Traditional Healers and their provision of Mental
Health Services in Cosmopolitan Informal Settlemenin Nairobi, Kenya
TECHNOPOLICY BRIEF No. 38

ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 38

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ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 38

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Traditional Healers and their provision of Mental
Health Services in Cosmopolitan Informal Settlementsin Nairobi, Kenya

David M. Ndetei
Professor of Psychiatry, University of Nairobi and Founding Director, Africa
Mental Health Foundation (AMHF)
Anne W Mbwayo
Research Fellow, Africa Mental Health Foundation (AMHF)
Victoria N Mutiso
Research Fellow, Africa Mental Health Foundation (AMHF)
Lincoln I Khasakhala
Hon. Lecturer, Department of Psychiatry, University of Nairobi & ResearchFellow, Africa Mental Health Foundation (AMHF)
Paul M. Chege
Senior patent examiner, Kenya Industrial Property Institute (KIPI)	  ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 38

3This paper should be cited as:
African Technology Policy Studies, ATPS 2013: Traditional Healers and their provision ofMental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, [David M.
Ndetei, Anne W. Mbwayo, Victoria N. Mutiso, Lincoln I. Khasakhala, Paul M. Chege], ATPS
Technopolicy Brief No. 38© 2013Published by the African Technology Policy Studies Network

ISBN: 978-9966-030-49-8

ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 38

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Table of Contents
Acknowledgements							

31. Introduction								

42. Key Messages								

53. Conclusion and Policy Options:					7ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 38

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Acknowledgement
This paper was produced as part of the implementation of the ATPS phase VI Strategic Plan,
2008-2012, funded by ATPS Donors including the Ministerie van Buitenlandse Zaken (DGIS)
the Netherlands, amongst others. The authors hereby thank the ATPS for the financial andtechnical support during the implementation of the Intellectual Property Program. The authors
particularly thank Prof. Kevin Urama, the Executive Director of the ATPS for his visionary
leadership as programme director; Mr. Joseph Wekundah the Executive Director of theBiotechnology Trust Africa (BTA) and Prof. Moni Wekesa (Mount Kenya University) who werecoordinators of the programme and Dr. Nicholas Ozor, Senior Research Officer (ATPS) andall the ATPS team members for their technical support during programme implementation.

ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 386

1. Introduction
One of the major challenges for the Government is the provision of health services for
its people, which is a basic need. However, Kenya just like other developing economies
is generally constrained by lack of sufficient resources to sustain this demand. Traditional
medicine in all its form was the only mode of treatment in Kenya for the various communities
before the white man came to Kenya. It was as it is practiced in various forms; for example,use of herbs, animal parts, divination and others. This traditional knowledge can be protected
for the benefit of mankind in general and in particular the communities in question. However,there are no policies in place for such protection. Also, the individual healers do not appear
to be aware of the need to protect their traditional knowledge.

2. Key Messages
Lack of policies that address and regulate the practice of traditional medicine puts both thetraditional healers and their patients at risk of exploitation. Such vital information has been‘pirated’ and, in certain cases, exploited elsewhere. The country should not loose important
knowledge on traditional medicine to other countries through the ignorance of her people.
Proper policies and regulation of the traditional healers would complement the government in
the provision of mental health services to the people and the reduction of stigma associatedwith mental illness, and hence, has this population contributing to the development of thecountry.
The policy questions to be addressed are:
1. Whether traditional medicine is practiced in urban cosmopolitan informal settlements ofKibera, Kangemi and Kawangware in modern Kenya?
2. Whether the traditional healers in Kibera, Kangemi and Kawangware are consulted bypeople suffering from mental illnesses?
3. Whether the consulted traditional healers treat mental illnesses and if they are able toidentify the different types of mental disorders?
4. How the traditional healers identify the types of mental illnesses that they treat and how
valid are the identified mental illnesses according to Diagnostic and Statistical Manual ofMental Disorders, 4th Edition (DSM-IV)?
5. Whether the traditional healers have any knowledge on patenting, benefit sharing andintellectual property
The study, having enrolled 59 traditional healers in the three study sites of Kibera, Kawangware
and Kangemi, found that the traditional healers are consulted. The patients are both men andwomen though the majority of the 305 patients were women.
The traditional healers are consulted for all types of diseases with the majority of the illnesses
being physical illnesses as per the diagnosis of the traditional healers. Of the 305 patients,
236 patients were given a diagnosis of physical illness. The traditional healers were able togive a diagnosis of 30 (9.8%) mental illness patients. Some patients were given a diagnosisof depression, while others had the diagnosis of being mad.
ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 387

The MINI-International Neuropsychiatric Interview (MINI - Plus) is a structured diagnostic
interview developed by Sheen DV et al 2 in 1998, it was used to assess the diagnoses ofpsychiatric conditions according to DSM-IV and ICD-10 criteria was administered to all thepatients of the traditional healers. A number of diagnoses were made, higher than what had
been diagnosed by the traditional healers. A few of the diagnoses were similar, indicating thelimitation of the traditional healers to make a proper diagnosis.
The traditional healers reported that they treated mental disorders using various methods,
for example, (i) Counselling- being the most popular method of treatment; (ii) Use of different
types of herbs which can be taken orally, others for washing while others are inhaled; (iii)
Combining herbal treatment with counselling; (iv) Consulting the spirit world including theancestors who then give instructions on how the patient should be treated; (v) moving to thepatients home to help him/her remove certain items which the TH claims have been used tobewitch the patient.
All the traditional healers had little, if any, knowledge on intellectual property. However, during
the capacity building on this particular area it became clear that they are wary of researchers
who want to find out about their methods of treatment. This is because they reported thatthose who have gone to them especially for the treatment of HIV/AIDS only used their findings
to advance themselves (stole their methods of treatments) but never acknowledged them.
They did not want to take any of their information to any government body. They said that
others will use them. They preferred to protect and retain this information within their families
by passing it down orally and through ancestral instructions to specific members of the family.

3. Conclusion and Policy Options
There is need to recognize the contribution of the traditional healers and through thisrecognition, their working environment and that of the patients will be improved. There will be
no loss of the traditional knowledge related to traditional healing as the traditional healers will
have known how to protect their information and how to share it out when necessary.
Policy options
The following are the policy options:
1. Though the government is aware that traditional healers exist, there is need for them
to be recognised formally. This recognition will help to streamline the operations of the
traditional healers and hence, protect the clients.
2. Empower the traditional healers on how to recognize the different types of mental illnesses.
This can include, showing them how to use simple tests which can be translated to theirmother tongues. They will therefore be able to screen at their level and in the processincrease referrals and improve on the mental health information system.
3. Strengthen their skills on interventional methods that do not require the use of drugs.
This would include individual therapy, family therapy and group therapy as they use
counselling to treat certain types of mental illnesses. Therapies have been shown to beeffective even when practised by lay people. This would go a long way in ensuring thesafety of the patients from getting certain herbs which could have serious side effects andalso ensure that human rights observance in relation to practices that may be harmful tothe patients.
4. Empower them on when and where to refer. This can only be possible if they arerecognised and appreciated rather than being shut out.
5. The government to make it easy for the traditional healers to register and practice in theopen.
6. There is need for the traditional healers to be engaged in constructive dialogue by bodies
that can fight for the interest of the traditional healers. These include but not limited to;
Kenya Medical Research Foundation, the various Universities, Kenya Industrial Property
Institute (KIPI). Through this kind of dialogue, the traditional healers would be educated
ATPS (2013):Traditional Healers and their Provision of Mental Health Services in Cosmopolitan Informal Settlements in Nairobi, Kenya, ATPS Technopolicy Brief No. 388on the need to have their herbs tested, the need to have their work protected using thelegal means and even the processes that are involved if collaborative research has totake place and the legal processes that are required. Through this, the traditional healers
are not exploited and neither is their knowledge used without their consent.
7. There is need for environmental conservation. This is because African medicinal plantresources may be doomed to extinction by overexploitation resulting from excessivecommercialization (unsustainable use of medicinal plants), habitat destruction andother natural and man-made destructive influences, unless energetic conservation
measures are taken to ensure their continued availability. This can be done through theestablishment of medicinal plant gardens and farms. The acquisition of large scales ofland required for cultivation can be a serious obstacle.
8. The government should domesticate the conventions that have been passed in the region
and customize them so that traditional knowledge can be protected. This will eliminate
the secrecy that surrounds the traditional healing and which is at risk of disappearing withthe death of the TH and the shunning of traditional medicine by the younger generation
as they go to schools. The instruments of protecting traditional knowledge and, hence,
medicine so that there can be benefit sharing and protection of the knowledge must
be developed and made simple for the TH to follow. Finally, the THs need to be given
information on the importance of sharing the information that they have with the rightpeople and bodies in order to avoid bio piracy and also get benefits if their methods oftreating are unique.

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ISBN: 978-9966-030-49-8