SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
April, 2017 - SUPPORT Summary of a systematic review | print this article |
Traditional healers are important healthcare providers in a number of societies for a variety of healthcare concerns, including sexually transmitted diseases (STDs) and HIV. However, some traditional healing practices are risk factors for HIV infection, such as male circumcision using unsterilized equipment. The provision of training for traditional healers about STDs, HIV and evidence based medicine is seen as a way to improve their knowledge, reduce risk behaviours, and improve acceptance of and collaboration with formal health services. Training could also increase referrals to the formal health services.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
Providing treatment and support for people living with HIV and AIDS places an enormous strain on healthcare systems, particularly in lowincome countries. The shortage of healthcare professionals, and the recognition of the importance of traditional healers as healthcare providers in certain societies, has led to efforts to improve collaboration between traditional healing and allopathic or evidence based medicine. Traditional healers are seen as trustworthy by many people because of their cultural and social familiarity, and because traditional healers are perceived as being more responsive to people’s spiritual concerns. However, some traditional healing practices are risk factors for HIV infection. Training traditional healers about STDs and HIV, or evidence based medicine in general, is seen as a possible way to further knowledge, reduce risk behaviours, and to increase their acceptance of and collaboration with formal health services.
| Review objectives: To evaluate the efficacy of interventions for educating traditional healers in the fundamentals of STDs and HIV medicine. | ||
| Type of | What the review authors searched for | What the review authors found |
|---|---|---|
| Study designs & interventions | Randomised trials, non randomised trials, and controlled before after studies of interventions aimed at educating traditional healers in STDs and HIV medicine. |
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| Participants | Traditional healers in any setting |
Traditional healers |
| Settings | Any setting in which traditional healers are practising |
South Africa (1 study in 2 urban and 2 rural communities in KwaZulu Natal Province) and Nepal (I study in 10 village development committee areas in a remote, rural region). |
| Outcomes |
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| Date of most recent search: November 2008 | ||
| Limitations: This is a well conducted systematic review with only minor limitations. | ||
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
Two studies were identified which assessed the impact of short training courses on HIV, STDs and other health issues for traditional healers. One study was performed in South Africa and one in Nepal. Both reported the impact of the training on STD and HIV knowledge, and on behaviour.
Short training course in allopathic, evidence based medicine versus no training |
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| People: Traditional healers. Settings: South Africa, Nepal. Intervention: Training course. Comparison: No training course. |
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| Outcomes | Impact | Certainty of the evidence (GRADE) |
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| Increase in knowledge about STDs and HIV |
Training traditional healers may increase their general knowledge about HIV/AIDS, knowledge about HIV/AIDS prevention and knowledge about HIV/AIDS signs and symptoms. |
Low
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| Change in behaviour |
One study showed that training traditional healers may improve their HIV/STD patient management practices but may lead to little or no difference in the incidence of HIV/AIDS risk behaviours among healers or in their self reported referral practices. A second study showed that traditional healers who have received training may refer patients to allopathic health more frequently if their traditional treatment fails. |
Low |
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| GRADE: GRADE Working Group grades of evidence (see above and last page) |
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| Findings | Interpretation* |
|---|---|
| APPLICABILITY | |
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Both of the included studies were conducted in low and middle income countries.
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Traditional healers are an integral part of certain societies but uncommon in others. In addition, the extent to which healers are integrated into allopathic healthcare systems differs widely between societies. Knowledge of where traditional healers are commonly used should guide efforts to engage with these groups and to offer them training in evidence based medicine.
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| EQUITY | |
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The studies provided little information regarding the differential effects of the interventions for the most disadvantaged populations.
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Where traditional healers work in poor or more remote communities, with poorer access to allopathic healthcare, training these healers about STDs and HIV might benefit these otherwise marginalised populations.
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| ECONOMIC CONSIDERATIONS | |
| The review did not include information on the absolute costs or cost effectiveness of the interventions. |
The resources needed to implement training for traditional healers will vary across settings, depending on the range and number of traditional healers in practice and where they are based.
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| MONITORING & EVALUATION | |
| The certainty of the evidence on the effects of educating traditional healers about STDs and HIV is low. |
The effectiveness of educating traditional healers about STDs and HIV should be further evaluated using rigorous designs.
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*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low income countries. For additional details about how these judgements were made see:www.supportsummaries.org/methods |
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Flint A, Payne J. Reconciling the irreconcilable? HIV/AIDS and the potential for middle ground between the traditional and biomedical healthcare sectors in South Africa. Forum for Development Studies. 2013; 40 (1): 47-68.
Lakshmi JK, Nambiar D, Narayan V, Sathyanarayana TN, Porter J, Sheikh K. Cultural consonance, constructions of science and co existence: a review of the integration of traditional, complementary and alternative medicine in lowand middle income countries. Health policy and planning. 2015;30(8):1067-77.
Mills E, Singh S, Wilson K, Peters E, Onia R, Kanfer, I. The challenges of involving traditional healers in HIV/AIDS care. International Journal of STD & AIDS. 2006;17: 360-363.
Wreford, J. Missing each other: Problems and potentials for collaborative efforts between biomedicine and traditional healers in South Africa in the time of AIDS. Social Dynamics. 2005; 31;2(55): 89.
Peter Steinmann, Swiss Tropical and Public Health Institute, Switzerland.
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Katherine Sorsdahl, Harriet Nabudere, Robert Basaza, Simon Goudie, and Hanna Bergman.
Sorsdahl K, Ipser JC, Stein DJ. Interventions for educating traditional healers about STD and HIV medicine. Cochrane Database of Systematic Reviews 2009, Issue 4. Art. No.: CD007190.
Steinmann P. Do interventions for educating traditional healers about STDs and HIV improve their knowledge and behaviour? A SUPPORT Summary of a systematic review. April 2017. www.supportsummaries.org
evidence-informed health policy, evidence based, systematic review, health systems research, health care, low and middle income countries, developing countries, primary health care, education, HIV, medicine, traditional healer, traditional medicine, training.
