So it is not true what they say – traditional healers are not as widely used after all

We have all heard it said that most of the African population makes heavy use of traditional healers alongside allopathic care. According to the WHO, “up to 80% of the population [of African member states] uses traditional medicine for primary health care.”[1] However, this idea has been challenged by Kate Wilkinson, who traced the roots of the claim.[2] She found that it has been copied from document to document from its origins in a 30 year old book available in the University of Witswatersrand library. The statement in the book is not referenced, so does the trail end there? Wilkinson turned to the South African General Household Survey, 2011,[3] and found that traditional healers were the least favoured healthcare provider, comprising first choice for only 0.1% of South Africans. Even allowing for respondent bias, this is not impressive! The South African DHS survey (n=8,115) found that only 2.6% of people reported receiving care from a traditional healer and 3.1% from a faith healer, versus 20.0% reporting contact with a public sector health faculty, and 15.2% reporting such contact with a private provider.[4] Likewise a 2008 survey of households in South Africa (n=4,762) found that only 1.2% of respondents reported using traditional healers,[5] with much lower utilisation rates than public sector clinics or hospitals. Reported use of traditional healers was higher among those of a lower socio-economic status (p<0.01), who were unemployed (p<0.01), lived in rural areas, were aged between 25-49 years and reported low health status (p<0.01), although these associations are not consistent across different countries.[6] [7]

In many traditional African belief systems mental health problems are perceived as being due to ancestors or bewitchment, and traditional healers are viewed as having more expertise in these areas.[8] Maybe consultation rates are higher in mental health? A 2011 cross-sectional survey of 2,514 adult Qatari/Arab expatriates residing in the State of Qatar found that nearly 40% of respondents believed that possession by evil spirits could be a reason for mental illness, and ~50% thought it could be a punishment from God (for comparison, ~80% believed it could be caused by brain disease; ~75% by stress; ~75% by genetic inheritance).[9] The study also found that approximately 40% believed that traditional healers could treat mental illness. Other reasons for preferring to see traditional healers included the psychosocial support afforded, their availability/accessibility, the flexibility in payment (including paying after treatment, in kind, in instalments, or payment being waivered).[10] [11] A 2003 study in Tanzania found that the prevalence of mental disorders among patients of traditional healer centres was approximately twice that of patients attending primary health care clinics.[6] Meanwhile a study in Eastern Uganda found that over 80% of patients diagnosed with psychosis used both biomedical and traditional healing systems, with those combining both seemingly having a better outcome.[12] A study by Sorsdahl et al.[8] looked at care for mental health disorders in South Africa using a national survey of 3,651 adults – only 9% of the respondents reported using traditional healers (and 11% reported consulting a religious/spiritualist advisor), the use of traditional healers was predicted by older age, black race, unemployment, lower education, and having an anxiety or substance-use disorder. A number of small studies have also been conducted in sub-Saharan African countries, which showed that 41-61% of individuals with mental illness were reported to have consulted a traditional healer.[13] [14]

It seems that use of traditional healers is declining in Africa – certainly in South Africa – but that they may have a larger role in mental health. This is a point we propose to investigate under CLAHRC International using the SAGE database.

— Richard Lilford, Director CLAHRC WM;

— Peter Chilton, Research Associate;

— Oyinlola Oyebode, Associate Professor in Public Health

References:

  1. World Health Organization. Traditional Medicine. Fact sheet No. 134. 2003.
  2. Wilkinson K. Do 80% of S. Africans regularly consult traditional healers? The claim is false. Africa Check. 2013.
  3. Statistics South Africa. South African General household survey, 2011. Pretoria: Statistics South Africa. 2012.
  4. MRC South Africa. South Africa Demographic and Health Survey, 2003. Part III. Pretoria: MRC South Africa. 2003.
  5. Nxumalo N, Alaba O, Harris B, Chersich M, Goudge J. Utilization of traditional healers in South Africa and costs to patients: Findings from a national household survey. J Pub Health Pol. 2011; 32 (s1): s124-36.
  6. Sorsdahl K, et al. Traditional healers in the treatment of common mental disorders in South Africa. J Nerv Ment Dis. 2009; 197(6): 434-41.
  7. Bener A, Ghuloum S. Gender differences in the knowledge, attitude and practice towards mental health illness in a rapidly developing Arab society. Int J Psych. 2011; 57(5): 480-6.
  8. Ae-Ngibise K, Cooper S, Adiibokah E, Akpalu B, Lund C, Doku V. ‘Whether you like it or not people with mental problems are going to go to them’: A qualitative exploration into the widespread use of traditional and faith healers in the provision of mental health care in Ghana. Int Rev Psychiatr. 2010, 22(6):558-67.
  9. Mbwayo AW, Ndetei DM, Mutiso V, Khasakhala LI. Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya. Afr J Psychiatry. 2013;16(2):134-40.
  10. Ngoma M, Prince M, Mann A. Common mental disorders among those attending primary health clinics and traditional healers in urban Tanzania. Br J Psych. 2003; 183: 349–355.
  11. Abbo C. Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Global Health Action. 2011; 4.
  12. Freeman M, Lee T, Vivian W. Evaluation of mental health services in the Orange Free State. Parktown, South Africa: Department of Community Health, University of the Witwatersrand Medical School. 1994.
  13. Ensink K, Robertson B. Patient and Family Experiences of Psychiatric Services and Indigenous Healers. Transcultural Psych. 1999;36(1):23–43.
  14. Patel V, Simunya E, Gwanzura F. The pathways to primary mental health care in high density suburbs in Harare, Zimbabwe. Soc Psych Psych Epid. 1997; 32: 97–103.
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2 thoughts on “So it is not true what they say – traditional healers are not as widely used after all”

  1. Working on HIV with gold-miners in the 1990s who were rural peasants doing unskilled labour in the most inhumane conditions a common comment in relation to STIs was: “We first go to the Western Doctor who takes away the symptoms and then go to the Traditional Healer who takes out the seeds of the illness.”

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