|Collaboration with Traditional Healers in HIV/AIDS Prevention and Care in Sub-Saharan Africa - A literature review (UNAIDS, 2000, 64 p.)|
|AIDS and traditional medicine in Africa|
With growing interest and increasing need for expanded health care in the past 20 years, the governing bodies of WHO have adopted a series of resolutions. Policies regarding collaboration with traditional medicine have been shifting since the late 1970s. As early as 1974, the WHO Regional Committee for Africa decided that the topic for the technical discussions at its upcoming twenty-sixth session would be Traditional medicine and its role in the development of health services in Africa. Three years later, the World Health Assembly adopted a resolution promoting training and research related to traditional medicine. In 1978 in Alma Ata, WHO and UNICEF adopted resolutions supporting the use of indigenous health practitioners in government-sponsored health programmes.
In 1984, 1989 and 1990, further resolutions were adopted, encouraging specific measures governing the practice of traditional medicine to be incorporated within national health legislation, adequate budgets to allow promotion of traditional medicine, the development of traditional medicine systems, effective launching of these programmes, and inventories of medicinal plants. In 1990, the WHO Traditional Medicine Programme and the WHO Global Programme on AIDS came together in Botswana to consider ways to involve traditional health practitioners more actively in measures to prevent and control HIV infection and AIDS in African communities. In 1994, the WHO offered further observations and direction regarding traditional healers, suggesting that upgrading their skills made more sense than training new groups of health workers, such as village health workers.
Since then, changing policies and a growing body of data concerning cooperation with traditional healers have fuelled an ongoing debate on the public health relevance of investing in efforts for partnership with traditional healers. In this debate, the following points are made in favour of collaboration:
· Traditional healers often outnumber doctors by 100 to 1 or more in most African countries. They provide a large accessible, available, affordable trained human resource pool.
· Traditional healers possess many effective treatments and treatment methods.
· Traditional healers provide client-centred, personated health care that is culturally appropriate, holistic, and tailored to meet the needs and expectations of the patient. Traditional healers are culturally close to clients, which facilitates communication about disease and related social issues. This is especially important in the case of STDs.
· Traditional healers often see their patients in the presence of other family members, which sheds light on the traditional healers' role in promoting social stability and family counselling.
· When traditional healers engage in harmful practices, there is a public health responsibility to try to change these practices, which is only possible with dialogue and cooperation. Research has shown that traditional healers abstain from dangerous practices when educated about the risks.
· Traditional healers are generally respected health care providers and opinion leaders in their communities, and thus are treating large numbers of people living with HIV/AIDS. Healers have greater credibility than village health workers (who are often their counterparts in village settings), especially with respect to social and spiritual matters.
· Since traditional healers occupy a critical role in African societies, they are not likely to disappear soon. They survived even strict colonial legislation forbidding their practice. Even with the rapid sociocultural changes occurring in many African societies, traditional healers continue to play a crucial role in addressing the variety of psychosocial problems that arise from conflicting expectations of changing societies.
· Numerous studies (see below) document traditional healers' enthusiasm for collaborating with biomedical health providers and show that their activities are sustainable as they generate their own source of income.
· Many biomedical health providers want such collaboration (Oja & Steen, 1996).
· Especially since the 1980s, healers have been organizing themselves into traditional healers' associations, which makes it easier to establish collaborative programmes.
· Efforts at collaboration seem to improve health delivery in a number of ways:
- increased knowledge and skills of traditional healers
- increased confidence in their practice
- increased openness (transparency) towards the community within their work
- earlier referral to hospital or health centre
· The training and licensing of healers is not institutionalized, which makes it difficult to reach and train them regularly in a standardized manner
· Quality control of healers is difficult in the absence of officially recognized licensing procedures
· There is no general monitoring of healers' activities or claims
· Traditional healers lack detailed anatomical and physiological knowledge
· Traditional healers may engage in some harmful practices or cause delays in referral to biomedical facilities
· Promotion and improvement of traditional methods may undermine efforts to increase access to biomedicine
· The effects of combining traditional and biomedical treatments are not known and may be harmful
· Official recognition of traditional medicine gives legitimacy to traditional healers when their treatments and methods are still largely untested
· Opening up collaboration with traditional healers raises their expectations of greater recognition from government, which governments may not be able to give.
Many public health experts involved in this ongoing debate have concluded that, despite the limitations, it makes sense to at least attempt collaboration, given the vast health needs in developing countries and the numerous realistic and practical advantages. The following section discusses eight projects that have developed collaboration between biomedical and traditional health practitioners for HIV/AIDS prevention and care. In addition, Guinea is also discussed as a supplementary case, since the government has tried to integrate traditional healers into many different aspects of health care, though not specifically AIDS.
A healer tends a herbal garden in Mbarara, western Uganda.