train TBAs in basic and emergency obstetric care, family planning, and other maternal health topics, in order to enhance the links between modern health care services and the community, and to improve the chances for better health outcomes among mothers and babies. There is little evidence of large-scale effectiveness of targeted intervention programmes for training TBAs, as they are rarely integrated within a general strategy for improving maternal and child care. Integration into healthcare systems in developing countries Historically, Traditional Birth Attendants (TBA) have operated outside of the formal healthcare delivery structure. TBA training has been used as a means of extending health services to underserved communities in developing nations in hopes of decreasing mortality and morbidity. While the focus in the past two decades has been on training TBAs, studies on training impact has shown conflicting results in maternal outcomes with many studies showing little to no impact on high maternal mortality outcomes. As a result, there has been a shift toward skilled birth attendants, capable of averting and managing complications. The TBA role in the community should not be overlooked; they are highly respected members and proven assets in addressing poor maternal outcomes. TBAs have been unsuccessful in handling obstetric complications, but have contributed to successful maternal, neonatal, and child health interventions, although there is insufficient evidence that TBA training improves peri-neonatal mortality. The key piece missing in TBA training is an adequate referral system, which allows TBAs to use their close ties with the community to link pregnant women to skilled birth attendants (SBA). The effectiveness of TBA referrals to health facilities is dependent on the healthcare system’s ability to support an increase in services provided and the supervision needed to support TBA integration. “Five mechanisms for TBA integration were identified: training and supervision of TBAs; collaboration skills for health workers; inclusion of TBAs in facility-based activities; systems for communication between TBAs and SBAs; and defining roles for TBAs and SBAs.” While these mechanisms are important, complementary activities also influenced TBA referral and integration success: “careful selection of TBAs; community participation; health system development; and affordability changes.” TBA’s must be provided with appropriate knowledge, easy access to health personnel, and quality and regular supervision; all three components enable training to become a tool for TBA integration into the healthcare system. The referral training for TBAs allows them to act as “intermediaries between the community and the formal