October 12, 2010

Ban on traditional birth assistants lifted

A ban on traditional birth assistants (TBAs), which has been in place since 2007, was lifted by President Bingu wa Mutharika. In order that the lift comes to effect, the ministry of health’s approval ist still needed, as well as the issuing of guidelines, and consultation with stakeholders. Health practitioners say the president's pronouncement "will now allow them [TBAs] to come back and operate openly".

The rationale for the 2007 ban was that low-skilled TBAs were unable to identify obstetric emergency cases early enough. Delays caused by poor transport infrastructure and the paucity of medical facilities contributed to the high incidence of maternal deaths. It was hoped that by preventing TBAs from practising, mothers would utilise the country's medical facilities, but nearly half of all deliveries still occur outside medical facilities. Dorothy Ngoma, executive director of the National Organisation of Nurses and Midwives in Malawi, said TBAs continued to exist because the health system failed to provide services. "They never really stopped ... What happened is that they went underground for fear of being fined a goat. So, in terms of statistics, we were losing out, as deaths and births from these people were not recorded", she said.

The World Health Organization estimates there are about two doctors and 59 nurses for every 100,000 people and that in 2006 the vacancy rate for nurses stood at about 65%. About 59% of Malawi-born physicians were practising outside the country. The statistics further mask the skewed distribution of health infrastructure, which is concentrated in urban areas even though about 70% of the national population of 15 million live in rural areas. (The Nation/The Guardian)


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