Records on the number of deliveries, obstetric procedures performed, referrals, complications and maternal deaths in facilities with obstetric registers were not readily available at the time of the survey.
The NHW received 6 days training on birthing care, clean delivery, basic management, and referral of complication.
In addition, TM have limited training in the recognition of complications, and in the study community there were no formal mechanisms for timely referral if complications arose.
Basic obstetric care was defined as care for a normal delivery and referral if complications occurred.
In turn, such processes are likely to affect the reporting and referral of complications [ 35].
However, some informants favoured the current policy of encouraging health centre deliveries to enable easier referral of complications.
Challenges and controversies surround the best methods to train TBAs in techniques for clean delivery and recognition and effective referral of complications.
CHO services include childhood vaccination, antenatal and postnatal care, family planning outreach, emergency deliveries, and referral for complications during pregnancy and delivery.
A skilled birth attendant is someone 'trained to proficiency in the skills needed to manage normal pregnancies, childbirth and immediate postpartum period, and in the identification, management and referral of complications in women and newborns' [ 7].
Two-thirds of PCPs reported referring less than a quarter of their patients with diabetes to specialists; reasons for referral included complications with insulin therapy and use of advanced treatment strategies.
The World Health Organization (WHO) defines a SBA as an individual trained to proficiency in the skills needed to manage normal pregnancy, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns [ 27].
