whereas TBA always have time todiscuss our issues” When it comes to the TBAs’involvement in PMTCT endeavours, these women are of the idea that TBAs aretalented 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 withholdwomen’s HIV-sero-status classified. A woman who was assisted to deliver by aTBA alluded: “It thereforerelies on the TBA’s ability to keep a secret if I reveal to them my HIV-positivestatus.
I would not be comfortable with a situation where every-one in thecommunity is aware of my HIV-positive status. “At the clinic, in mostcases the nurse does not know you so she is not tempted to tell anyone, thatway my status stays a secret,”