Integrating Traditional and Biomedical Maternity Care: A Case Study of Sustainable Practices in Sierra Leone

In many sub-Saharan African contexts, maternal healthcare is delivered through a dual system where traditional birth attendants (TBAs) and biomedical practitioners work separately, often resulting in fragmented care. Sierra Leone, which faces persistently high maternal mortality rates, exemplifies this challenge and highlights the need for integrated, sustainable models. This case study aimed to document and analyse a long-running programme in Sierra Leone that sought to establish a sustainable, collaborative maternity care model through the formal integration of TBAs into the district health system. A qualitative, longitudinal case study approach was employed. Data were collected through in-depth interviews and focus group discussions with TBAs, midwives, community health workers, and health officials. Programme documents and local health facility records were reviewed to contextualise stakeholder perspectives. The integration process increased formal referrals from TBAs to health facilities, with a reported rise in supervised deliveries. A key outcome was the development of mutual respect, which mitigated initial professional scepticism. Programme sustainability, however, relied heavily on continuous community-led dialogue and on non-monetary incentives for TBAs, such as public recognition and inclusion in health campaigns. This case demonstrates that structured collaboration between traditional and biomedical maternity care systems is feasible and can contribute to a more cohesive healthcare network. Success depends on acknowledging the social capital of TBAs while systematically strengthening their linkage to formal services. Policymakers should consider formalising TBA roles within national community health strategies. Training programmes for midwives should incorporate modules on respectful engagement with traditional practitioners. Sustainable integration requires ongoing investment in platforms for community dialogue. maternal health, traditional birth attendants, health systems integration, Sierra Leone, sustainable healthcare, midwifery This case study provides a detailed account of a long-term integration initiative, offering evidence-based and practical insights for policymakers and practitioners seeking to develop collaborative maternity care models in similar settings.