Development of a framework for collaboration between midwives and traditional birth attendants at a selected province in South Africa

Thesis (PhD (Nursing Science))--University of Pretoria, 2023.Background: The World health Organization (WHO) has identified collaboration between traditional health practitioners (Traditional birth attendants [TBAs]) and skilled birth attendants (midwives) as an essential strategy towards the reduction of maternal and neonatal mortality and morbidity rate (MNMR) especially in low- and middle-income countries (LMICS). In South Africa, the traditional birth attendants' care is often performed in a reticent manner. Nevertheless, the reality remains in South Africa, there is no collaboration existing between western health practitioners and traditional healthcare practitioners. Aim: The study aimed at developing a framework for collaboration between midwives and traditional birth attendants as part of the re-engineering of maternal Primary Health Care services in selected provinces in South Africa. Methods: The study was conducted in two phases and was guided by the Structure-ProcessOutcome (SPO) Donabedian framework (1986). Phase 1 was a convergent parallel mixed methods design including concurrent data collection from quantitative and qualitative research design. The findings of phase 1 were analysed and merged to inform the next phase. Phase 2: a consensus method nominal group technique (NGT) held with various stakeholders was employed in the study. Results and findings: Subphase 1-Quantitative study. Overall Midwives in South Africa displayed a low level of knowledge (mean = 41.8, SD=1.7) on the role and practices of traditional birth attendants for maternal and neonatal healthcare. In terms of attitude, the midwives displayed a negative attitude towards collaboration for maternity care (mean=46.8, SD=2.1). Midwives (70.4%, n = 183) only agreed to collaborate for antenatal care. In addition, there was a significant relationship (p