It has been the policy of the Botswana Government to actively promote collaboration and cooperation between the traditional and the formal health sector for more than 10 years now. Attempts to integrate the two systems have not been actively pursued, since it is felt one or the other of them might suffer in the process; instead, parallel development is encouraged.
Although collaboration was initiated and formalized by the Ministry of Health, activities with traditional health workers are now carried out by district health workers, mainly with support from the Health Education Unit. Collaboration has involved the following activities:
- seminars and discussions with traditional healers, which take up cooperation and two-way referral, the management of different diseases, and prevention and control of the main public health problems;
- facilitating self-referral by patients from the modern health care centre and encouraging follow-up by the traditional health practitioner after completion of treatment;
- informal arrangements whereby traditional health practitioners treat their clients/patients in modern health facilities.
A law has been drafted and is now ready for presentation to the Cabinet that essentially seeks to regularize the registration and licensing of traditional health practitioners. This will be done under the umbrella of the associations through which traditional health practitioners are registered with the Ministry of Home Affairs.
Collaboration with traditional health practitioners
District medical officers, health education officers, and other community health workers in all the health districts in Botswana hold regular seminars with traditional practitioners. These are routinely planned and budgeted for under a local government fund for community leaders' seminars.
At these seminars, views are exchanged with traditional health practitioners about the probable etiology of various diseases, their management, and the prevention of public health problems. Traditional health practitioners have been successfully involved in the management of diarrhoeal diseases and tuberculosis in Botswana; the latter might form a useful model for their involvement in the management of HIV/AIDS prevention and control activities.
Traditional health practitioners have also extended invitations to modern health practitioners to attend and speak at their meetings.
The response of traditional health practitioners to the attempts of the modern health sector to accelerate collaboration has, on the whole, been positive, particularly if it is carried out in an atmosphere of mutual respect and genuine exchange of ideas and expertise. They have also suggested the adoption of a standard format for use in the referral of patients from traditional health practitioners to modern health facilities. However, traditional health practitioners feel that referral of patients is generally one-sided; they have suggested that more patients be referred to them by modern health workers.
Involvement of traditional health practitioners in HIV/AIDS prevention and control - the traditional health practitioners' perceptions of HIV/AIDS
No systematic research has been done to assess the traditional health practitioner's knowledge and ideas about HIV/AIDS. However, during discussions at seminars and meetings, a variety of views about HIV/AIDS have been expressed by them, ranging from claims to have known and been able to cure the disease for a long time, to admissions that AIDS is a new and unknown disease about which they have to gain more knowledge.
The most commonly expressed view is that AIDS is “baswagadi”, an illness caused by the failure to observe certain taboos and go through cleansing ceremonies following bereavement. AIDS is also attributed to mixing one's blood with that of strangers who do not observe the same taboos; in essence, having sexual contact with strangers. This view has interesting parallels with the known risk factor of having multiple sexual partners and has possibilities for development and incorporation into health education messages. Research is needed to collect more comprehensive and detailed knowledge about traditional health practitioners and, therefore, the community's perception of the etiology and pathogenesis of HIV/AIDS.
Seminars on HIV/AIDS for traditional health practitioners
District and local seminars on HIV/AIDS are becoming increasingly important as a way to disseminate and discuss information on this topic. Traditional health practitioners are being informed about HIV/AIDS from their perspective as health care providers. Information about the risks related to certain practices and to the practitioner and the client is given with special emphasis on midwifery, bleeding, and scarification. Traditional health practitioners are taught about hygienic practices to avoid infection and the need, in all cases, to use a new razor blade with each client for the practice of scarification.
Seminar attendants subsequently inform their colleagues in their own association meetings.
A pilot activity has been carried out in several districts where, after being informed about HIV/AIDS, traditional health practitioners agree to distribute condoms to their clients, particularly those with sexually transmitted diseases. This has been continued successfully with a few traditional health practitioners but has failed in some cases, mainly because of poor support from modern health workers. Attempts are being made to restart and sustain these activities.
Traditional health practitioners have been recognized as a valuable counselling resource in the community because they already manage a variety of health, family, and social problems as part of their work. A study is being carried out in one district to collect information about the counselling methods of traditional health practitioners for incorporation into the training of modern health workers in counselling.
It has become clear that traditional health practitioners in their roles as community leaders and health care providers have an important part to play in most of the components of the National AIDS Programme. Activities will be developed to strengthen their involvement in information and education, counselling, condom promotion, prevention of infection during health care, and research.