|Collaboration with Traditional Healers in HIV/AIDS Prevention and Care in Sub-Saharan Africa - A literature review (UNAIDS, 2000, 64 p.)|
|Additional criteria for collaborative projects|
In addition to the UNAIDS Best Practice criteria, which are general criteria used to assess a wide variety of AIDS-related projects, the following are considerations which apply specifically to collaborative projects between traditional medicine and biomedicine. (For a summary, see Table 3 at the end of the review.)
Due to the lack of regulatory bodies for traditional healers in most countries, selection of 'genuine' or 'authentic' healers can be a challenge for most new projects.
In general, these eight projects generally consulted community leaders, traditional healer associations and the ministries in charge of traditional healer activities for approval and for recommendations of genuine or authentic healers. Many project leaders commented on the extensive time needed to select genuine traditional healers who were truly interested in collaboration.
In Senegal, criteria for selection were initially based on healers' reputations. The selection was enhanced by the use of children, considered innocent and unbiased. They were asked to which healer in their community they would refer someone with an ailment.
In South Africa, the project first contacted five traditional healers' associations to select healers for training. However, in the second round of training, it was found that the trained healers were much more effective at selecting genuine healers than the traditional healers' associations were.
Other initiatives also noted that it was preferable to avoid traditional healers' associations, as the internal politics of these associations can sometimes interfere with selection, training, or other project objectives. Such was the case in Uganda, where the criteria for traditional healers' selection used by THETA are the following:
· being recognized as healers by the community and local authorities
· having regular patient attendance
· having a clinic or shrine to receive and treat patients
· knowing how to prepare herbal remedies.
The list in Figure 6 can be useful in selecting healers to participate in collaborative projects.
Figure 6. Issues in selecting 'genuine' or 'authentic' healers
· Did the project consider the community recommendations for genuine or authentic healers?
Traditional healers' associations
· Did the project consider traditional healers' association recommendations critically?
· Does the country have an office in the ministry under which traditional healers' activities fall?
· If so, did the project collaborate with this office in the selection of traditional healers?
· Do the traditional healers selected have regular patient attendance?
· Herbal preparations
· Do the traditional healers selected prepare herbal treatments?
· Has the project budgeted enough time to select genuine traditional healers?
Discussion, interviews and listening to traditional healers' needs were the most common methods used for building trust with traditional healers, and it was agreed that doing this slowly, without rushing the traditional healers, was important.
In Uganda, explicit recognition of healers' rights to their treatment secrets was emphasized in order to help gain trust in setting up the initial collaborative clinical research on herbal treatments for opportunistic infections. In both the United Republic of Tanzania and Uganda, a series of workshops were held after initial contacts to share ideas between representatives of the two health care systems. Other initiatives used repeated visits to healers' homes/clinics or focus group discussions as a way of establishing trust. Figure 7 lists issues to be considered in building trust.
Figure 7. Issues in establishing trust with traditional healers
· Has the project budgeted enough time to build strong and lasting relationships with traditional healers?
· What methods will the project use to build trust (focus group discussions, visits to traditional healers' homes/clinics, etc.)?
· Does the project treat traditional healer participants with respect?
Recognizing traditional healers' rights to their treatment secrets
· Does the project recognize traditional healers' proprietary rights to their treatments?
· How has this recognition been conveyed to traditional healers?