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  • Title: Traditional health practitioners as primary health care workers.
    Author: Hoff W.
    Journal: Trop Doct; 1997; 27 Suppl 1():52-5. PubMed ID: 9204727.
    Abstract:
    The author conducted a field study in 1993 to evaluate the effectiveness of four projects that were training traditional health practitioners (THPs) to provide primary health care (PHC) services in Ghana, Mexico, and Bangladesh. The study, funded by a grant from the World Health Organization, Division of Strengthening Health Services, concluded that incorporating trained THPs in PHC programmes can be cost effective in providing essential and culturally relevant health services to communities. The main objective of the study was to evaluate how effective the training projects were and to determine what impacts they might have upon the communities served. A qualitative field evaluation was performed using data collected from project documents, observations, and field interviews with a selection of health agency staff, THPs, and community members. A summary of results is presented from the four field studies. For details refer to the full report. This study examines the effectiveness of programs for training traditional health practitioners (THPs) as primary health care (PHC) workers in four projects in Ghana, Mexico, and Bangladesh in 1993. The objective was to prove that THPs could be incorporated into PHC programs and that clients would benefit from culturally relevant and essential health services. Qualitative data were collected on PHC provision by THPs after training, community satisfaction with THPs, changes in health behaviors after THPs provided services, and improvements in health conditions. Interviews were conducted among 152 health staff with different training backgrounds during 2-week visits at each site. Traditional birth attendants (TBAs) provided a variety of new services, which included, for instance, pre- and postnatal care, identification of high-risk conditions and referrals, cleanliness during delivery, delivery in a safe and sterile manner, and artificial respiration as needed. TBAs counseled on personal hygiene and sexuality, advised on nutrition and diet, and supplied iron tablets and vitamin E capsules. Herbalists, bonesetters, and spiritualists used clean water and hygienic practices in the storage of herbs, advised on hygiene and sanitation, promoted use of latrines and tubewells, and helped dispel superstitions. All community members were pleased with services received from THPs. Problems included the low level of literacy of THPs and the need to develop special training materials and methods. THPs did not have a good rapport with hospital physicians, but did have a rapport with other clinical and hospital staff. Training costs were low: $98 per healer and $40-95 per TBA. Statistical records of the health impact were only available for Ghana. Findings suggest, without baseline data, improvement in health, mortality, morbidity, and nutrition. Community health practices improved in all sites.
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