Sponsored by Village Education Resource Center
A. DESCRIPTION OF PROJECT
The Village Education Resource Center (VERC) is a non-governmental organization which started as a collaborative project of Save the Children, USA and UNICEF in 1977. Based approximately 60 kilometres outside of Dhaka in the rural area of Savar District, it conducts a variety of integrated community development programmes in collaboration with various local, national, international NGO’s and Government Departments, all aimed at empowering the rural poor to achieve self- reliance. The VERC places a high priority on training programmes to enable men, women and children to improve conditions of health, nutrition, family planning, water and sanitation, agriculture, education and income.
In May, 1990, with financial assistance from the Bangladesh Population and Health Consortium and the British Overseas Development Agency, and in coordination with and approval of the Government of Bangladesh, VERC began a three year project to train TBAs in specific target areas in three Districts. During the three year period, the VERC project trained 219 TBAs from selected regions in all three Districts. This resulted in approximately one trained TBA per village in the target area. The Savar region, which contains 164 villages, was selected for this evaluation.
The TBAs that were interviewed described some of the most severe health problems of the women they knew in the communities. These conditions included tetanus, haemorrhoids, early pregnancy and other pregnancy risk factors such as young age or being overweight, difficult or prolonged labour, painful urination, eclampsia and anaemia of pregnant women, abnormal presentation, infected umbilical cord, and retained placenta.
The major aim of the VERC’s MCH project was to reduce the neonatal and maternal mortality rates by training TBAs to provide maternal and child health services to mothers. The scope of the project was to provide MCH care not only during the labour and delivery period but additionally, pre- and post-natal care would be offered to mothers and children over the entire 320 day period, from conception until two months after birth.
The specific objectives of this project were:
• To insure safe delivery of pregnant mothers.
• To provide prenatal and postnatal mothers with care and advice and to refer risky mothers and children to health care centres or hospitals.
• To motivate eligible couples to practice family planning.
• To assist TBAs in income-generation activities.
• To increase literacy among TBAs.
C. RECRUITMENT AND SELECTION OF TRADITIONAL PRACTITIONERS
Each training group contained approximately 20 TBAs chosen from among the total 218 selected from the target areas by the selection committee. This committee consisted of representatives from the donor agency, the Upazila Health and Family
Planning authority and the VERC. The committee followed the procedure and criteria set forth by the government.
These criteria included:
• Age between 30 & 50 years and in good health;
• Experience of conducting 8-10 deliveries;
• Known as a TBA in her locality;
• Desire for training as a TBA.
D. TRAINING CONTENT
The content of the training programme followed the guidelines established by the Ministry of Health, but permission was obtained to schedule it in two sessions (a basic residential training of ten days followed later by a five day refresher course.
The curriculum included teaching the TBAs how to:
• examine pregnant women, identify high risk mothers and refer them to the nearest clinic/hospital;
• advise women to get tetanus injections and get their children immunized;
• supply iron tablets to pregnant mothers and vitamin A capsules to postnatal mothers;
• attend the delivery in a hygienic manner;
• advise mothers on family planning and proper nutrition for themselves during breast feeding and weaning of their babies;
• organize community meetings for health education;
• explain to mothers and complete the “Home Based Maternal Record” (a pictorial record card) and update it during pregnancy;
• write and read Bangla (for illiterate TBAs);
• organize and implement income generating activities.
E. TRAINING METHODS
The TBAs resided at the training centre for 10 days of basic training, after which they returned to their communities to practice for four to six months. After this period they returned for a five day refresher course to review their skills and to report any problems they had experienced in the field.
The content of the curriculum was presented according to the training manual developed by the VERC. Course content was generally presented in brief lectures followed by questions and answers, discussions, role-plays, and demonstrations. Some flip charts and models were used as well.
F. FOLLOW-UP SUPPORT
An important aspect of the training project was the weekly follow-up meetings that were scheduled for all TBAs. Fifteen field supervisors were employed by the project to organize and conduct these weekly, small group, half-day sessions in the areas where the TBAs worked. The purpose of these sessions was to review the daily progress of TBAs, to provide guidance and assistance in solving their problems, and to provide continuing field training. In addition to reviewing the TBAs’ work at these weekly sessions, the women studied their literacy materials and made plans for income generating activities.
These weekly sessions were generally held at government clinics or local hospitals in order to improve coordination and referrals between TBAs and government facilities. Additionally, this location provided the opportunity to orient government staff to what TBAs were doing.
G. CHARACTERISTICS OF PERSONS INTERVIEWED
1. Health Agency Staff - Four representative official health agency staff were interviewed concerning their views on the training of TBAs in communities and their own relationships with the TBAs. The group consisted of three women and four men (ages 21 to 33) who had worked in their present positions: Project Coordinator, Assistant Project Officer, Senior Supervisor, and TBA Supervisor.
2. Traditional Practitioners - Ten traditional birth attendants from three different villages were interviewed. All were women, who had practised as TBA’s, and were 35 to 70 years of age, with an average age of 55. None of the women could read or write and none had attended school.
3. Community Members - Twenty-six members of five villages were asked their opinions about the services of the TBAs and if they had suggestions to improve their community’s health. Twenty-two mothers and four men, (a farmer and small businessman, a shopkeeper, a government worker, and a labourer) were interviewed. The group had an age range of 17 to 75.