Regional Health Forum WHO South-East Asia Region(Volume 5, Number 2)

Health Care

Utilizing Traditional Healers in Primary Health Care - Dr N Jha * and Dr A T Kannan**

Introduction

THERE are different kinds of traditional medicine. Some of these are: Ayurvedic medicine, the Chinese yin/yang system and homoeopathic medicine. These are complex systems of medicine with written books and registration procedures for recognition. Others are small-scale, informal and passed on orally through traditional healers taking on apprentices to study under them. Traditional healers treat a number of conditions with herbal extracts acting on the body metabolism.⁽¹⁾

In South-East Asian and Far Eastern countries, over 80% of the people living in rural areas and 80% of the trained health manpower being urban based, hardly 10 to 15% of the people have access to officially-provided health care facilities. This makes people in rural areas to seek health care from practitioners of indigenous medicine. ⁽²⁾

The Need

In the developing countries, traditional healers are an important resource who should be fully employed in the effort to provide adequate health care. They include herbalists, divine healers, spiritual faith healers, traditional midwives, shamans, traditional Chinese doctors, bone setters and others.⁽³⁾

There are many elements in the traditional system which are beneficial while many others are not. In the United States, it is estimated that 30% of the population use herbal medicines, acupuncture, and homoeopathy. In some South Asian countries, such as China, India and Nepal, formal training in some of these like offering courses for ensuring quality standards in the health care delivery system are part of the national health system. ⁽⁴⁾

In this context, traditional healers in Nepal have a great opportunity to play an important role. The present scenario of health indicators in Nepal indicate a high death rate (13.3/1000 population), a high infant mortality rate (79/1000 live births) and a low contraceptive prevalence rate (29%). ^(5,6)

The doctor-population ratio is far from accepted norms.⁽⁷⁾ At the same time, the main objective of the national health policy is to upgrade the health of the rural people through the primary health care approach. To reach the targets envisaged, health facilities at the different levels have been constituted as follows: ⁽⁸⁾      

Positive outcomes and changes

A great variety of healers from different cultures were successfully trained to work in primary health care centres in Afghanistan, Brazil, China, Ghana, India, Nepal and Nigeria ⁽³⁾ The positive outcomes based on the above experiences show that:

     they were willing to work in primary health care centres;

     there is increased use of oral rehydration solution;

     there is rational use of treatment procedures for diarrhoea;

     latrines have been constructed and are in use in homes;

     increasing number of cases are referred to the health centres;

     there is increased attendance at the health post, and

     traditional healers are able to act as a link between the local population and health workers.

Problems

The problems faced by traditional healers are also multi-faceted. They are as follows:

     Lack of clear recognition by the government about their role and value for the health system.

     Lack of government commitment about their participation in the national health care system and programmes which discourages their participation.

     Lack of dialogue between them and the government system, which makes their role insignificant.

     Lack of trust between them and health workers trained in the allopathic system, which produces many conflicts, ultimately leading to counter-productive results.

Recommendations

The following recommendations are made in order to resolve the above problems:

1.      There should be a government policy for training and using traditional healers.

2.      Traditional healers should be fully incorporated into the health system based on the need of the community.

3.      There should be an atmosphere of understanding, trust and respect between them and health workers.

4.      Their role in primary health care must be defined and clearly identified. The roles may vary according to responsibility, status and culture practices of the healers.

5.      The planning, implementation and evaluation of programmes for training and using traditional healers in primary health care should be done jointly by representatives from health and other related sectors of the government, nongovernmental organizations, traditional healers and the community they serve.

6.      A partnership in health model can be developed as follows.

7.      The training course should contain all the principles and elements of primary health care.

Conclusion

It is important to collect information about the attitude, knowledge and practices of traditional healers and give them proper and adequate training according to the local needs of the community. They can be brought into the nation's health care delivery system. They however need recognition, respect and reward. At the same time, they should be viewed as allies in the delivery of primary health care. It is high time that these systems are evaluated for therapeutic significance, cost-benefit ratio and their sociocultural importance. These are the basis for evaluation of their use in primary health care.

In countries where the needs are great and the resources scarce, traditional healers can play a significant role in helping the rural community to improve its health and quality of life.

References

1.      Hubley J. Communicating health. The Macmillan Press Ltd, 1993.

2.      Pilapitiya U. Traditional medicine. Regional Health Forum 1996;1(2):51-56.

3.      Hoff W. Traditional healers and community health. World Health Forum 1992;13.

4.      World Health Organization. World Health Report 1997.

5.      His Majesty's Government, Nepal. Central Bureau of Statistics, 1995.

6.      His Majesty's Government, Nepal. Nepal Family Health Survey, 1996.

7.      His Majesty's Government, Nepal. Health Information Bulletin, 1992.

8.      His Majesty's Government, Nepal. National Health Policy, 1991.

* Dr. N. Jha, MD (Community Medicine), Associate Professor, Department of Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

** Dr. A.T.Kannan, MD (Community Medicine), Professor, Department of PSM, UCMS, New Delhi, Formerly Professor & Head, Department of Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.