**Plc,Research, and External Affairs**

# **Population, Health, and Nutrition**

# WPS 735

- This paper a pioduct of the Population, Health, and Nutrition Division, Population and Hutim;an Resources Departmcnt - is part of a large.' study undertauken by PRE on African health policy. Copies are availahie free from thc World Bank, 1818 11 Street NW, Washington, DC 20433. Plcase contact Olilia Nadora, rooml So-063, extension 31091.

A wide range of traditional healers is active in Africa, but information about their number and activities is scarce. There is growing recognition, however, tdat traditional practitioners provide accessible care, especially in rural Africa, and that they are a valuable resource which often should be incorporated into a country's health care system.

Survey data indicate that about 20 percent of Africans who seek medical care first consult traditional healers. Patients tend to consult modern health care services for infectious or acute diseases, or those for which modern health care has been shown to be highly effective. But patients tend to consult traditional practitioners for chronic diseases, for diseases related to psychological or social disruption or to reproductive systems, for diseases that are slow to respond to treatment or are caused by organisms that have become resistant to drugs, and for diseases deemed to be "magical" in origin. The prestige and credibility of traditional healers have been waning in the face of modernization and an increasingly educated public, but even so many highly educated people consult traditional practitioners. A survey in Ibadan of two groups -one educated elite, the other a traditional, less privileged group - found that roughly 70 percent _of both_ groups used traditional health care, particularly traditional drugs.

Governments have many policy options for traditional medicine. One would be simply to leave traditional health care alone, but that would mean not taking full advantage of the positive contributions traditional health care providers can make and not being able to regulate their activities in the interests of their clients. More active policy options open to governments include encouraging further professionalization through such means as licensing and establishing prof'essional associations, providing them with drugs and traininig themil in beticr tecihniques. In Tanzania, for examiiple, the government has developed a program to tIrain local cai(dvives in the delivery of some maternal and child healti services in areas with no moderin healtih care. In sonilc instances training programs ha reduced the incidence of neonatal tetanus.

There are several potential areas of cooperation and complementarity between traditional and modern health care woi kers. TIhe most obvious is working with traditional birth attendants trained as referral agents to provide safe prenatal and postnatal care and( to manage uncomplicated( dcliveries. Another is in the treatmient of psychosomatic and psychological illnesses. Traditional practitioners may also have a comparative advanitage in counscliling patients with terminal illnesses, such as AIL)S. Tradition;al practitioners might be employed as community health workers.

DeJong shows that traditional medicine is an i.nportant source of health care for signilicant numbers of Africans and that traditional hlealers, particularly those who wield authority within their commtilnities, are an implortant huliman resource for health care. Traditional healih care is unlikely to disappear, particularly i tdie quuality of anid access to modern health care service (1o not improve significandy. The boundaries between traditional and modern health care practitioners are beginning to blur, with the former adopting many ol the practices of the latter. The consequent competition between the two groups will likely necessitate health policies that address the entire spectrum of healdi care, traditional and modemr, and the rela tio(inship) between them.

Thc PRE Working Papcr Scries disseminatcs thc findings of vo,k under wiay in tde 13ak's l'olicy. Rcc.sarch, al)d Extcmal AffairsComplex. An objectiveofthcscrics is togettlhcsc indingsmoujtquickly,cven ifprecsntaitions are Icss tlhan fully 1 isie(i. Thc findings, interprctations, and conclusions in thcse papers do not necessarilTy TeprCsent Offi **i** al Blalnk p0liC).

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