Despite its many successes and general acceptance throughout the world, the Western system of healing has not replaced but has augmented indigenous health systems. This is because traditional healing is deeply embedded in wider belief systems and remains an integral part of the lives of most people. Thus, in most developing countries of the world, the traditional medical system continues to exist side-by-side with the modern system, and the majority of the population regularly consults both types of healers. In fact, traditional practitioners far outnumber modern health professionals. For example, according to the late Robert H. Bannerman1, “traditional midwives... form the main body of primary health care workers in maternal and child care, and in some countries they are responsible for over 90% of the births.”
During the past decade, the gulf of misunderstanding between modern and traditional practitioners has begun to narrow. A growing realization has developed that it is possible for traditional and modern medicine to work hand-in-hand in improving the health and well being of rural people, and that both traditional and modern practitioners can learn from each other.
The World Health Organization has played a lead role in proposing the use of traditional practitioners as part of the primary health care system. In 1977, WHO held a meeting on the Promotion and Development of Traditional Medicine in Geneva to foster a realistic approach to improving health care by incorporating traditional medicine2. A year later, the 1978 Declaration of Alma Ata3 recommended the use of all resources, including traditional practitioners, where applicable, in the primary health care system. The Alma Ata Conference recommended inter alia:
“...that governments give high priority to the full utilization of human resources by defining the role, supportive skills, and attitudes required for each category of health worker according to the functions that need to be carried out to ensure effective primary health care, and by developing teams composed of community health workers, other developmental workers, intermediate personnel, nurses, midwives, physicians, and, where applicable, traditional practitioners and traditional birth attendants.”
This recommendation sets forth a clear mandate for governments to define the role traditional practitioners and birth attendants can play in communities as members of the primary health care team. If we compare the needs for primary health care services in communities to the resources that are currently available, it becomes apparent that the goal of Health For All will never be achieved unless all existing community resources, including traditional practitioners, are mobilized and used more effectively.
In places where few trained health practitioners are available, families turn to traditional practitioners to help them fight for survival. In some developing countries traditional medicine caters to most of the health needs for up to 80 percent of rural families. There has been a broad gap between the need of the family for prevention and intervention, and the view of many Western health practitioners who believe healers are charlatans and profiteers, preying on the superstitions of local families. Now, because of the aforementioned worldwide health problems combined with shrinking resources, the importance of the traditional healer is undergoing a gradual re-evaluation.
Because of the critical need for primary health care throughout the world, and WHO’s recommendations that traditional practitioners be utilized as a component part of this primary health care team, there is a need to review studies and projects that have used traditional practitioners in some aspects of promoting community health. By evaluating the results of these studies and projects, we may be able to identify the positive outcomes and potential of using traditional practitioners in local communities, as well as to define the problems and limitations involved.
Few evaluations have been conducted of existing traditional practitioner primary health care training projects to provide answers to some basic questions. These include:
• What is the range of primary health care tasks which traditional practitioners can be trained to carry out effectively?
• What training methods and materials are appropriate for their cultural background and educational level?
• What kinds of follow-up services are required to insure quality of care?
• What impact will these extended services have upon reducing illness and in promoting the health and quality of life in communities?
• What would be the cost of providing such service?
• Can improved collaboration contribute toward creating a more acceptable and sustainable system of health services to communities?
• Are the differences between traditional healing and Western medicine surmountable so that the two groups can collaborate effectively?
• Would closer collaboration between the two groups foster greater understanding and trust between them and satisfy the needs of rural people for a sustainable, more culturally based health system?
In order to explore the answers to these and related questions, the World Health Organization, conducted a world wide literature review and field evaluation of four regional training projects for traditional practitioners. This report attempts to explain the health impact of these efforts on the communities served and to evaluate how greater cooperation and collaboration between conventional and traditional practitioners may provide a more effective and efficient system of health services for communities.