Centre of African Studies, School of Social and Political Science, University of Edinburgh, 15a George Square, EH8 9LD Edinburgh, UK.
Department of Economics and Quantitative Methods, University of Westminster, 35 Marylebone Road, London NW1 5LS, UK.
Health Policy Plan. 2018 May 1;33(4):483-493. doi: 10.1093/heapol/czy002.
This study contributes to the health policy debate on medical systems integration by describing and analysing the interactions between health-care users, indigenous healers, and the biomedical public health system, in the so far rarely documented case of post-conflict Burundi. We adopt a mixed-methods approach combining (1) data from an existing survey on access to health-care, with 6,690 individuals, and (2) original interviews and focus groups conducted in 2014 with 121 respondents, including indigenous healers, biomedical staff, and health-care users. The findings reveal pluralistic patterns of health-care seeking behaviour, which are not primarily based on economic convenience or level of education. Indigenous healers' diagnosis is shown to revolve around the concept of 'enemy' and the need for protection against it. We suggest ways in which this category may intersect with the widespread experience of trauma following the civil conflict. Finally, we find that, while biomedical staff displays ambivalent attitudes towards healers, cross-referrals occasionally take place between healers and health centres. These findings are interpreted in light of the debate on health systems integration in Sub-Saharan Africa. In particular, we discuss policy options regarding healers' accreditation, technical training, management of cross-referrals as well as of herb-drug interactions; and we emphasise healers' psychological support role in helping communities deal with trauma. In this respect, we argue that the experience of conflict, and the experiences and conceptualizations of mental and physical illness, need to be taken into account when devising appropriate public or international health policy responses.
本研究通过描述和分析医疗保健使用者、本土治疗师以及生物医学公共卫生系统之间的相互作用，为医疗体系整合的健康政策辩论做出了贡献，而这在冲突后布隆迪这一案例中至今鲜少被记录。我们采用了一种混合方法，结合了（1）一项关于获得医疗保健机会的现有调查数据，该调查涵盖了 6690 人，以及（2）2014 年与 121 名受访者（包括本土治疗师、生物医学工作人员和医疗保健使用者）进行的原始访谈和焦点小组。研究结果揭示了多元化的医疗保健寻求行为模式，这些模式并非主要基于经济便利或教育水平。本土治疗师的诊断围绕着“敌人”的概念以及保护自己免受其侵害的需求展开。我们提出了这种类别可能与民间冲突后广泛经历的创伤相互交织的方式。最后，我们发现，尽管生物医学工作人员对治疗师持矛盾态度，但治疗师和医疗中心之间偶尔会进行交叉转诊。这些发现是在撒哈拉以南非洲卫生系统整合辩论的背景下进行解释的。特别是，我们讨论了关于治疗师认证、技术培训、交叉转诊管理以及草药与药物相互作用管理的政策选择；并强调了治疗师在帮助社区应对创伤方面的心理支持作用。在这方面，我们认为，在制定适当的公共或国际卫生政策应对措施时，需要考虑冲突经历以及身心疾病的经历和概念化。
