title: Traditional Birth Attendance (TBA) in a health system: what are the roles, benefits and challenges: A case study of incorporated TBA in Timor-Leste.
abstract: BACKGROUND
  One current strategy to overcome the issue of shortage of qualified health workers has focused on the use of community health workers in the developing countries to deliver health care services specifically to the most vulnerable communities in the rural areas. Timor-Leste is the one of the world's newest developing countries that has incorporated the traditional birth attendance in its health system through a family health promoter initiative in response to reproductive and child health, hence to improve primary health care delivery and increase number of healthcare workforce.
  
  
  METHODS
  The study utilized a non-systematic review of the literature using key words such as community health workers, traditional birth attendants, reproductive health, child health and health outcomes. A case study from Timor-Leste was also used.
  
  
  RESULTS
  Traditional birth attendants have performed wide variety of tasks including outreach and case finding, health and patient education, referrals, home visits and care management. Evidence indicated that there were, to varying degrees, positive associations between traditional birth attendance training and maternity care. Traditional birth attendance training was found to be associated with significant increases in attributes such as knowledge, attitude, behavior, advice for antenatal care, and pregnancy outcomes. However, some challenges faced by traditional birth attendants' role in encouraging women to go to health center for preventive services would be the compliance and refusal of the referral. The implementation case study from Timor-Leste shows that integrating traditional birth attendance into a national healthcare system through Family Health Promoter program has been programmatic effective. It is recommended that the implementation should consider regular communication between health staff and community leaders in recruiting members of family health promoters, and the use of supportive supervision tools to identify weaknesses in the management of this initiative.
  
  
  CONCLUSIONS
  In Timor-Leste, incorporating traditional birth attendance through family health promoter program has played crucial roles in delivering and increasing access to reproductive health services by women in rural communities of the nation. Whilst it requires a long-term commitment and good partnership, the current reduction in maternal mortality ratio in Timor-Leste is encouraging and serves to illustrate how this initiative aims to improve primary health care delivery and increase number of healthcare workforce.
authors.affiliation: School of Public Health, Georgia State University, Atlanta, 30303 Georgia.
authors.forename: Decio
authors.initials: D
authors.lastname: Ribeiro Sarmento
keywords: Community health workers; Family health promoters in Timor-Leste; Reproductive health; Traditional birth attendants