Are traditional healers the solution to the failures of primary health care in rural Nepal?

In the last two decades the great expansion of Primary Health Care (PHC) in the rural areas of developing countries has not been matched by significant improvements in health standards. Nepal is no exception. This study explores the view that some of these failures derive from the communication difficulties that exist between the rural health services and the client population. In other parts of the world traditional healers have been used as go-betweens to overcome these difficulties. In this study a group of 22 Traditional Medical Practitioners in a district of North Eastern Nepal were trained as TB and Leprosy referral agents. Ways of integrating them into existing rural health services were explored by discussion between themselves and local government health workers. Our results suggest that they are interested in participating in PHC delivery. Their specific task of referring patients proved more successful for leprosy than for TB. While their most important influence was a general effect of improving attendance at rural health facilities. This improved attendance is likely to be their chief success at raising health standards. By improving the communication between the health facilities and the people; the confidence of local people in PHC is raised, this brings more people into contact with the services and thereby raises health standards.