|Collaboration with Traditional Healers in HIV/AIDS Prevention and Care in Sub-Saharan Africa - A literature review (UNAIDS, 2000, 64 p.)|
|Selected projects reviewed according to UNAIDS Best Practice criteria|
It has been formally recognized since the late 1970s that, for developing countries, it is imperative to include traditional healers in primary health care (WHO, 1978). As discussed above, since the early 1990s, the same has been agreed upon for AIDS, especially in sub-Saharan Africa, where ministries of health cannot pay for adequate health care services. In addition, the debilitating direct and indirect costs associated with AIDS in many countries make the prospect of cooperating with traditional healers all the more appealing. In general, the basic fact underlying this approach is that African healers are accessible, affordable, and culturally appropriate and acceptable, thereby fulfilling the major criteria for low-cost, effective health care service delivery in most sub-Saharan African settings. Thus, the relevance of the overall approach of working with healers will be taken as a given; instead, it is the relevance of specific strategies used by particular projects that will be assessed.
Relevance is about how closely a project is focused on the HIV/AIDS response in the context of the society in which it is implemented. Issues such as cultural and political factors are usually considered. For the projects compared here, the emphasis was placed on how appropriate the particular strategy of each project was to the HIV/AIDS situation and how project objectives related to the prevalence of HIV, needs assessments and the priorities of the National AIDS Programme. For instance, countries with a mature epidemic should combine prevention with counselling and care, as was done in the project in the United Republic of Tanzania.
In the projects reviewed in Table 2, objectives were defined following baseline research with traditional healers, carried out either through surveys or focus group discussions. In only a few projects was it mentioned that needs were assessed according to the larger political context - specifically with reference to the AIDS epidemiology - or the surrounding community needs. However, in almost all the countries in this review, the prevalence of HIV was already high when the projects were initiated. The differences in political will to work with traditional healers between countries can play a strong role in the overall success of this type of collaborative project, but this was rarely mentioned in project literature.
THETA Uganda may be the only project that carried out needs assessment in communities surrounding the traditional healers. Three projects stated that their objectives were directly based on National AIDS Programme priorities. The Malawi project noted that its objectives changed as the AIDS situation did. In the Central African Republic, it was noted that the content of the training curriculum was relevant to all types of healers trained, as the magnitude of knowledge and attitude change was not related to traditional healers' characteristics.
Measures of relevance therefore varied widely in the different contexts of the projects reviewed. Where the relevance of involving traditional healers in HIV/AIDS control efforts is no longer in question, it is essential that the objectives and strategies used by each project be appropriate for a given context. This will have a considerable impact on effectiveness. Issues to consider are listed below.
Figure 5. Relevance issues
· Did the project carry out a needs assessment study before developing objectives?
· Did the project take into consideration the local HIV prevalence, incidence and other AIDS interventions?
Relevance to National AIDS Programme priorities
· Did the project take into consideration the priorities of the National AIDS Programme?
· Did the project consider the political, social and cultural context surrounding traditional medicine, AIDS and other STD issues?