In The Gambia’s North Bank Region and Nigeria’s Jigawa State, communities are working to connect mothers with skilled care during childbirth. For Rose Mendy, a resident of Mendy Kunda, a rural community in The Gambia, support from her community has been essential in getting her to a hospital during labor.
Rose’s experience with childbirth has been marked by unexpected deliveries, including one at home. However, with the help of a traditional birth attendant (TBA) in her village, she was able to deliver her second child safely at Essau District Hospital. The TBA, who has been trained to recognize danger signs and provide basic assistance, played a key role in ensuring Rose received timely care.
The use of TBAs is common in many rural communities across West Africa, where weak and inadequate healthcare systems can make it difficult for women to access medical care during childbirth. In The Gambia and Nigeria, public-private partnerships, community-led interventions, and innovative policy reforms are working to integrate TBAs into the formal healthcare system and improve outcomes for mothers and newborns.
A Regional Crisis Meets Local Solutions
Studies have shown that many women in The Gambia and Nigeria face significant challenges in accessing healthcare during childbirth, including insufficient time for travel and transport difficulties. In The Gambia, 75% of women cite insufficient time for travel as a major reason for avoiding health-facility births, while 29% blame transport difficulties.
In Nigeria, a similar situation exists, with many women attending antenatal care and intending to use a hospital for delivery, but ultimately giving birth at home or with a TBA. However, rather than criticizing the use of TBAs, local health systems are recognizing their role and working to integrate them into formal healthcare structures.
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Through training and the provision of essential equipment, TBAs are being supported to carry out safer pregnancies and childbirth, while strengthening links between communities and formal health facilities. Veronic Mendy, a local TBA in Mendy Kunda, noted that past challenges involved women hiding labor pains to deliver at home without medical help, but that her community is now working to prioritize accompaniment to the hospital.
In Nigeria, a similar evolution is happening, with trained TBAs like Hafsat Shehu acting as community bridges to connect women with formal healthcare services. Hafsat screens women, urges them to visit primary health care centers for routine antenatal care, and initiates referrals if obstructed labor occurs.
The Jigawa State Maternal and Neonatal Emergency Transport Scheme has also been introduced to address the transportation barrier, with local community health ambassadors maintaining a directory of vetted drivers to transport women to the nearest primary health care center at a subsidized fee.
According to Dr. Shehu Sambo, the Executive Secretary of the Jigawa State Primary Health Care Development Agency (JSPHCDA), Governor Malam Umar Namadi doubled the drivers’ per-trip stipend from ₦5,000 to ₦10,000 to ensure drivers remain motivated.
This development has significant implications for the women in these communities, as it means they can now access skilled care during childbirth without having to worry about the cost of transportation. With the support of their communities and the integration of TBAs into the formal healthcare system, women in The Gambia and Nigeria are one step closer to receiving the care they need to ensure a safe and healthy delivery.
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Measurable Changes on the Ground
The Gambia has seen a significant drop in home deliveries, with rates plunging from 36.18% in 2013 to 14.39% in the latest Demographic and Health Survey. The Gambia’s Health Ministry is building on this momentum through the National Reproductive, Maternal, Neonatal, Child and Adolescent Health Policy, which reinforces mortality monitoring at the central, regional, facility, and community levels.
In Jigawa State, Nigeria, the impact of the transport scheme and the integration of TBAs into the formal healthcare system is equally commendable. Ahmad Yakubu Kwaimawa, Officer in Charge at the Jaudi Primary Health Care Center, noted a sharp increase in facility utilization, saying, “Now, we record up to 100 deliveries in a month.”
Khadijat Umar, a resident of Jigawa, noted that, “Now, we record up to 100 deliveries in a month.”
Community-based support is key in helping women access healthcare during childbirth. In Mendy Kunda, Samuel Chaw, the Village Development Committee Chair, emphasizes similar local progress, noting that the committee has appointed women leaders as TBAs, who regularly check in on expectant mothers. These TBAs provide basic assistance and help connect women to formal health services. The committee also organizes educational forums on proper nutrition and encourages husbands to ease their wives’ household workloads.
