Dalglish Sarah L, Straubinger Sarah, Kavle Justine A, Gibson Lacey, Mbombeshayi Evariste, Anzolo Jimmy, Scott Kerry, Pacqué Michel
International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Maternal and Child Survival Program/PATH, Washington, DC, USA.
BMJ Glob Health. 2019 Jul 3;4(4):e001529. doi: 10.1136/bmjgh-2019-001529. eCollection 2019.
Recent years have seen increasing momentum towards task shifting of basic health services, including using community health workers (CHW) to diagnose and treat common childhood illnesses. Yet few studies have examined the role of traditional healers in meeting families' and communities' health needs and liaising with the formal health system. We examine these issues in Tshopo Province in the Democratic Republic of the Congo, a country with high rates of child mortality (104 deaths per 1000 live births). We conducted 127 in-depth interviews and eight focus group discussions with a range of community members (mothers, fathers and grandmothers of children under 5 years of age) and health providers (CHWs, traditional healers, doctors and nurses) on topics related to care seeking and case management for childhood illness and malnutrition, and analysed them iteratively using thematic content analysis. We find significant divergence between biomedical descriptions of child illness and concepts held by community members, who distinguished between local illnesses and so-called 'white man's diseases.' Traditional healers were far less costly and more geographically accessible to families than were biomedical health providers, and usually served as families' first recourse after home care. Services provided by traditional healers were also more comprehensive than services provided by CHWs, as the traditional medicine sphere recognised and encompassed care for 'modern' diseases (but not vice versa). Meanwhile, CHWs did not receive adequate training, supervision or supplies to provide child health services. Considering their accessibility, acceptability, affordability and ability to recognise all domains of illness (biomedical and spiritual), traditional healers can be seen as the de facto CHWs in Tshopo Province. National and international health policymakers should account for and involve this cadre of health workers when planning child health services and seeking to implement policies and programmes that genuinely engage with community health systems.
近年来，包括利用社区卫生工作者（CHW）诊断和治疗常见儿童疾病在内的基本卫生服务任务转移势头日益增强。然而，很少有研究探讨传统治疗师在满足家庭和社区健康需求以及与正规卫生系统联络方面的作用。我们在刚果民主共和国的北基伍省研究了这些问题，该国儿童死亡率很高（每1000例活产中有104例死亡）。我们与一系列社区成员（5岁以下儿童的母亲、父亲和祖母）以及卫生服务提供者（社区卫生工作者、传统治疗师、医生和护士）就儿童疾病和营养不良的就医和病例管理相关主题进行了127次深入访谈和8次焦点小组讨论，并使用主题内容分析法对其进行了反复分析。我们发现，儿童疾病的生物医学描述与社区成员所持概念之间存在重大差异，社区成员区分了当地疾病和所谓的“白人疾病”。与生物医学卫生服务提供者相比，传统治疗师的费用要低得多，而且家庭在地理位置上更容易找到，通常是家庭在家庭护理之后的首选。传统治疗师提供的服务也比社区卫生工作者提供的服务更全面，因为传统医学领域认可并涵盖了对“现代”疾病的治疗（反之则不然）。与此同时，社区卫生工作者没有得到提供儿童健康服务的充分培训、监督或物资供应。考虑到传统治疗师的可及性、可接受性、可负担性以及识别所有疾病领域（生物医学和精神方面）的能力，可以将其视为北基伍省事实上的社区卫生工作者。国家和国际卫生政策制定者在规划儿童健康服务以及寻求实施真正与社区卫生系统互动的政策和计划时，应考虑到这一卫生工作者群体并让其参与其中。
