Traditional health practitioners are a valuable and sustainable resource that already exists in most communities. The training and utilization of these practitioners in primary health care, working in close collaboration with conventional health staff, can be expected to contribute, in many countries substantially, to obtaining more practical, effective, and culturally acceptable health systems for communities.
These Guidelines for Training Traditional Health Practitioners in Primary Health Care were developed as part of a contract awarded by the World Health Organization, Division of Strengthening of Health Services, Geneva, Switzerland, to the International Child Resource Institute in Berkeley, California. The purpose of the contract was to evaluate the effectiveness of programmes training traditional health practitioners (THPs) to perform primary health care (PHC) services in rural Third World communities. Data for this evaluation study were collected from four field projects based in Ghana, Mexico, and Bangladesh. The results of this evaluation study are reported in a separate document published by WHO1.
One objective of this evaluation was to utilize the findings that related to the training of the THPs in these areas and compile guidelines that could assist others in planning, conducting, and evaluating similar training programmes for THPs. Accordingly, from the evidence collected from the above field evaluations, we have found some common elements that seem to be effective in teaching PHC skills to THPs.
In addition to using information collected from the interviews with training staff and THP participants, and from observations of actual training sessions in the above-mentioned projects, we have drawn upon two other sources.
One is data collected from an earlier study. This was an international review of literature describing projects using traditional healers as community health workers2. The other source is a large collection of recent publications that contained information about the principles and methods for planning, conducting, and evaluating training programmes for traditional birth attendants, other traditional health practitioners, and community health workers. These publications also contained information about the selection, use, development, and testing of training and health education materials for nonformal adult education and low-literate audiences.3,4,5,6,7,8
The aim of these guidelines is to help individuals and organizations develop training programmes that will enable THPs to play a more significant role in primary health care programmes and thus to improve health conditions in their own localities. These are merely guidelines, and as such, must be flexibly used to create training programmes that are appropriate for the needs and conditions in local regions and communities.
The contents of these guidelines are arranged in a series of major steps that one would take to develop a training programme for health workers such as THPs. The experience collected in the above-mentioned training projects has shown that a successful training programme requires careful planning. This planning begins by identifying the health needs, priorities, and resources from health organizations and communities. These needs can then be translated into specific PHC functions and tasks that THPs can learn, and then the appropriate training methods and materials that can be selected for teaching the PHC content. Trainers and other health professionals must then be adequately prepared for conducting the training sessions. And finally, a practical plan should be constructed to evaluate the outcomes of the training.
The activities required to plan, carry out, and evaluate an effective training programme for traditional health practitioners are described according to the following six steps:
STEP I: PLANNING FOR THE TRAINING
STEP II: DETERMINING THE CONTENT FOR TRAINING
STEP III: DETERMINING THE TRAINING METHODS
STEP IV: SELECTING TRAINING MATERIALS
STEP V: TRAINING THE TRAINERS
STEP VI: EVALUATING THE TRAINING