Evaluation of a Traditional Birth Attendant and Community Health Leader Training and Mentoring Program in Matagalpa, Nicaragua

Abstract

Evidence strongly shows that the risk of childbirth is best mitigated through giving birth at or near a health institution with emergency obstetrical services and receiving regular prenatal visits. These interventions have been shown to improve maternal morbidity and mortality. Many under-resourced areas of the world continue to have difficulty connecting poor rural women to these services. In Matagalpa, Nicaragua a pioneering project, "Destrezas para Salvar Vidas," was implemented in August 2011 to provide training and mentorship to the traditional birth attendants and community health leaders to connect pregnant women in rural communities with the formal health sector. This project was evaluated at the one-year point through tests of knowledge both before and after an initial one-week training, records of activities conducted by participants, and interviews with program participants and mentors. The aggregate test scores of participants' knowledge during the initial week of training increased from an average score of 59.5% to 79.9% (differences 21.4%, p<0.001). Of the pregnant women in contact with program participants, 93% delivered at an institution, compared to 81% of all pregnant women in Matagalpa. Participants performed an average of 51 home visits each over the year. Reciprocal trust and communication increased between community participants and health sector workers. Participants felt empowered to take active roles in the health system: activating emergency services when needed, accompanying women during labor and delivery at health centers, and embracing a greater leadership role in their communities. While this project is only one of many that the ministry of health employs to reduce maternal mortality, it can be a model for increasing community engagement and referrals to the formal health sector in a resource-limited area.