Traditional Healers can Heal the Mind, as well as Body

Mental healthcare is critical to physical health and overall wellbeing, yet it is seriously neglected around the world – and especially in poorer countries.

Often seen as a luxury for the wealthy or an indulgence for the weak, mental health services are often left at the bottom of any list of development priorities. Yet Professor Martin Prince of King’s College London in the United Kingdom found that an estimated 14 percent of the global burden of disease is due to neuropsychiatric disorders, mostly depression, alcohol- and substance-use disorders, and psychoses.

Since the contribution of mental disorders to physical illness is inadequately appreciated, the actual global burden of mental disorders is probably higher than this. Dr. Shekhar Saxena of the World Health Organization has reported that a scarcity of resources for mental health is compounded by inequities and inefficiencies in the delivery of mental healthcare.

As a result, people who need care get none. “The treatment gap – the proportion of those who need but do not receive care – is too high for some mental disorders,” Saxena said. As many as one in three people with schizophrenia and one in two with other mental disorders do not receive any treatment. The WHO has reported that the treatment gap for serious disorders is 76 percent to 85 percent for low- and middle-income countries. And the organization says shortages of healthcare professionals have been shown to be the main limiting factor in delivering mental healthcare in most low- and middle-income countries.

But an ingenious solution to this problem has emerged in the South American country of Ecuador. It involves turning to the traditional healers who are already well-established in communities. They are both cheaper and faster than waiting for medical psychiatrists to turn up in poor communities, and they can start right now to provide the support people need in a culturally tolerant way. Their effectiveness has been proven by Dr. Mario Incayawar, director of the Runajambi Institute for the Study of Quichua Culture and Health in Otavalo.

“Poor countries where you find numerous traditional healers could benefit the most,” he said.

In findings published in the prestigious British Journal of Psychiatry (The British Journal of Psychiatry (2008) 192: 390-391. doi: 10.1192/bjp.bp.107.046938), Incayawar found there are just 800 psychiatrists in Ecuador, and most live in the cities and speak Spanish. The native population on the other hand, mostly speak the local Quechua language and are served by only one psychiatrist, but thousands of traditional healers.

In the Andean mountain city of Otavalo, most people are descendents of the ancient Inca people. Health conditions are poor and far worse than in Spanish-speaking regions. Over 3 million of Ecuador’s 12 million residents speak Quechua, many of them living in indigenous communities high up in the mountains, bypassed by development. Roughly 90 percent of indigenous communities live below the poverty level, a fact reflected in high maternal and infant mortality rates. In some remote communities, maternal mortality reaches 250 deaths per 100,000 live births, compared to the national average of 130, and one in 10 infants does not live to see his or her first birthday.

For 5 million Indigenous people in Ecuador, for example, there is not one single mental professional paid to work within the Indigenous communities.

Traditional healers’ practices are widespread around the world, yet their diagnostic skills have rarely been investigated. Incayawar’s study found the yachactaitas (Quichua healers) in the Andes were able to identify cases of psychiatric illness in their communities. During the study over 18 months, 10 yachactaitas participated in the identification of 50 individuals with a condition. None of the participants was found to be healthy in biomedical or psychiatric terms when reviewed by psychiatrists. The results suggest yachactaitas can be an early warning system for identifying general psychiatric cases in their communities through their powers of observation.

“From the Quichua perspective, it is a matter of common sense,” said Incayawar. “We have a sizable number of traditional healers, why not promote their clinical skills for taking care of our communities.”

“Healers are paid in cash or by gifts such as a bag of potatoes, a basket of eggs, or a couple of chickens. The Quichua people are not familiar with psychiatrists or mental health professionals.”

He also sees a bright future for the role of the traditional healer: “Young people feel less threatened to pursue a career as a traditional healer. Currently, the trend points to an increase of traditional healers.”

In the future, Incayawar would like to see a happy co-habitation between the scientifically-trained psychiatrists, and the traditional healers: “We would like to see traditional healers working in a respectful partnership with biomedically trained mental health workers. The collaboration between equals … could be something to work on for the coming decade.”

By David South, Development Challenges, South-South Solutions

Published: August 2008

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Combating Counterfeit Drugs

Access to good quality drugs is a serious problem across the South. The International Narcotics Control Board estimates that up to 15 per cent of all drugs sold around the world are fake or counterfeit, and in parts of Africa and Asia this figure jumps to 50 per cent. The US Food and Drug Administration estimates counterfeit drugs make up 10 per cent of the global medicine market. The US Centre for Medicines in the Public Interest predicts counterfeit drug sales will reach US $75 billion globally in 2010, an increase of more than 90 per cent from 2005.

Fake drugs are a major cause of unnecessary death and destroy public confidence in medicines and health services. While counterfeit drugs have been on the rise, there is little co-ordinated or effective action to counter this menace afflicted on the sick.

But in Ghana, a solution has emerged that shows a way to guarantee that quality drugs get to the sick who need them. CareShop Ghana uses the franchise model – where licenses are sold to approved vendors who adhere to strict guidelines – to ensure that the quality, accessibility and affordability of essential medicines in and around Accra is guaranteed. CareShop has made deals with close to 300 franchisee pharmacies – often modest operations – who sell over-the-counter drugs.

In Ghana, preventable and curable illnesses like malaria and diarrhoeal diseases are among the leading causes of death. Their treatment pushes many people to financial despair; they can ill afford the extra burden of worrying about counterfeit drugs and the harm they do. Like many countries in the South, Ghana’s public healthcare system is unable to meet these needs and so most people turn to the private sector for help.

An estimated 65 per cent of people turn to licensed pharmacies. But many of these operate haphazard businesses, dispensing expired or counterfeit drugs.

The Ghana Social Marketing Foundation Enterprises Limited (GSMFEL) founded CareShop in 2002, hoping to battle common infectious diseases in poor areas by making sure good drugs get through to the sick.

GSMFEL makes a small profit as the franchisor by selling high-quality drugs to the franchisees. The key to CareShop’s success is imposing standardization on franchisees, so they have to stick to common diagnosis, quality and pricing. They make more money when they adhere to these rules than when they break them. To ensure there is no tampering with the drugs, they are delivered straight to the vendor’s doorsteps, and it is all backed up with health and business training support and branded materials.

The tide can be turned around on fake drugs: in 2002, the WHO reported that 70 per cent of drugs in Nigeria were fake or substandard: by 2004 that figure had fallen to 48 per cent.

Stimulating private sector solutions to African healthcare problems is now receiving an additional boost from a new fund established by the World Bank’s private sector arm, the International Finance Corporation. Launched in 2007, it offers cash and loans totalling US $500 million to commercial healthcare projects in Africa. According to its own statistics, 60 per cent of health expenditure in sub-Saharan Africa is privately funded, and the market, excluding South Africa, is worth US $19 billion.

By David South, Development Challenges, South-South Solutions

Published: May 2008

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Traditional Medicine is now a Proven Remedy

Once dismissed as old fashioned, ineffective and unscientific, traditional medicine is now seen as a key tool in bringing healthcare and healing to poor people bypassed by existing public and private health measures.

Acknowledging traditional medicine as a useful tool goes back to the World Health Organisation’s Alma-Ata Declaration in 1978, which urged governments for the first time to include traditional medicine in their primary health systems and recognise traditional medicine practitioners as health workers. During the last 30 years there has been a considerable expansion in the use of traditional medicine across the world. Despite their ancient origins, it is still critical these medicines do meet efficacy and health standards and are proven to work.

In Mongolia, when the Soviet Union collapsed a decade and a half ago, new market forces meant that supplies of conventional medicines became prohibitively expensive for most of the population. With one doctor for 600 people in the rural areas – and the vast distances to be covered – medical services were virtually unobtainable in rural communities.

This situation led to a revival of Mongolia’s 2,000-year-old traditional medicine. This includes acupuncture, cauterisation, manual therapy, blood letting and therapies using mares’ milk – all integral to the rural way of life.

Research by the Japanese Nippon Foundation – the largest private foundation in Japan – explored how Mongolia’s public health care could be improved through traditional medicine. It focused on the possible use of traditional medicine alongside Western medicine, the depth of faith in traditional medicine, the affordability of traditional medicine, and the lifestyles of herdsmen living in remote areas away from hospitals. The project, launched in 2004, distributes medical kits with 12 types of traditional medicines to households in rural areas. As they use them, the households pay for them. The kits, which mostly target stomach and intestinal ailments and fever, have so far been distributed to 10,000 households (50,000 people) across the country. The Foundation found doctors’ house calls were down by 25 per cent after one year of the project.

In India, Gram Mooligai and its Village Herbs label helps bring quality healthcare to the country’s 170 million rural poor currently left out by public healthcare programmes, or who can’t afford private services. At present, the Indian government has been unable to find adequate funds to provide healthcare to all its people. Gram Mooligai uses a network of 300 women health practitioners to reach villagers who spend on average US $50 a year on health services – so far, they reach 30,000 households. It has built trust with the poor by offering herbal remedies based on India’s strong Ayruvedic heritage of herbal healing. It also draws on India’s rich biodiversity by harvesting medicines sustainably from native plant species – over 18,000 are known.

The company is owned by a network of rural growers that manufacture herbal remedies like Trigul balm for joint pain, Sugam cough syrup and Jwaracin fever reducer. Gram Mooligai combines modern heathcare with local remedies familiar to rural villagers.

The website gives a good example of this folksy approach. In answer to a villager whose daughter is complaining of pain in her legs and back, the villager is advised to give her milk and ghee (clarified butter). “Add nuts and dry fruits to her daily diet in small quantity. If she is lean, then a weekly massage with Lakshadi Thailam (which is available in the Ayurvedic shops) is very useful. Slightly warm the oil before massage and add a pinch of common salt to the oil for better absorption.”

By David South, Development Challenges, South-South Solutions

Published: September 2007

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

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Safe Healthcare is Good Business and Good Health

 

Many people have been shocked by recent stories about the proliferation of counterfeit drugs and the rate at which they are killing and harming people in Nigeria. The International Narcotics Control Board found that up to 50 percent of medicines in developing countries are counterfeit. This has driven home the point that without the presence of legitimate players in the African drug market, the illegal sharks will step in to make large profits – and a literal killing.

To counter this negative trend, what is most needed is support for reliable Africa-based companies: businesses that are long-term, sustainable and not living from one grant to the next. But as experience has shown around the world, nurturing businesses requires certain fundamentals: they must work to be profitable, they must find a market and exploit it, and they need cash infusions that are timed to the company’s growth, not to the cycle of international donors. This role, often served in developed countries by venture capitalists, who want a fast return of 35 percent – is too onerous a burden for most African businesses. What African companies need is a more conservative, long-term approach; one that expects returns of between five and 10 percent.

Kenyan company Advanced Bio-Extracts (ABE) is one good example. Only 18 months old and based in Nairobi, the company produces one of a new generation of low-cost anti-malarials known as artemisinin-based combination therapies (ACTs). The drug is produced from the green leafy plant Artemisia, or sweet wormwood. The company is the first in Africa to make this drug, and employs 7,000 local farmers in Kenya, Tanzania and Uganda, as well as scientists.

ABE has received two infusions of cash from non-profit social venture capitalists Acumen, as well as investment from Swiss drug giant Novartis. Acumen has so far invested US $9.6 million in 11 active investments focused on a diverse set of health challenges, including basic healthcare access in rural areas and treatment for malaria and HIV/AIDS.

“We are commercializing a product that had never been commercialized,” said ABE’s owner, Doug Henfrey, to the New York Times. “Those little windows of support make these things happen. We could not have done it otherwise.”

Acumen’s Kenya country director, Nthenya Mule, said “there are positive things happening in Africa, but they are not happening overnight, and some are happening quietly. ABE is exemplary. You will not see it as front-page news, but in 18 months they set up a factory with 160 people interfacing with 7,000 farmers and supplying one of the major pharma companies in the world.”

Stimulating private sector solutions to African healthcare problems is receiving an additional boost from a new fund established by the World Bank’s private sector arm, the International Finance Corporation. To be launched later in 2007, it will offer cash and loans totaling US $500 million to commercial healthcare projects in Africa. According to its own statistics, 60 percent of health expenditure in sub-Saharan Africa is privately funded, and the market, excluding South Africa, is worth US $19 billion.

By David South, Development Challenges, South-South Solutions

Published: May 2007

Development Challenges, South-South Solutions was launched as an e-newsletter in 2006 by UNDP's South-South Cooperation Unit (now the United Nations Office for South-South Cooperation) based in New York, USA. It led on profiling the rise of the global South as an economic powerhouse and was one of the first regular publications to champion the global South's innovators, entrepreneurs, and pioneers. It tracked the key trends that are now so profoundly reshaping how development is seen and done. This includes the rapid take-up of mobile phones and information technology in the global South (as profiled in the first issue of magazine Southern Innovator), the move to becoming a majority urban world, a growing global innovator culture, and the plethora of solutions being developed in the global South to tackle its problems and improve living conditions and boost human development. The success of the e-newsletter led to the launch of the magazine Southern Innovator.  

Follow @SouthSouth1

Like this story? Here is a dirty secret: this website is packed with stories about global South innovators. We spent 7 years researching and documenting these stories around the world. We interviewed the innovators to learn from them and we visited them to see how they did it. Why not use the Search bar at the top and tap in a topic and see what stories come up? As for my work, I have been involved with start-ups and media ventures since the early 1990s. While most tech entrepreneurs were either still in their nappies in the 1990s (or just a drunken night away from being conceived in the 2000s), I was developing content for this new thing they called the "Internet". In the years since I have learned a great deal about innovation and digital and have shared these insights in the stories on this website as well as in the 5 issues of Southern Innovator magazine. So, stick around and read some more!    

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