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Integrated systems
There has been a global consciousness regarding the necessity to move away from exclusive, tolerant and inclusive systems and move towards integrated systems characterised by the amalgamation of all health care systems available in a society, for purposes of optimising health care for all. Such systems seem to be well implemented in Asian countries such as China and South Korea [25]. This system would be more relevant is SA, where a significant percentage of patients consult THPs.
The WHO refers to an integrative system, whereby THPs are officially recognised and incorporated into all areas of health care provision. This entails (i) including traditional medicine in the relevant country’s national drug policy; (ii) registering and regulating providers and products of traditional healing; (iii) providing access to THPs at both public and private hospitals and clinics; (iv) reimbursing treatment with traditional medicine under health insurance; (v) undertaking relevant research in traditional health practices; and (vi) making education in traditional healing available. Very few countries have been able to integrate traditional and western health care systems into a single national health care network. South Africa has not achieved that. The introduction of THPs Act, and the formation of Interim Traditional Health Council is a step in the right direction, albeit progress is very slow. To date, only the Democratic People’s Republic of Korea, China; the Republic of Korea and Vietnam have arguably attained an integrated health care system [25]. Selected initiatives in various countries aimed at integrating THPs and AHPs are discussed in section 2.5 of this chapter.
RECOGNITION OF THPs IN SOUTH AFRICA
It is well-documented that in developing countries, especially in rural areas (including that of South Africa), THPs operate in close proximity and in association with the communities to treat various diseases and ailments [32, 40, 49, 50]. Although traditional healing has its shortcomings, the World Health Organisation (WHO) recognised that THPs could be an answer, especially in dealing with psychosocial problems which are based on culture- specific worldviews. In a study conducted in Vhembe district, Bereda [49] confirmed that THPs were well established health care providers, utilizing plants, animals and mineral substances together with methods based on the social, cultural and religious background, as well as prevailing community knowledge, attitudes and beliefs for the physical, mental and social well-being of the community.
In 1978 the Declaration of Alma-Ata [84] on primary health care recommended, among others, that THPs be integrated into primary health care services in order to respond to the expressed health needs of communities. The WHO has since then repeatedly emphasised the necessity to ensure respect, recognition and collaboration among practitioners of the various health care systems concerned. Part of the call by WHO was heeded almost 40 years later in South Africa. Respect and collaboration seem to be posing a challenge, especially when it involves accepting and respecting traditional medicine as a health science which can work side by side with allopathic medicine [43]. It would appear that the legacy of colonialism, western cultures and exclusive defining of health sciences through the lens of allopathic medicine will persist for some time in South Africa. The promulgation of the THPs Act and the draft policy on African Traditional Medicine for South Africa, Notice No 906 of 2008, has been an important epoch in the history of the new democratic South Africa, whereby THPs are no longer viewed as “witches” in societies but part of health providers [73]. This THPs Act is an initial milestone in the development of indigenous health knowledge, the encouraging the interaction between AHPs and THPs. Prior to the THPs Act, the Witchcraft Suppression Act of 1957 was the only legislation which related to THPs, and it referred them as “witches” [93]. The THPs Act, commits to enhancing the quality and credibility of the traditional health system in South Africa through the execution of numerous objectives and functions, some of which are in line with international resolutions and frameworks promoting the development of training and research in traditional systems of medicine, such as the Alma-Ata Declaration [84] and the WHO Traditional Medicine Strategy and Plan of Action 2000-2005.
CHAPTER 1: INTRODUCTION AND BACKGROUND
1.1 Introduction
1.2 Background and rationale for the study
1.3 Research problem
1.4 Research question
1.5 Aim of the study
1.6 Objectives of the study
1.7 Paradigm perspective
1.8 Relevance of the study
1.9 Definition of terms
1.10 Research design and structure of the Thesis
1.11 An outline of the chapters
1.12 Summary
CHAPTER 2: LITERATURE REVIEW
2.1 Introduction
2.2 Health systems
2.3 Recognition of Traditional Health Practitioners in South Africa
2.5 Knowledge, beliefs and management practices of THPS
2.6 Collaboration Between Allopathic and Tradition Health Practitioners
2.7 Fighting the HIV/AIDS and TB pandemic together
2.8 The missing element: Decolonization of mind process
2.9 Summary
CHAPTER 3: RESEARCH DESIGN AND METHODS
3.1 Introduction
3.2 Pre-Phase I: Consultation with communities
3.3 Phase I: Knowledge, attitudes and practices of HIV/AIDS and TB
3.4 Phase II: Research design and methods
3.5 Ethical considerations
3.6 Measures to ensure trustworthiness of study
3.7 Limitations and challenges experienced
3.8 Summary
CHAPTER 4: PHASE 1:DISCUSSION OF THE FINDINGS
4.1 Introduction
4.2 Psychometric properties of the questionnaire
4.3 Presentation of the findings
4.4 Discussion of the findings
4.5 Summary
CHAPTER 5: PHASE TWO: DISCUSSIONS OF FINDINGS
5.1 Introduction
5.2 Research findings
5.3 Summary
CHAPTER 6: MODEL DEVELOPMENT AND DESCRIPTION
6.1 Introduction and background to a model development
6.2 Chilisa’s decolonization process
6.3 Research journey
6.4 Steps followed in developing the model
6.5 Graphic Representation of the model
6.7 Description of COHORT model
6.8 Summary
CHAPTER 7: FINDINGS, CONCLUSION, LIMITATION AND RECOMMENDATIONS
7.1 Introduction
7.2 Findings
7.3 Conclusion
7.4 Limitations and challenges
7.5 Recommenadations
REFERENCES
