Indigenous medicine and biomedical health care in fragile settings: insights from Burundi

Abstract

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.

Effectiveness of Integrated Health Systems in Africa: A Systematic Review

“…Three studies (23.1%) were conducted in South Africa [ 25 , 26 , 27 ]. The remaining five studies were carried out in Burundi [ 28 ], Botswana [ 20 ], Cameroon [ 29 ], Nigeria [ 30 ], and Zambia [ 31 ]. The reviewed studies were conducted over a period of thirteen years.…”

“…Two of the qualitative studies used a phenomenology approach (qualitative research which emphasizes similarities in lived experiences within a specific group of people) to achieve the study objectives [ 22 , 27 ], while one study [ 12 ] used an inductive reduction approach. Ethnography (qualitative research in which the researcher defines and interprets common and learnt forms of behavior, values, beliefs, and language of a culture-sharing group) was employed as research design for the qualitative aspect of the mixed methods study [ 28 ]. However, three of the qualitative studies did not state the research design used [ 23 , 25 , 26 ].…”

“…As shown in Table 1 , four studies targeted health practitioners and patients as study participants [ 12 , 22 , 25 , 28 ]. Two studies only focused on health practitioners [ 24 , 31 ].…”

The relationship between Indigenous and allopathic health practitioners in Africa and its implications for collaboration: a qualitative synthesis

“…Indigenous health systems have been found to be more accessible (favourable practitioner-toservice user ratios and greater geographic access) [8,[40][41][42], more affordable (lower out-of-pocket expenses) [43], and provide more holistic care [40]. However, the most important reason for continued reliance on Indigenous medicine is its cultural relevance to the population it serves, making it capable of meeting their psychological and social needs [22,27], explaining why some people are prepared to travel further and pay higher fees to consult IHPs in spite of the availability of closer and less expensive allopathic services [39,[44][45][46].…”

Estrategias de inserción de chamanes inga y kamsá en las urbes medianas y pequeñas del altiplano cundiboyacense: una propuesta desde la categoría de medicina indígena empaquetada

“…Esta es una posición que ha sido influenciada por las políticas diferenciadas que han llegado desde afuera del país y que tienen alcances globales. Varios intentos se han dado alrededor del mundo en donde las políticas globales inciden en las locales en este tema (27). Políticas o recomendaciones, como las de la Organización Mundial de la Salud (oms), en cuanto al reconocimiento de 'lo indígena' como algo que se debe preservar y reconocer; esto no es más que un diálogo que no se da entre sistemas médicos (28,29).…”