Govt resets relations with traditional healers

Some of the traditional medicine practitioners during a training session facilitated by the National Drug Authority (NDA). PHOTO| LILLIAN NANTUME

What you need to know:

  • Traditional healers (witchdoctors), whose practices are rooted in indigenous religious beliefs such as ancestral worship and sacrifices to spirits, are embedded in Uganda’s cultural fabric.

By the time the Ministry of Health declared an Ebola outbreak in Mubende District, Central Uganda, at the end of September 2022, an unknown number of residents had succumbed to what was initially reported as a “strange illness.”

Harriet Nabbanja, a resident of Kasaana LC1 B, in Mubende Municipality, told this publication that the residents thought that patients suffering from Ebola Virus Disease (EVD) had been bewitched.

“People believe in traditional healers, so, when this disease began killing people (sic), word spread that someone had failed to control the strong charms they had brought into the area. The affected families sought out traditional healers. Our people do not know about diseases (sic). So, when the government delays to inform them about a disease and how to avoid it, what do you expect? The government waited until the disease was fully in the community, then began sensitisation campaigns,” she said.  

Traditional healers (witchdoctors), whose practices are rooted in indigenous religious beliefs such as ancestral worship and sacrifices to spirits, are embedded in Uganda’s cultural fabric.

Joseph Ssemakula, the chief executive officer of Katonda Mulungi Project, which carries out social work among people living with HIV, says traditional healers believe ancestors and spirits have power over life and death and can cause sickness.

“They believe the spirits can create wealth or poverty. So, many people go to shrines in search of health and wealth. A traditional healer can claim to have the power to heal any disease on earth, including Ebola. People fear witchcraft so much that they are compelled to believe in it,” he says.

Similarly, traditional medicine practitioners, whose practices are rooted in the knowledge and dispensation of herbal mixtures to maintain health and prevent, diagnose and treat physical and mental illness, are very popular among Ugandans.

Jamil Mukwaya Lutaakome, the president of the National Herbalist Association, says there are similarities between traditional healers and traditional medicine practitioners but the communities in which both practise their trade cannot differentiate between them.

“While the aim of traditional healers is to summon ancestral spirits to avenge a client’s enemies, real or imagined, the role of the traditional medicine practitioner or herbalist is to maintain health and cure diseases. The similarity is that both use traditional medicine,” he says.

First choice

In the early 80s, at the start of the HIV/Aids pandemic, families turned to traditional healers to treat a disease they did not understand.

“A herbalist would make cuts on the patient’s skin and rub traditional medicine into their body. Then, he would use the same razor blade to make cuts on other family members and use the same finger – which had touched the blood of the patient – to rub the medicine into those cuts. The medicine was believed to protect the family from the ‘curse’ of the disease,” Ssemakula says.

Most of those family members got infected with HIV and this increased the people’s belief that the disease was caused by witchcraft.

The Ministry of Health (MOH) estimates that 60 percent of Ugandans consume herbal medicine.

Dr Francis Machambala, who was the team leader at the Mubende Ebola Treatment Centre, says communities trust traditional medicine practitioners because they have been dispensing herbal treatments for years.

“They are visible in the community and accessing them is easy. At some point during an epidemic, standard operating procedures kick in and medical staff have to receive patients while wearing protective gear. Herbalists do not wear this gear, so people believe this makes them more human. Besides, they have good customer care because they are not overworked like medical workers,” he says.

Moreover, herbal medicine is cheaper, with concoctions costing Shs 3,000 ($0.1) in rural areas and Shs 10,000 in urban areas ($2.7). Herbal medicine is also the first choice in rural communities because patients seeking treatment in conventional health facilities are often met with drug shortages in government hospitals and high treatment costs in private hospitals.

In addition, Uganda’s doctor-patient ratio is approximately 1:25,000, which means patients have to wait for hours to see a doctor.

Dr Richard Kabanda, the commissioner for health services in-charge of health promotion, education and health communication, says delayed communication during outbreaks is a challenge.  

“For instance, Covid-19 was a new disease and it took us 14 days to prepare the right content and cross-check with WHO and other credible scientific sources. But the recent Ebola outbreak was different because we had content that we had worked on during the 2018/2019 outbreak. So, immediately the recent outbreak was declared, we just picked that content and sent it out,” he says.

Communication gaps

However, Dr Kabanda notes that while they had content for different media, interpersonal communication with communities was not easy.

“In the first days, we only had engagements with the families which had the first cases. It took 14 days, from the day the outbreak was declared, for us to access resources to deploy teams for aggressive community engagements. Not all villages were reached by our teams although the local village health teams did a commendable job,” he says.

Dr Kabanda adds that the MoH is aware that the delay in communication might drive people to traditional healers. “We discovered that there are more than 600 traditional healers and herbalists in Mubende District alone. I just couldn’t believe it. They outnumber the health facilities we have in the district. This means people visit them often,” he says.

A month into the declaration of the Ebola outbreak, President Museveni asked traditional healers to let the government handle epidemics, ordering them to stop their activities.

However, health authorities are also adopting a different approach, with the government stepping up efforts to collaborate with traditional medicine practitioners in its health referral pathways.

“During the Ebola outbreak, the Ministry of Health, in conjunction with UNICEF, organised a programme to sensitise traditional healers and herbalists on pandemics and epidemics,” says Lutaakome, who is also a board member of the National Drug Authority (NDA).

“We trained 870 traditional healers from seven districts and discovered that they didn’t believe Ebola existed. They thought the declaration of an outbreak was a political scheme devised by the government to impoverish people through targeted lockdowns,” he adds.

Dr Kabanda says through the Stakeholders Engagement Plan, traditional healers in different sub-counties, at least in Mubende District, were engaged.

Ssemakula believes sensitising witch doctors and herbalists or temporarily banning their practices is not enough.

“These training efforts need to be decentralised and carried out by government-funded community-based organisations which are based in the specific areas where doctors and herbalists reside. This would build trust,” he says.

“Government should also consider facilitating these people to encourage them to refer patients to health centres,” he adds.

The government does not only deal with traditional medicine practitioners. NDA also regulates manufacturers of herbal medicine. In 2021, NDA issued Professional “Guidelines for Regulation of Local Traditional/Herbal Medicines for Human and Veterinary use in Uganda.”

Dr Micheal Mutyaba, the NDA manager for traditional and complementary medicine, says although there is no structured training programme for herbalists, in collaboration with the National Chemotherapeutic Research Institute and the Directorate of Industrial Training, NDA has developed a curriculum for occupational herbalists.

“Farmers who grow the herbs are trained at Level 1, processors of herbs at Level 2, and manufacturers at Level 3. We also inspect premises of people who manufacture herbal medicine and if we identify hygiene or drug mix gaps in their processes, we take them on study tours to other manufacturing premises which are in good condition,” he says.  

So far, the NDA has approved 250 herbal products to be sold in licensed drug outlets.

Challenges and way forward

In September 2019, President Museveni assented to the Traditional and Complementary Medicine Act 2019, which spells out the regulations and guidelines for herbal medicine in Uganda. Section Four of the Act calls for the setting up of a National Council of Traditional and Complementary Medicine Practitioners. The Act has not been operationalised due to a lack of funding.

“The lack of a regulatory framework is fueling masqueraders and charlatans in this sector because there is no Council that is responsible for registering, licensing and monitoring the activities of traditional medical practitioners,” Lutaakome says. 

Dr Mutyaba says another challenge lies in the weak enforcement of copyright laws, which makes it difficult for NDA to approve herbal medicine.

“Some herbalists have inherited their knowledge and they fear disclosing the formulas because of intellectual property rights. Also, lack of funding to set up central manufacturing facilities that herbalists can use is a challenge,” he says.

Continuous training and sensitisation efforts need to be carried out. For instance, the Ministry of Health and UNICEF only trained 870 traditional healers and herbalists from seven districts, yet Uganda has 135 districts.

Dr Kabanda says more engagements are in the offing, targeting traditional healers.

“We discovered that there are more than 600 traditional healers and herbalists in Mubende District alone. I just couldn’t believe it. They outnumber the health facilities we have in the district. This means people visit them often,” he says.
Mubende District has 51 health centres and one regional referral hospital.
 

Working with traditional medicine practitioners
A month into the declaration of the Ebola outbreak, President Yoweri Museveni asked traditional healers to let the government handle epidemics, ordering them to stop their activities.

However, health authorities are also adopting a different approach, with the government stepping up efforts to collaborate with traditional medicine practitioners in its health referral pathways.
“During the Ebola outbreak, the Ministry of Health, in conjunction with UNICEF, organised a programme to sensitise traditional healers and herbalists on pandemics and epidemics. We trained 870 traditional healers from seven districts and discovered that they didn’t believe Ebola existed.
“They thought the declaration of an outbreak was a political scheme devised by the government to impoverish people through targeted lockdowns,” says Lutaakome, who is also a board member of the National Drug Authority (NDA).
Tezira Bukirwa, a traditional healer who attended the training says her outlook towards ‘complicated diseases’ changed.
“I inherited this craft from my father, who also inherited it from his father. We are taught that we can cure any disease. But, after the training, I realised that some diseases are too dangerous to be treated in the shrine. So, in case of another outbreak, I will heed the government adverts. Now I know that not every disease is caused by witchcraft,” she says.

Dr Kabanda says through the Stakeholders Engagement Plan, traditional healers in different sub-counties, at least in Mubende District, were engaged.
“We did well during the Ebola outbreak, but we (MOH) need to improve our engagements with traditional healers for modern healthcare service delivery. I know people still visit them for treatment for malaria and other diseases. We recently launched the comprehensive health communication strategy for key stakeholders, who include witch doctors and herbalists,” he says.
Ssemakula believes sensitising witch doctors and herbalists or temporarily banning their practices is not enough.
“These training efforts need to be decentralised and carried out by government-funded community-based organisations which are based in the specific areas where witch doctors and herbalists reside. This would build trust. Government should also consider facilitating these people to encourage them to refer patients to health centres. Dispensing charms or portions is their job, so if they refer their clients to health centres, they are losing money. How do you then incentivise them to continue referring their clients?” he asks.
Nabbanja agrees, saying that as long as herbalists and witch doctors are not facilitated by the government, the training may be in vain.
“People in my family still visit witch doctors for any illness they do not understand. As long as it is not malaria or typhoid, the traditional healer is the first point of call. People have a mistrust of government information, so the onus is on the witch doctor to send them to health centres,” she says.
 The government does not only deal with traditional medicine practitioners. The National Drug Authority (NDA), also regulates manufacturers of herbal medicine. In 2021, NDA issued Professional “Guidelines for Regulation of Local Traditional/Herbal Medicines for Human and Veterinary use in Uganda.”
Dr Micheal Mutyaba, NDA’s Manager for Traditional and Complementary Medicine, says although there is no structured training programme for herbalists, NDA, in collaboration with the National Chemotherapeutic Research Institute and the Directorate of Industrial Training, has developed a curriculum for occupational herbalists.
“The first batch of trainees are graduating this week (last week) on three levels. Farmers who grow the herbs are trained at Level 1, processors of herbs at Level 2, and manufacturers at Level 3. We also inspect premises of people who manufacture herbal medicine and if we identify hygiene or drug mix gaps in their processes, we take them on study tours to other manufacturing premises which are in good condition,” he says.  
So far, the NDA has approved 250 herbal products to be sold in licensed drug outlets. One of these products is Covidex, which is used as a supportive treatment in the management of viral infections. Others include Kabuti and Kisakyamuzade cough syrups.
Challenges and way forward
In September 2019, President Museveni assented to the Traditional and Complementary Medicine Act 2019, which spells out the regulations and guidelines for herbal medicine in Uganda. Section Four of the Act calls for the setting up of a National Council of Traditional and Complementary Medicine Practitioners. The Act has not been operationalised due to a lack of funding.

“The lack of a regulatory framework is fueling masqueraders and charlatans in this sector because there is no Council that is responsible for registering, licensing and monitoring the activities of traditional medical practitioners,” Lutaakome says. 
Operationalising the Act will set clear referral pathways for herbalists who will be part of the healthcare system at the district level, reporting to district health officers. However, this would be a band-aid solution, when the ideal is to hire more health workers. If patients are referred to hospitals but do not get the services needed, they will return to the traditional healer.
Dr Mutyaba says another challenge lies in the weak enforcement of copyright laws, which makes it difficult for NDA to approve herbal medicine.
 “Some herbalists have inherited their knowledge and they fear disclosing the formulas because of intellectual property rights. Also, lack of funding to set up central manufacturing facilities that herbalists can use is a challenge,” he says.
Continuous training and sensitisation efforts need to be carried out. For instance, the Ministry of Health and UNICEF only trained 870 traditional healers and herbalists from seven districts, yet Uganda has 135 districts.
“Now that Uganda is Ebola-free, everybody is silent on the training. This training should be a countrywide exercise. I intend to write to the government about this,” says Lutaakome.

 In November 2021, one of the outstanding outcomes of these engagements was the huge turnout when the Buganda Kingdom called on its subjects to get vaccinated against Covid-19.

What other countries have done
Other African countries have warmed up to the idea that traditional medicine, backed with scientific methods can make a significant contribution to achieving universal health coverage.

For instance in Ghana, during the Covid-19 pandemic, researchers recommended herbal products that could boost immunity and embarked on testing and planned trials of other medicines. Also, there are now over 40 centres in districts and regional hospitals where medical herbalists work side by side with conventional medical workers.
To ensure increased access to affordable health services, Ghana’s government reimburses patients’ consultations with traditional health practitioners through an insurance scheme and is planning to do the same for the herbal medicines in its national essential medicines list.
Globally, the World Health Organisation (WHO) estimates that around 80 per cent of the world’s population uses traditional medicine to meet their primary healthcare needs and that 40 per cent of approved pharmaceutical products in use today are derived from natural substances.
According to WHO, 170 of the 194 member states have reported the use of traditional medicine, and their governments have asked for WHO’s support in creating a body of reliable evidence and data on traditional medicine practices and products.
In March 2022, the WHO signed an agreement with the government of India to establish the Global Centre for Traditional Medicine to harness the potential of traditional medicine through modern science and technology, to improve the health of people and the planet.
As traditional medicine becomes increasingly prominent in the world of modern science Uganda is joining the quest to include it in the formal healthcare system.

This article was produced as part of the Aftershocks Data Fellowship (22-23) with support from the Africa Women’s Journalism Project (AWJP) in partnership with The ONE Campaign and the International Center for Journalists (ICFJ).