(541) School of POWHER Training Impact on Traditional Birth Attendant Motivation and Client Empowerment in Kenya

Objective:
In rural Kenya, where maternal morbidity and mortality are high, traditional birth attendants (TBAs) often serve as the first point of care. The School of POWHER (SOP), led by a maternal health NGO, is a community-based training program that aims to strengthen TBAs’ clinical knowledge, referral practices, and client-centered care. We assessed TBA motivation and client-reported trust and empowerment using adapted, validated community health worker (CHW) performance tools in two TBA cohorts in West Pokot, Kenya that were trained using the SOP model.

Study Design:
Quantitative surveys were conducted with SOP-trained TBAs (n=15) and their clients (n=17). TBAs completed the Multi-Dimensional Motivation Scale, assessing supervision, value/capacity, peer support, and compensation. Clients completed three validated measures: Trust in CHWs, Client Empowerment in Community Health Systems (CE-CHS), and CHW Influence on Empowerment. Composite scores were calculated using published protocols.

Results:
TBAs exhibited moderate to high motivation (mean = 12.6; range: –1.1 to 24), with highest scores in perceived supervision and peer support. Clients reported high levels of trust in TBAs (mean = 3.81/4) and perceived them as positively contributing to their empowerment (mean = 3.74/4), particularly in navigating healthcare and promoting community well-being. Overall client empowerment was also high, as reflected in the CE-CHS score (mean = 3.25/4).

Conclusion:
SOP-trained TBAs in West Pokot, Kenya are highly trusted and contribute meaningfully to client empowerment and community-based care. These findings offer evidence of implementation success and highlight motivation, trust, and empowerment as key benchmarks for TBA program evaluation. Insights from this evaluation will guide refinement of the SOP model, including structured peer mentorship, enhanced supervision, and strengthened referral support to better integrate community-based services with formal health systems. By expanding access and quality in remote settings, this work supports global efforts to reduce maternal morbidity and mortality.