Treating diabetes in Ghana: is there a role for traditional medicine?

Diabetes is a major cause of death and disability among adults in Ghana. Factors blamed include high medical costs, lack of drugs, and poorly financed diabetes services, as well as the inappropriate use of traditional medicine, in particular the practice of “healer shopping”.

Current research suggests that healer shopping (going from one healer to another without referral) is the first and most common response to chronic illness in Africa. It is driven by a belief in the spiritual causes of chronic illness (such as witchcraft and sorcery), the need for cures, and faith in the powers of traditional religious healers. These beliefs can lead people to abandon modern medicine and search for spiritual cures.

Researchers have concluded that inappropriate use of traditional medicine is undermining health care goals for the management of diabetes, including patients’ self-care. However, a study by Ama de-Graft Aikins (at the University of Cambridge) presents contradictory evidence, derived from an analysis of health care seeking behaviour among people with diabetes in Ghana. This analysis involved individual and group interviews and ethnographies conducted in two urban towns (Accra and Tema) and two rural towns (Nkoranza and Kintampo).

The analysis identified four kinds of illness practice: biomedical treatment of diabetes through drug and dietary management and changes to lifestyle; spiritual action in response to the disease, including traditional religious healing, Christian faith healing and Christian prayer; cure seeking, both intermittent and persistent, the latter often driven by strong Christian faith; and medical inaction (passive withdrawal from drug and dietary management). Findings suggest that:

• Healer shopping is a secondary practice in Ghana, co-existing with biomedical management, spiritual action, and medical inaction.
• Belief in the spiritual causes of chronic conditions is secondary to belief in biological and lifestyle causes.
• Wealthy urban people prefer to buy traditional drugs which have been scientifically approved.
• People on low incomes are unable to afford the high cost of prescribed drugs and recommended foods, and consult traditional healers for cheaper medicines.
• Low income rural and urban groups are more likely to use unregulated services.
• There is a lack of psychosocial support for people with diabetes, especially those on low incomes in both urban and rural areas.
• People draw heavily on their Christian faith in coping with the impact of diabetes and broader life circumstances.

The study concludes that in order to minimise inappropriate healer shopping, policymakers need to focus on providing affordable drugs, including scientifically approved traditional drugs, and improving access to recommended foods for those on low incomes. They also need to prioritise social support, and regulate faith healing practices. Recommendations include:

• using the recently implemented national health insurance scheme to help those who can afford the premiums
• expanding the use of scientifically approved traditional drugs, combined with tighter regulation
• working with the agriculture and food export sectors to make recommended foods more affordable
• establishing self-help groups for people with diabetes, especially those on low incomes, drawing on lessons learned in Nkoranza
• giving more attention to Christian faith healing practices in policy discussions and research, focusing on the role of faith healers as providers of healthcare and psychosocial and spiritual support.

Source(s):
'Healer shopping in Africa: new evidence from rural-urban qualitative study of Ghanaian diabetes experiences', British Medical Journal 331(737), by Ama de-Graft Aikins, 2005
HINARI subscribers can access the full-text article here. Full document.

Funded by: London School of Economics Financial Office; Paper written while author in receipt of an ESRC Postdoctoral Fellowship (PTA 026 27 0404)

id21 Research Highlight: 23 February 2006

Further Information:
Ama de-Graft Aikins
Department of Social and Developmental Psychology
Faculty of Social and Political Sciences
University of Cambridge
Cambridge CB2 3RQ
UK

Tel: +44 (0)1223 334526
Fax: +44 (0) 1223 334550
Contact the contributor: ada21@cam.ac.uk

Other related links:
Department of Social and Developmental Psychology, Faculty of Social and Political Sciences, University of Cambridge, UK

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