Trust in the patient-provider relationship is a crucial aspect of providing good care. However, in areas with high levels of systemic poverty this trust is fragile and more challenging to establish. Additionally, many health systems in the Global South are vestiges of colonial health structures that served to support first and foremost the colonizers and not the native population – which also often jeopardizes trust till today. Beyond poverty and post-colonial structures, there are many other factors that can cause mistrust. As Universal Health Coverage (UHC) Day was celebrated earlier this week, it’s good to reiterate that lack of trust is a major barrier towards reaching UHC. Building this trust requires clever and deliberate strategies and policies to expand access and healthcare service utilization. One strategy to expand UHC is through integration of traditional healers into the modern science-based health care system in order to improve faith and trust in the system. In this short article I’ll focus on this pathway.

For those of us growing up with modern Western medicine, when we hear traditional healers or medicine often the immediate response is skepticism at best and complete disapproval at the worst. As someone interested in becoming a doctor in the United States throughout high school and university, I was one of those highly skeptical individuals. Then in my third year of my bachelors, my mindset changed while assisting on a qualitative study regarding traditional healers’ use of personal protective equipment for reducing the spread of HIV in South Africa. While analyzing the 30 interviews, many of the healers expressed an interest in conducting HIV testing and counseling or to refer patients suspected of HIV to the clinic. Dr. Carolyn Audet, my advisor at the time, has published these results describing how the healers believe that by conducting the testing themselves they could overcome issues related to HIV stigma, confidentiality at health facilities, and trust. Through the integration of traditional and modern medicine, healers could act as intermediaries between the community and clinics or hospitals.

Learning more about traditional healers really opened my eyes to the benefits they could have on a health system by increasing trust. Integration of traditional medicine and healers, if done well, would build faith through the mechanisms of decolonizing health systems, increasing cultural awareness, and improving access to care. For First-Nations communities in the Northwest Territories of Canada, for example, there is evidence of a desire for integration of traditional healing practices to counteract the historical silencing of their voices. Meanwhile, in a survey of Ethiopian healers and their patients, 65.4% of the patients had a positive attitude on efficacy, and 70% of the healers reported using history taking and physical symptoms for diagnosis and illness determinations. In Ghana, traditional healers fill in crucial primary healthcare (PHC) gaps. Approximately 80% of the Ghanian population rely on traditional healers for PHC due to a lack of formal care access, as well as influence of family, and religious/spiritual beliefs. As these studies begin to illustrate, traditional healers could be a valuable resource for health systems to overcome systemic barriers to healthcare access and utilization. Although potentially beneficial, healers should not act as a replacement for well-resourced and accessible primary health care, however, but rather as an integrated and additional resource in the system that patients can trust. 

For example, increasing integration of traditional healers could help reach the UNAIDS 95-95-95 goals for HIV (the goal to have at national level or globally, 95% of people with HIV diagnosed, 95% of those diagnosed on proper treatment, and 95% of those on treatment with viral suppression by 2030). Trust in the health system is cited as one of the major barriers to HIV diagnosis and treatment. Referrals from a traditional healer or even receiving their screening and counseling from their healer could greatly improve progress towards reaching this goal, certainly in some settings. As Dr. Audet’ s research illustrated, the healers have expressed a willingness and desire to act as the conduit for patients to get initial testing and referral to HIV care. Yet, having a successful and patient focused integration requires much more than just the willingness of healers.

The concept of integrating traditional healers into modern medical systems has been around since the Alma Ata conference in 1978, but efforts to successfully do so remain limited. In a renewed effort to integrate them, WHO established the new Global Centre for Traditional Medicine (March 2022). This global knowledge centre will be set up in Gujarat, India, and is a very promising effort. However, in order for  WHO’s efforts or any other programs for integration to be successful, it is critical to acknowledge the barriers and limitations of involving traditional healers into the biomedical health system. Some of the challenges are: a lack of knowledge on safety and efficacy of herbal medicine due to the lack of related research, difficulty of ensuring the same quality of treatment, potential interactions between herbal and drug medicine, and ensuring proper patient use. The power dynamics between modern medicine and traditional medicine are another barrier. Overcoming these and many other cultural, ethical and political barriers is going to require a clear and regulated evidence-based policy effort.

In sum, in many settings collaboration with traditional healers could be a valuable step towards decolonizing health systems and increasing patient participation in care by building trust between the general community, traditional medicine, and the formal healthcare system. In order to have successful integration policies and efforts, however, more research must be done on the efficacy of traditional medicines, countries need to formulate clear and tangible plans, and regulations or guidelines should be created for both the formal care sector and traditional healers to ensure the best safety for patients as the WHO Traditional Medicine Strategy 2014-2023 describes.