Building Bridges and Exploring the Role of Traditional Birth Attendants in Community-Based Health Systems

Abstract: Traditional Birth Attendants (TBAs) remain central to maternal and newborn care in many low- and middle-income countries, particularly in rural and underserved settings where skilled birth attendants and functional facilities are limited. In Nigeria, high fertility, rapid population growth, and persistent health system constraints intersect with an unacceptably high maternal mortality burden, reinforcing reliance on TBAs as culturally trusted, accessible, and affordable providers. This paper explores the evolution, roles, and cultural significance of TBAs and examines how their structured integration into community-based health systems can strengthen maternal and child health outcomes. Drawing on empirical and policy literature, the paper synthesises evidence that, when appropriately trained and supervised, TBAs can improve health promotion, facilitate earlier recognition of danger signs, increase timely referrals, and strengthen linkages between households and formal services. It further argues that exclusion of TBAs sustains fragmented care pathways, erodes community trust in formal interventions, and contributes to preventable maternal and neonatal deaths. The paper concludes that pragmatic integration anchored in role clarity, referral systems, supportive supervision, culturally competent collaboration, and enabling policy frameworks offers a context-sensitive pathway for advancing equitable maternal health and accelerating progress toward Sustainable Development Goal 3. Keywords: Traditional birth attendants; Maternal mortality; Community-based health systems; Skilled birth attendance; Referral systems; Nigeria,