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This paper reviews and reflects on the policy efforts to integrate traditional healers in Nepal. Most people in rural Nepal rely on traditional healers for their primary health care needs, not only because health facilities in rural areas are poorly functioning but also because these healers meet various health care needs. The kind of traditional medicine provided by traditional healers (such as herbalists, bone setters, faith healers, and traditional midwives) is much more accessible to them than the practitioners of biomedicine and scholarly traditional medicine (such as Ayurveda, Unani, and Homeopathy). However, traditional healers have not been recognized as legitimate practitioners. Policy initiatives are needed to facilitate recognition, accreditation, or licensing of traditional healers so that they can be integrated into the formal structure of the health care system. Nepal’s recent initiative of registration of traditional healers is an important policy effort in this direction.

This paper offers an understanding of medical pluralism as practiced among the Tharus of Nepal, and makes a discussion on the indigenous medicine in relation to the state health policy and the ambivalence that exists regarding official recognition of indigenous healers. Field data were collected from a village cluster of Dang district following qualitative methods: observation of healing sessions, interview with healers, patients, and key informants. Tharu healing tradition consists of three main practices: shamanic, herbal, and midwifery; practiced mainly by three types of healers: guruwa, baidawa, and surenya who employ three major strategies of healing: mantra, medicine and massage. The knowledge of healing mantras, use of local herbal medicine, and traditional midwifery and massage are the most important features of the Tharu’s indigenous healing practices. Such practices, along with those of co-inhabited non-Tharu healers and healing practices form the universe of local folk medicine. The folk medicine, which represents an oral tradition, co-exists along with scholarly traditional medicine and biomedicine. In terms of official recognition and support, biomedicine is on the top followed by scholarly traditional medicine and folk medicine falls at the bottom of the hierarchy. The scope of medical pluralism has been widened with the inclusion of scholarly traditional medicine in the official health care system. However, many of the indigenous traditional medicines that indigenous ethnic communities continue to practice still fall outside the purview of state regulation. The legitimacy of indigenous healers remains in question. An expression of sceptical and ambivalence attitudes towards indigenous healers has been reflected in the policy and planning documents. There has been an insignificant and inconsistent efforts to link indigenous healers with the official health care system and a hesitation to legitimize indigenous traditional medicine. A serious reflection is needed to move ahead from this ambivalence and inaction towards a more inclusive and democratic medical pluralism.

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It has become a custom citing development reports, which show remarkable progress in some of the health indicators, to signify the higher quality of life achieved over the years. The human development datasets, for instance, present impressive progress in terms of decreased mortality, increased life expectancy, higher literacy and falling poverty which is synonymous to a higher standard of living. With the amazing success in medical science, advancement in therapy and surgery, and prevention and control over some of the dangerous diseases, we are bound to believe that we have achieved much, and there is no question whether the overall health condition has been worsened in the last few decades. The real life experience of local people, however, challenges this fact and compels us to reflect on "are we really healthy than before?" Drawing from a qualitative study conducted in a district of midwestern Nepal, this paper presents people's narratives to deepen our understanding of how people in an urbanizing village experience health. The paper recognizes the deteriorating health experience of the people which has primarily resulted from a loss of local health traditions exacerbated by the current change and development.