Research Snapshot: Improving prenatal support with traditional health attendants

Wakobo Ti Kodro was a pilot study testing an intervention designed to strengthen the role of traditional birth attendants (TBAs) in identifying high-risk pregnancies and ensuring timely referral to health facilities, using a digital application.

The Central African Republic faces high maternal mortality, in part due to limited access to maternal health services and a shortage of skilled health personnel. TBAs play a significant role within communities, particularly as around 41% of deliveries occur at home. Evidence has accumulated on the benefits of collaborating with trained and supervised TBAs, as well as on the use of digital health for improving maternal health outcomes.

The study used a quasi‑experimental before/after design. First, maternal care attendance at seven health facilities was assessed ten months after implementation, covering deliveries and pre/postnatal care. Then, prenatal and postnatal follow‑up and maternal/neonatal outcomes were documented for a cohort of 1,869 pregnant women, followed by an implementation study evaluating acceptability and feasibility of the intervention among 86 TBAs, pregnant / postpartum women, husbands, and community/district health stakeholders.

The approach combined collaboration between healthcare workers with TBAs, trained in community-based maternal care. A digital application on tablet, created for low-literacy users, supports TBAs in recognising danger signs early and guiding women at elevated risk to deliver in health centres in the Central African Republic (CAR). Preliminary findings suggest the approach improves community-to-facility referral, prenatal consultation attendance, safe childbirth at health facilities, and increases TBA’s maternal health knowledge, which can support better maternal and neonatal outcomes.

This snapshot contains key messages, findings, implications for humanitarian policymakers and practitioners and recommendations for further research.