Engagement of Traditional Healers and Birth Attendants as a Controversial Proposal to Extend the HIV Health Workforce

Abstract

“Medical pluralism” is the use of multiple health systems and is common among people living with HIV/AIDS in sub Saharan Africa. Healers and traditional birth attendants (TBAs) often are a patient's first and/or preferred line of treatment; this often results in delayed, interrupted, or abandoned diagnosis and therapy. Literature from the study of medical pluralism suggests that HIV care and treatment programs are infrequently and inconsistently engaging healers around the world. Mistrust and misunderstanding among patients, clinical providers, and traditional practitioners make the development of effective partnerships difficult, particularly regarding early HIV diagnosis and antiretroviral therapy. We provide recommendations for the development of successful collaboration health workforce efforts based on both published articles and case studies from our work in rural Mozambique.

Southern Africa: the Highest Priority Region for HIV Prevention and Care Interventions

“…Audet et al explain that while successful program expansion requires a radical expansion in the health workforce, this has not happened accordingly with the need [•15,16,17]. Continual nursing and physician “brain drain” from Africa to high income nations such as the U.S. and the U.K. has not been addressed successfully [18-20].…”

“…Hence, more effective partnerships between close to community health care workers (community health workers, traditional birth attendants, etc.) and traditional healers must be considered to facilitate referrals and establish a strong system of support for treatment adherence and other HIV care related issues [•15,23,24]. As providers and governments move toward expanded service and scale, retention in care proves to be one of the most important components.…”

“…Audet et al states that while there have been successful efforts to increase referrals from traditional practitioners to allopathic care, buy-in from the health care workers themselves, who are deeply skeptical of traditional healers, is critical for fruitful collaboration. Structural changes in clinical settings, training needs for healers, clinician attitude changes, patient buy-in (of healer/TBA/clinician collaboration), and recruitment of effective traditional partners are all cited as important recommendations [•15]. While political and social awareness regarding HIV/AIDS increases, effective and well-sustained implementation remains a looming challenge for both prevention and treatment.…”

Collaborative HIV care in primary health care: nurses’ views

“…Throughout sub‐Saharan Africa, most people still believe in consulting traditional healers as an alternative to inadequate allopathic services (Audet et al. ). The THPs are also well known to be experts in different areas such as herbal, spiritual and religious practices.…”

“…These groups of THPs are readily available and accessible to the patients in rural areas (Audet et al. ). The African traditional medicine system existed prior to the advent of the Western approach.…”