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 researchsuggests that healer shopping (going from one healer to another withoutreferral) 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 aswitchcraft and sorcery), the need for cures, and faith in the powers oftraditional religious healers. These beliefs can lead people to abandon modern medicineand search for spiritual cures.

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

The analysisidentified four kinds of illness practice: biomedical treatment of diabetesthrough drug and dietary management and changes to lifestyle; spiritual actionin response to the disease, including traditional religious healing, Christianfaith healing and Christian prayer; cure seeking, both intermittent andpersistent, the latter often driven by strong Christian faith; and medicalinaction (passive withdrawal from drug and dietary management). Findings suggestthat:

• Healer shopping is a secondarypractice in Ghana, co-existing with biomedical management, spiritualaction, and medical inaction.
• Belief in the spiritual causes ofchronic conditions is secondary to belief in biological and lifestylecauses.
• Wealthy urban people prefer to buytraditional drugs which have been scientifically approved.
• People on low incomes are unable toafford the high cost of prescribed drugs and recommended foods, andconsult traditional healers for cheaper medicines.
• Low income rural and urban groups aremore likely to use unregulated services.
• There is a lack of psychosocialsupport for people with diabetes, especially those on low incomes in bothurban and rural areas.
• People draw heavily on their Christianfaith in coping with the impact of diabetes and broader life circumstances.

The studyconcludes that in order to minimise inappropriate healer shopping, policymakersneed to focus on providing affordable drugs, including scientifically approvedtraditional drugs, and improving access to recommended foods for those on lowincomes. They also need to prioritise social support, and regulate faithhealing practices. Recommendations include:

• using the recently implementednational health insurance scheme to help those who can afford the premiums
• expanding the use of scientificallyapproved traditional drugs, combined with tighter regulation
• working with the agriculture and foodexport sectors to make recommended foods more affordable
• establishing self-help groups for peoplewith diabetes, especially those on low incomes, drawing on lessons learnedin Nkoranza
• giving more attention to Christian faithhealing practices in policy discussions and research, focusing on the roleof faith healers as providers of healthcare and psychosocial and spiritualsupport.