title: [Inclusion of traditional birth attendants in the public health care system in Brazil: reflecting on challenges].
abstract: The present article describes an experience with traditional birth attendants carried out in the state of Tocantins, Brazil, between 2010 and 2014. The experience was part of a diagnostic project to survey home deliveries in the state of Tocantins and set up a registry of traditional birth attendants for the Health Ministry's Working with Traditional Birth Attendants Program (PTPT). The project aimed to articulate the home deliveries performed by traditional birth attendants to the local health care systems (SUS). Sixty-seven active traditional birth attendants were identified in the state of Tocantins, and 41 (39 indigenous) participated in workshops. During these workshops, they discussed their realities, difficulties, and solutions in the context of daily adversities. Birth attendants were also trained in the use of biomedical tools and neonatal resuscitation. Based on these experiences, the question came up regarding the true effectiveness of the strategy to include traditional birth attendants in the SUS. The present article discusses this theme with support from the relevant literature. The dearth of systematic studies focusing on the impact of PTPT actions on the routine of traditional birth attendants, including perinatal outcomes and remodeling of health practices in rural, riverfront, former slave, forest, and indigenous communities, translates into a major gap in terms of the knowledge regarding the effectiveness of such initiatives.
authors.affiliation: Curso de Enfermagem, Fundação Universidade Federal do Tocantins, Palmas, TO, Brasil, christine@uft.edu.br.
authors.forename: Christine Ranier
authors.initials: CR
authors.lastname: Gusman
authors.affiliation: Grupo Curumim, Recife, PE, Brasil.
authors.forename: Ana Paula de Andrade Lima
authors.initials: AP
authors.lastname: Viana
authors.affiliation: Área Técnica de Saúde da Mulher, Secretaria de Estado da Saúde do Tocantins, Palmas, TO, Brasil.
authors.forename: Margarida Araújo Barbosa
authors.initials: MA
authors.lastname: Miranda
authors.affiliation: Área Técnica de Saúde da Mulher, Secretaria de Estado da Saúde do Tocantins, Palmas, TO, Brasil.
authors.forename: Mayane Vilela
authors.initials: MV
authors.lastname: Pedrosa
authors.affiliation: Departamento de Medicina Preventiva, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Wilza Vieira
authors.initials: WV
authors.lastname: Villela
mesh_terms: D001938:Brazil; D003906:Developing Countries; D005006:Ethnicity; D018588:Fee-for-Service Plans; D005260:Female; D006297:Health Services Accessibility; D006700:Home Childbirth / Q000706:statistics & numerical data; D006801:Humans; D008427:Maternal Health Services / Q000600:supply & distribution; D008880:Midwifery / Q000191:economics / Q000193:education; D009313:National Health Programs / Q000458:organization & administration; D011247:Pregnancy; D011256:Pregnancy Outcome; D015397:Program Evaluation; D000078329:Workforce