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The WHO5 defined a TBA as one (mainly a woman) who acquired her skills of delivering babies by herself, or working with other TBAs, and assists mothers during childbirth. TBAs are mostly initiated through internship with family and non-family TBAs and from dreams and revelations6. Their practice is associated with the exercise of spiritual and physical approaches involving the use of artefacts, herbs, as well as physical examination6.

In Ghana, efforts have been made in recent times to limit the activities of TBAs in some areas to sensitisation and awareness-raising. Also, the introduction of free maternal health services for pregnant women and the introduction of the National Health Insurance (NHIS) in Ghana are expected to reduce the financial burden on pregnant women in order to increase access to skilled birth-care services provided by professionals11. However, recent studies in Sub-Saharan Africa and Ghana show that the practice of TBAs is still widespread and government policy of curtailing their services may not be successful as rural women still prefer the services of TBAs12,13 due to multiple factors militating against access to professional maternal care14. In rural settings, TBAs are known to offer affordable15 and accessible services as well as conduct delivery in an environment familiar to the woman16,17. Also, the preference for TBA services is due to their respect for the religious beliefs of clients18. In particular, women still use TBA services, especially those from rural and deprived communities12 such as the Bongo District in the northern part of Ghana. The situation has led to a wide gap between antenatal care attendance and skilled delivery attendance in Bongo District. For instance, in 2009, antenatal care attendance in Bongo District was 90.2% whereas skilled delivery performance was only 47.6%19. In 2010, antenatal care attendance increased to 96.5% whereas skilled delivery attendance increased marginally to 54.6%19. What one can infer from this high antenatal coverage and low skilled attendance at delivery is that most of the women attended antenatal care, but when it came to delivery, they delivered at home, probably through a TBA (relatives or friends). This implies that TBAs continue to play an important role in deliveries at home, especially in rural areas.

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In contrast, using empirical evidence from Kenya, Carter29 has argued that the age of the mother does not affect her choice of delivery service. Another perspective is presented by Constanze and Rosemarie30 in Tanzania and Ogolla31 in Kenya that suggests that younger mothers use the services of TBAs more than older women. These divergent views about the relationship between age of a mother and the use of TBAs can be explained by several factors inter alia, cultural, attitude of service providers, the perception about the quality of services and financial constraints. For instance, a study in Nigeria revealed that teenage mothers lack the financial resources to access services from professionals and therefore rely more on relatives or TBA services, which are relatively cheaper1.

The study also reveals the importance of education in the health-seeking behaviour of rural women. Majority of mothers without formal education access the services of TBAs. This finding is consistent with Mwinfadhi et al.27, Henry and Tukur32 in Tanzania and Seter et al.33 in Iraq, whose studies suggest that women without formal education are more likely to access the services of TBAs than women with a formal education. In contrast, the Siajabu study from Tanzania proves the opposite. Again, these differences in health-seeking behaviour can be attributed to cultural, financial, and other factors28.

Simon Ateba is Chief White House Correspondent for Today News Africa covering President Joe Biden, Vice President Kamala Harris, U.S. government, UN, IMF, World Bank and other financial and international institutions in Washington and New York.

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French president Valry Giscard d'Estaing claimed that Bongo helped bankroll Jacques Chirac's campaign in the 1981 presidential election. Giscard said Bongo had developed a "very questionable financial network" over time. "I called Bongo and told him 'you're supporting my rival's campaign' and there was a dead silence that I still remember to this day and then he said 'Ah, you know about it', which was extraordinary. From that moment on, I broke off personal relations with him", said Giscard.[29] Socialist parliamentarian Andr Vallini reportedly claimed that Bongo had bankrolled numerous French electoral campaigns, on both the right and the left.[30] In 2008, President Nicolas Sarkozy demoted his minister in charge of looking after the ex-colonies, Jean-Marie Bockel, after the latter noted the "squandering of public funds" by some African regimes, provoking Bongo's fury.[28]

One of the strategies identified by the World Health Organisation as being crucial for saving the lives of pregnant women and as an indicator for progress in the reduction of maternal mortality is provision and utilisation of skilled birth care [1]. Skilled birth care describes a care by which a woman is provided with adequate care during labour, delivery and the immediate postpartum period by a trained health care professional [1]. Skilled care at birth occurs in a health facility or homebirth setting, assisted by trained professionals including midwives, nurses and doctors.

In Sub-Saharan Africa, many women deliver their babies at home in rural areas and are usually attended by various untrained family members, or the woman delivers alone unattended [4]. In Ghana, statistics from the Ghana Statistical Service (GSS) revealed that the percentage of births occurring in health facilities has increased from 57% in 2012 to 73% in 2014 [5]. A significant disparity exists between the utilisation of skilled birth care services in urban and rural areas in Ghana. The utilisation of skilled birth care is even lower in some parts of the country, especially the three Northern regions of Ghana [6].The Northern regions have consistently performed poorly in skilled birth attendance at delivery from 1990 to 2012 [5]. The exposure of women to poor care during labour and birth at home and by untrained TBAs, poses a great danger to the health of women [6].

Financial Disclosure: The law requires executive-level civil servants and civil servants who manage budgets to disclose their financial assets to the National Commission against Illicit Enrichment within three months of assuming office. Most officials complied, but some attempted to withhold information. The government did not make these declarations available to the public. There are administrative sanctions for noncompliance, but authorities did not provide information regarding enforcement.

The Babongo, Baghama, Baka, Bakoya, and Barimba ethnic groups are the earliest known inhabitants of the country. The law grants members of indigenous ethnic groups the same civil rights as other citizens, but they experienced societal discrimination. They remained largely outside of formal authority, keeping their own traditions, independent communities, and local decision-making structures, and did not have ready access to public services. Discrimination in employment also occurred. Indigenous persons had little recourse if mistreated by persons from the majority Bantu population, and there were no specific government programs or policies to assist them.

Key items on his agenda for the four summits include climate action in Africa, the crisis in Myanmar (ASEAN-UN Summit), reforming global financial institutions (G20), and getting the 2030 Agenda for Sustainable Development back on track (G-77 and China).

The future looks even brighter for the North Africans. Algeria swept up every junior race in the Continental Championships. First-year junior woman Malak Mechab particularly impressed by winning the road race and placing second in the time-trial. She went on, alongside several other young African talents, to spend the summer racing in Belgium and at the Worlds in Glasgow.

It might be strange to some that the three most prominent African cycling nations, South Africa, Eritrea and Ethiopia, play virtually no part in races across the continent. War (in Ethiopia\u2019s case), political instability and financial pressures mean that the federations of these countries are unable to support African racing. Many of the professionals we see on the world stage from these countries get there without ever really racing on the Africa Tour. ff782bc1db