4 Traditional Medicine in Sub-Saharan Africa particularly in matrilineal societies. In addition, traditional practitioners are usually older, and therefore command respect. Traditional healers are also more willing than their modern sector counterparts to accept payment in kind or to agree to delayet. payment. Finally, traditional practitioners are far more accessible (Dunlop 1975).

12. Unlike their modern counterparts, traditional practitioners treat disease holistically. The patient's family, and even community, are often involved in treatment. Indeed, the traditional healer often plays a much wider social role than merely providing health care. As Staugard describes the situation in Botswana: "The traditional healer in the Tswana village--in common with healers in other parts of southern Africa--is not only a medicine man. He is also a religious consultant, a legal and political adviser, a police detective, a marriage counsellor and a social worker" (quoted in Last 1986). In this sense, traditional and modezn health care workers are not directly comparable. Hence, patients often do not perceive the services provided by the two traditions as substitutes for one another.

# _Traditional and Modern Health Care in Africa Today_

13. As noted earlier, reliable data on the numbers and practices of traditional practitioners are not available. Information obtained from surveys is thought to understate the importance of traditional medicine because respondents are reluctant to reveal to researchers from the modern sector the extent of their reliance on traditional care. In addition, health surveys fail to capture rare and seasonal events because they adopt short recall periods in order to increase the reliability of responses. To the extent that traditional healers are more likely to be used in managing unusual problems, this results in underestimation of the importance of traditional medicine.

14. Despite the data limitations, it seems clear that in most Sub-Saharan African countries, a substantial proportion of ill people consult traditional healers. Semali's survey of Kinondoni District in Tanzania, for example, found that, on average, 8,000 people out of a population of 300,000 saw traditional healers every day in the district (Semali 1986). Such a survey provides only a 'snapshot" of the numbers and activities of traditional healers and thus does not reveal trends in their numbers or in their use. Evidence on this issue is conflicting, however. There is some evidence that the number of traditional practitioners has declined in some rural areas with modernization and that in the face of an increasingly educated public, the power base and legitimacy of traditional healers has diminished. Many traditional practitioners are older. The declining prestige and credibility of traditional healers which has resulted from modernization is making recruitment of replacements difficult.

_15._ Data for 1977 for Nigeria, Ghana, and Tanzania (cited in Akin, _et. al._ 1985) indicate that ratios of traditional healers to population are lower than that of modern health care practitioners to the general population (see table 1). Few studies have examined the geographical distribution of traditional practitioners, or attempted to distinguish particular types of traditional practitioners (Anyinam 1987). A useful approach to quantifying traditional health care has proven to be to analyze patient health-seeking behavior for different illnesses and at different stages of illness episodes. One such study in the Meru District in Eastern Kenya (Mwabu 1986), found that only