Reaching the rural poor : indigenous health practitioners are there already

Because over 2.3 billion people worldwide continue to rely on traditional healers and midwives rather than utilize a system they neither understand nor trust, a sensible policy to improve rural health is to encourage and utilize the resources represented by indigenous health workers (IHW's). This paper examines the potential for incorporating IHW's into formal primary health care (PHC) systems to increase community acceptance and improve the utilization of PHC services. The author recommends a comprehensive evaluation of all past and present projects containing a traditional health component to assess the problems and benefits involved in working with IHW's. Several common objections to the use of IHW's and countervailing arguments are presented. The objections include the tendency to disparage low-cost PHC as "second-class medicine"; donor fears that indigenous PHC is dangerous or of inferior quality; and the hypothesis that traditional medicine competes with modern medicine for patients. Since IHW's provide excellent services in drug distribution, birth attendance, and care of the mentally ill, their services in these areas should be encouraged. Where formal collaboration with IHW's is not possible, emphasis should be placed on understanding and building upon the concepts which underlie traditional practices, thereby making modern innovations more acceptable. The author recommends that A.I.D. follow the World Health Organization's lead in adopting the following policy changes: (1) encourage and support programs which train and utilize IHW's; and (2) focus attention on traditional practices in training professional health workers and in PHC project designs. Specific program guidelines and recommended sector studies conclude the report. Annexes on information needs, a 1977 World Health Assembly resolution, recommendations of a congress sponsored by the Pan American Health Organization, and a 100-item bibliography (1962-79) are attached.