In the remote villages of western Kenya, traditional birth attendants (TBAs) have played a pivotal role in shaping maternal and child healthcare. Their influence, deeply rooted in cultural and generational traditions, has historically made them the first point of contact for expectant mothers. However, these TBAs have recently embraced a new mission—promoting childhood vaccination and safe deliveries at health centers. Their efforts have transformed healthcare access in the region, significantly improving child survival rates.
For decades, TBAs in communities like Kibura village on the slopes of Mt Elgon relied on ancestral knowledge to assist with childbirth. Women such as Evelyn Chewuno, who learned midwifery skills from her grandmother, provided crucial maternal care when hospitals and clinics were inaccessible. However, many babies born under their care did not receive vaccinations, leaving them vulnerable to life-threatening diseases such as measles and polio.
The opening of the Kopsiro Model Health Centre in 2016 marked a turning point for maternal and child healthcare. Before its establishment, pregnant women had to travel up to 60 kilometers to the nearest clinic—a journey many could not afford. The new facility not only provided closer access to medical services but also introduced a training program that integrated TBAs into the healthcare system. These birth attendants were trained as community health volunteers, responsible for encouraging antenatal care visits and ensuring children received their vaccines.
The impact of this initiative has been profound. Within just a few years, childhood vaccination rates in the region skyrocketed from a mere 30% to over 90%. As a result, childhood mortality rates have plummeted. According to Herbert Ogoti, a nurse who formerly managed Kopsiro Health Centre, child deaths have decreased by an estimated 75% since the program began. Before the intervention, many mothers failed to attend antenatal clinics, leading to complications and preventable infant deaths.
Through the collaborative efforts of organizations like WHO, UNICEF, Save the Children, and the Kenyan government, TBAs were formally trained to advocate for maternal and child health. A select group of 23 TBAs and 10 community health volunteers underwent intensive five-day training sessions, equipping them with the knowledge to educate mothers on the importance of vaccinations and hospital deliveries.
While the TBAs continue to serve in a largely voluntary capacity, they receive small stipends for their efforts. Each time a TBA accompanies a mother to deliver at the health center, she receives a transport allowance and a payment of 250 Kenyan shillings (approximately $2). Additionally, they earn 50 shillings for every mother they refer for their first antenatal care visit. These incentives have provided an additional motivation for TBAs to actively engage in mobilizing expectant mothers.
Dr. Hesborn Kambo, the current head of Kopsiro Model Health Centre, notes that the facility has seen a remarkable increase in hospital deliveries. Between October 2023 and October 2024 alone, over 800 children were born at the center. The role of TBAs in connecting families to health services has been instrumental in this progress.
Families in the region have responded positively to the TBAs’ advocacy. Parents like Robert Kimutai and Aisha Kipkemei have ensured that their three children receive all necessary vaccinations. “A child who is not vaccinated falls sick all the time and is generally weaker,” Kimutai observed. Kipkemei echoed his sentiments, emphasizing that she had witnessed the consequences of home births and the lack of medical care.
For older generations, the importance of vaccination is even clearer. Catherine Nekesa, a grandmother in her seventies, recalls the tragic deaths of two of her uncle’s children due to measles. She now makes it her mission to accompany her daughters-in-law and grandchildren to the clinic. “None of my grandchildren will go unvaccinated,” she insists.
The success of this initiative extends beyond Kopsiro Health Centre. To further expand healthcare access, five additional clinics have been established in the region. While these new facilities may lack electricity and laboratory services, they still serve as critical vaccination points. Medical staff from Kopsiro supply them with vaccines, while TBAs and community health volunteers ensure mothers bring their children for immunization.
Transportation challenges, once a major barrier, have been mitigated by the use of motorbikes. These vehicles transport vaccines to remote clinics and also ferry emergency cases to the main health center.
The remarkable transformation of childhood vaccination rates in western Kenya is a testament to the power of community engagement. TBAs, once solely traditional midwives, have evolved into essential healthcare mobilizers. Their efforts have bridged the gap between rural families and modern healthcare, ensuring that fewer children succumb to preventable diseases.
Evelyn Chewuno, now 62, takes pride in her role as a vaccine champion. She keeps a record of the children she has helped over the years and is heartened to see them thriving. “I can’t imagine some of them would be dead if I had not helped their mothers come to the health center,” she reflects.
As Kenya continues its efforts to improve maternal and child health, the success of Kopsiro’s model demonstrates the potential of integrating traditional birth attendants into formal healthcare networks. By building on such initiatives, the country moves closer to universal healthcare access one mother and child at a time.
