Can modern and traditional health providers work together in Zambia?

Zambia has a serious shortage of health care workers due to emigration, the low output of medical schools and the loss of many health workers to AIDS. The insufficient health workforce is jeopardising the country’s ability to control the HIV and AIDS epidemic. Can modern and traditional health providers work together on HIV and AIDS care?

According to theWorld Health Organization, the shortage of trained human resources is one ofthe biggest obstacles to the strengthening of health systems in low-incomecountries and to increasing their HIV and AIDS initiatives. The human resourcescrisis is particularly serious in sub-Saharan Africa, where 28 million peoplewere reportedly living with HIV in 2005. Caring for patients with HIV and AIDS,most of whom live in hard-to-reach rural areas orcrowded cities, is a huge challenge for African health care systems.

A significantproportion of Zambians use traditional health practitioners. According toUNAIDS, at least 60 percent of patients with sexually-transmitted infections (STIs) and HIV and AIDS seek their advice. Given theshortage of health care workers, it is hardly surprising that traditionalhealth providers are increasingly being seen as essential if care of peoplewith HIV and AIDS is to be scaled up. Historically, however, the relationshipbetween modern and traditional health providers has been plagued with tension,denial and mutual dislike.

This study,involving four universities and two non-governmental organisations, looked atthe experiences and attitudes of modern and traditional health providerstowards collaborating together in caring for patients with STIsand HIV and AIDS. It identified both obstacles and potential opportunities forcollaboration. Over 150 biomedical health providers (nurses, midwives,physicians and laboratory and environmental health technicians) and 144 traditionalhealth providers (herbalists, spiritualists, diviners and traditional birthattendants) were interviewed in two cities, Ndola andKabwe, in May and June 2003.

The study made thefollowing findings:

• There was little experience ofcollaboration between modern and traditional health providers.
• Most of the collaboration involved modernhealth providers training traditional health providers (mainly traditionalbirth attendants) on safe delivery.
• Collaboration between the two sectorson care of patients with STIs or HIV and AIDSwas less common.
• The two groups both overwhelminglyacknowledged the role that traditional health providers could play infighting HIV and AIDS.
• Both groups identified policy-levelobstacles to collaboration, namely legislation and logistics.
• Collaboration is also hindered byindividual modern health providers’ lack of trust in traditional healthproviders – yet as many as 40 percent of the former said they wereinterested in working more closely with the latter.

The study foundthat current interactions between modern and traditional health practitionerstended to be along old paternalistic lines, in which traditional healthpractitioners were taught by modern health practitioners. This approach isinappropriate in the context of Zambia’s AIDS crisis. It is thereforerecommended that:

• a broader framework toacknowledge all the relevant stakeholders as useful partners – and allowsfor the distribution of roles among them – in controlling HIV and AIDSneeds to be defined.
• the state must tacklethe problem of the stigmatisation and lack ofrecognition of traditional health providers
• there is an urgentneed to involve modern and traditional health providers, patients andother stakeholders in exploring ways in which effective strategies can beset up to deal with key HIV and AIDS care issues through improvedcollaboration.