Who are the real community health workers in Tshopo Province, Democratic Republic of the Congo?

In Tshopo Province, a region with high rates of child mortality and malnutrition, community health workers (CHWs) play a crucial role in providing health services. However, recent studies have highlighted the importance of traditional healers in meeting families' and communities' health needs. Traditional healers in Tshopo Province are often the first point of contact for families seeking care for their children. They provide affordable, socially acceptable care that is close to the home, and liaise with the formal health system via referrals. Traditional healers also treat many illnesses not recognized by the formal health system, including local illnesses and "white man's diseases." Their services are more comprehensive than those provided by CHWs, as they recognize and encompass care for both biomedical and spiritual illnesses. The study found that traditional healers are far less costly and more geographically accessible to families than biomedical health providers. They serve as families' first recourse after home care, and their services are often more acceptable to community members than those provided by CHWs. In contrast, CHWs did not receive adequate training, supervision, or supplies to provide child health services. The study's findings suggest that traditional healers can be seen as de facto CHWs in Tshopo Province. They are more effective in providing care for childhood illnesses and malnutrition, and are more acceptable to community members. Policymakers should engage with and consider this cadre of health workers when planning child health services and implementing policies and programs that genuinely engage with community health systems. The study's methodology involved conducting 127 in-depth interviews and eight focus group discussions with community members and health providers in Tshopo Province. The data were analyzed using thematic content analysis, which revealed significant divergence between biomedical descriptions of child illness and concepts held by community members. The study's findings have implications for the development of community health systems in the DRC and highlight the need for policymakers to engage with traditional healers and other informal providers. In the context of the DRC's high rates of child mortality and malnutrition, the study's findings suggest that traditional healers can play a critical role in improving child health outcomes. By engaging with traditional healers and other informal providers, policymakers can develop more effective community health systems that meet the needs of families and communities. This approach can help to improve access to health services, reduce child mortality and malnutrition, and promote more equitable and effective health systems. The study's findings also highlight the need for a more nuanced understanding of community health systems in the DRC. By recognizing the importance of traditional healers and other informal providers, policymakers can develop more effective strategies for engaging with community members and improving health outcomes. This approach can help to promote more equitable and effective health systems that meet the needs of families and communities. In conclusion, the study's findings suggest that traditional healers play a critical role in meeting families' and communities' health needs in Tshopo Province, DRC. Policymakers should engage with and consider this cadre of health workers when planning child health services and implementing policies and programs that genuinely engage with community health systems. By doing so, they can develop more effective community health systems that improve access to health services, reduce child mortality and malnutrition, and promote more equitable and effective health systems.