Community perceptions of a policy promoting exclusive skilled birth attendance and banning traditional birth attendants (2)

25 May, 2019

Nobody should be surprised at the outcome of the ‘exclusive skilled birth policy in Malawi’: increased lack/poor access for pregnant women and families during pregnancy and birth.

It should be considered unethical to ban TBAs before adequate number and equitable distribution of skilled birth attendants have become a reality in any country. How many women and babies have died while such a policy is in place? Infact it is executive manslaughter, at least!

On this forum at least the role of TBAs has been so extensively discussed and evidence adduced by the majority that, yes untrained TBAs are a problem, but that engaging TBAs, training them and equipping them with basic knowledge about reproductive anatomy and physiology and equipping them with basic single use or sterilisable equipment, and monitoring them and their practice is definitely better than banning them.

Joseph Ana

HIFA Profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007.


Joseph is a member of the HIFA Steering Group:

Email: jneana AT