A review of projects in various countries suggests that traditional healers, if properly trained, can contribute significantly to the work of primary care teams. Recommendations are offered with a view to making the best possible use of this valuable resource.
PIP: Positive outcomes, constraints, and future involvement of traditional healers in community health projects is reviewed. 17 projects of which 2 were nongovernmental were included in the analysis of traditional practitioners trained in implementing 1 or more primary care (PHC) activities. Traditional medical persons were, for instance, herbalists, diviners, spiritual or faith healers, traditional midwives, and birth attendants, who worked well with other staff and were willing to contribute to PHC. Skills were taught in promotion of 1) health education and prevention relevant to local problems; 2) improving nutrition and food supplies (breast feeding, weaning foods balanced diets, kitchen gardens); 3) safe drinking water supplies and sanitation; 4) maternal and child health care and family planning (pregnancy monitoring, risk referral, contraceptive distribution); 5) prevention and control of local endemic diseases (diarrhea and oral rehydration therapy--ORS, tuberculosis, leprosy, malaria, malnutrition) and referral for treatment; 6) immunization and referral of children 5 to clinics for vaccination; and provision of 7) treatment of common diseases and injuries (1st aid and accident prevention); and 8) essential drugs and maintenance of a basic dispensary. Examples are given for Ghana, Swaziland, Nepal, and brazil and show the high level of interest of healers. There was increased use of ORS and decreased use of purges, use of handwashing in basins, construction and use of latrines, increased referrals, and increased use of midwives for birthing. 7 projects showed improvements in attitudes, knowledge, and behavior of healers; in the health status of population; and in attitudes and behavior of health staff. Constraints were the lack of government recognition of the value of traditional healers, of government commitment, and of dialogue between healers and government staff. Clearly defined roles and tasks are important for deterring problems. Harmful practices of healers can interfere with proper medical care. Recommendations were to stimulate government action to incorporate traditional healers into health services, to define carefully the role of healers, to engage in evaluation research with other sectors, to tailor training programs to the needs of local traditional healers, and to develop effective strategies to integrate healers. Traditional healers are a valuable resource in PHC.