Objective: To assess the effectiveness of a traditional birth attendant
(TBA) referral program on increasing the number of deliveries overseen
by skilled birth attendants (SBA) in rural Kenyan health facilities
before and after the implementation of a free maternity care policy.
Methods: In a rural region of Kenya, TBAs were recruited to educate
pregnant women about the importance of delivering in healthcare
facilities and were offered a stipend for every pregnant woman whom
they brought to the healthcare facility. We evaluated the percentage of
prenatal care (PNC) patients who delivered at the intervention site
compared with the percentage of PNC patients who delivered at rural
control facilities, before and after the referral program was
implemented, and before and after the Kenya government implemented a
policy of free maternity care. The window period of the study was from
July of 2011 through September 2013, with a TBA referral intervention
conducted from March to September 2013. Results: The absolute increases
from the pre-intervention period to the TBA referral intervention
period in SBA deliveries were 5.7 and 24.0 % in the control and
intervention groups, respectively (p < 0.001). The absolute
increases in SBA delivery rates from the pre-intervention period to the
intervention period before the implementation of the free maternity
care policy were 4.7 and 17.2 % in the control and intervention groups,
respectively (p < 0.001). After the policy implementation the
absolute increases from pre-intervention to post-intervention were 1.8
and 11.6 % in the control and intervention groups, respectively (p <
0.001). Conclusion: The percentage of SBA deliveries at the
intervention health facility significantly increased compared to
control health facilities when TBAs educated women about the need to
deliver with a SBA and when TBAs received a stipend for bringing women
to local health facilities to deliver. Furthermore, this TBA referral
program proved to be far more effective in the target region of Kenya
than a policy change to provide free obstetric care