Table 2 Summary of qualitative results
Respondent group | Global theme | Organizing theme | Basic findings from the FGDs and interviews |
|---|---|---|---|
Characterization of TBAs by HIV+ women who had accessed trained TBAs | Quality of care | Quality of care | •TBAs provide personalized care |
•TBAs provide continuous care from antenatal, labor, and postnatal •TBAs help in promoting adherence to treatment •Provided supportive logistic and services | |||
Limitations in quality | •Lack of skills to handle complications •Lack of medical supplies and equipment to prevent mother to child transmission | ||
Efficiency | Efficiency | •Provided psychological, emotional, and economic support •Referred and facilitated transportation to facilities •TBAs work to end stigma, discrimination, and patriarchy through advocacy Using advocacy to challenge structural drivers to poor maternal health outcomes e.g., stigma, discrimination, and patriarchy | |
Limitations in efficiency | •Lack of advanced medical equipment and supplies | ||
Affordability | Affordability | •Were cheaper and in some cases free •Payment or token of appreciation was not mandatory | |
Limitations in affordability | •N/A | ||
Access | Access | •Easily accessible •Lives within the community •Always available to provide care from antenatal to postnatal | |
Limitations to access | •N/A | ||
Characterization of TBAs by HIV+ women who had never accessed trained TBAs | Quality of care | Quality of care | •Less verbally and physically abusive than professionals in facilities •Provision of personalized care |
•More guaranteed support from antenatal until postpartum •Do provide resources and food •More friendly and caring than facility-based care | |||
Limitations in quality | •Professionals have more knowledge and skills to handle complications than trained TBAs •Professionals have access to equipment and medical supplies that can deal with HIV vulnerability during pregnancy but TBAs do not | ||
Efficiency | Efficiency | •N/A | |
Limitations in efficiency | •TBAs cannot help in PMTCT •TBAs cannot help easily conduct HIV tests •TBAs cannot help in the provision of ARVs •TBAs cannot help in conducting cesarean births | ||
Affordability | Affordability | •TBAs are cheaper than institutions where they require women to pay clinical fees •TBAs are cheaper as they do not require the patient to buy her own bucket, delivery bags | |
Limitations in affordability | •N/A | ||
Access | Access | •Always available when called upon •Follow the patients to their home | |
Limitations to access | •N/A | ||
Characterization of trained TBAs by trained TBAs | Quality of care | Quality of care | •Provide pragmatic services in the form of psychological and emotional support •Provide adherence-to-treatment support •Provide useful maternal health information •Help in providing priority attention to HIV-positive women upon recommendation at the facility |
Limitations in quality | •Limitation in skills •Lack of access to medical supplies and equipment | ||
Efficiency | Efficiency | •Protection from domestic violence and abuse •Provide useful information regarding maternal health promotion and nutrition •Provide transportation where possible to facilities •Help in providing priority attention to HIV-positive women upon recommendation at the facility | |
Limitations in efficiency | •N/A | ||
Affordability | Affordability | •Cheap •No fees required | |
Limitations in affordability | •N/A | ||
Access | Access | •Readily available to communities •Provide services to everyone including those who would have otherwise been left unattended to | |
•They view their work as a civic duty to the community | |||
Limitations to access | •N/A | ||
Policy | Provide referral services | •Provide transportation where possible to facilities •Help in providing priority attention to HIV-positive women upon recommendation at the facility | |
Advantages of government policy on TBAs | •N/A | ||
Limitations as a result of government policy on TBAs | •Lack of support from government due to promotion of facility-based policy creates cooperation problems with professionals •Obscures training opportunities for TBAs •In conflict with government policy | ||
Professional’s characterization of trained TBAs | Quality of care | Quality of care | •Can provide soft services, e.g., psychological and emotional support including treatment adherence support •Provision of referrals services |
Limitations in quality | •As opposed to TBAs, professionals can conduct completed procedures such as cesarean births •As opposed to TBAs, professionals can effectively handle complications •Have access to life-serving medical equipment used to conduct complicated operations | ||
Affordability | Affordability | More affordable than institutions | |
Limitations in affordability | •N/A | ||
Efficiency | Efficiency | •N/A | |
Limitations in efficiency | Inadequate funding to cooperation between TBAs and professionals | ||
Policy | Advantages of government policy on TBAs | •N/A | |
Limitations as a result of government policy on TBAs | •Policy frustrates cooperation between professionals and TBAs •Counterproductive government policy on TBAs •Creates barriers in accessing the most vulnerable women in remote areas |