THPs have special characteristics which must be considered while developing appropriate training programmes for them. These characteristics include:
1. Age and sex
THPs generally tend to be older and experienced in their profession. This can be an advantage. It may be useful to have them share experiences and learn from each other during training.
TBAs are almost always women, and most have had a lot of birthing experience, having children of their own. A project in Bangladesh illustrated how staff considered this fact in arranging their training programme. The staff planned a residential type training for their TBAs, so the women could get away from their families and concentrate more fully on the training. In the beginning, some of their husbands needed reassurance that their wives would be safe in the training centre quarters. But after the husbands were assured that their women would be secure, this arrangement proved more satisfactory than if the women had lived at home and had come daily for training.
2. Level of education
A large percentage of practitioners have low levels of education and many are not able to read or write. This places restrictions on how you can present information and on the kinds of educational materials you can use in classes. Low literacy levels make the selection and use of visual materials extremely important. This is discussed more fully in Step IV. To help overcome this problem, one project included literacy education in the training curriculum to raise the literacy level of the participants.
Some participants come from indigenous populations and may speak only their native tongue. They may not be able to communicate well in the country's official language. In Mexico, this problem was encountered with some of the older healers, making it necessary to do some translating in workshop sessions.
4. Traditional beliefs about healing
Most THPs have traditional beliefs about health, healing and illness that differ from concepts in modern or conventional medicine. It is essential that trainers understand these beliefs, be sensitive to the differences, and present, where possible, health information within the context of these traditional beliefs.
For example, a very traditional belief is that illness occurs when a person allows the spiritual, social, physical, and emotional aspects of his or her life to fall out of balance. And healing can occur only when he or she brings these elements into balance and harmony with nature. This belief exists among many Native Americans and is true within Eastern and African cultures.
Many ideas of conventional health knowledge and practice can be presented within the framework of these traditional beliefs. For example, the concept of selecting various foods to obtain a balanced diet, and the principle that oral rehydration solution is important to rehydrate a person with diarrhoea can be described as actions to bring the food or fluid level of the body into balance and harmony9.
The rationale for why immunization is important to protect children against common diseases can be explained as being similar to certain practices that many healers use to protect the body against some types of traditional illnesses. These practices include scarifying places on the skin and rubbing in herbal medicines to protect against evil spirits. Additionally, the concept of holistic health and healing which deals with the physical, emotional, social, and spiritual aspects of one's life is common to both traditional and modern medicine.
5. Economic status
THPs are private practitioners and, therefore, depend upon their own individual practices as well as other sources, such as farming and selling herbal medicines, for income. Most health agencies who have trained THPs to conduct PHC services have not employed these healers or paid them for their services. For many healers in the projects studied, the PHC services they perform are beyond the scope of their normal duties. Often, they receive no remuneration for them. It is, therefore, important that you build into the project some ways to reward trained healers for these extra services.
This has been done in several ways. Communities have been asked to remunerate their healers by committing resources to repay them in-kind, as with farm labour, food, or assistance in building village clinics where healers can practise. Some health agencies have included within their training programmes assistance toward helping healers engage in income-generating activities, such as beekeeping, cottage industries, and establishing savings banks to promote income-raising projects.