Promoting Collaboration Between Traditional and Modern Medicine Systems and Providers for Improved Delivery of Care and Services for Maternal and Child Care Programs in Rwanda

Session: Engaging Traditional Birth Attendants: What is Appropriate

Presenter: Didi Bertrand Farmer, Partners In Health/Inshuti u Buzima
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Background: In 2009, the Rwandan health system abolished the use of Traditional Birth attendants (TBA) and replaced them with a formal cadre of Community Health Workers (CHW) to address maternal and child mortality rates in pursuit of MDG goals 4 and 5. However, other Traditional Healers continue to play a critical role in primary health care delivery at the village level and often serve as a first entry point to the healthcare system.

Methodology: Partners in Health and the Rwandan Ministry of Health conducted a qualitative study in three rural districts between January-June 2013. Interviews and focus groups addressed community perceptions of traditional healing, interactions between traditional and biomedical health systems, and reasons for using traditional medicine.

Results: Traditional healers were described as an integral part of Rwandan culture and seen as offering unique treatments for a range of illnesses, including maternal and child health issues. They are sought out to cure infertility, ensure a pregnancy is not endangered by bewitchment from neighbors or family members, and induce labor. They assist women during delivery and ensure placenta removal following home-based childbirth. For illnesses affecting infants and children under five, their expertise covers coughs and pneumonia (Umusonga), diseases affecting the teeth (Ibyinyo), causes of fever, and watery stools (Uburo). Some women seek traditional treatment in secret before going to health facilities; this causes tension between traditional healers and CHWs, who encourage women to give birth at biomedical health facilities where they will receive skilled delivery assistance and postnatal care.

Conclusions: The reduction of maternal and child mortality requires a collaborative efforts of the traditional and biomedical health care systems. Achieving a partnership will help ensure that women and children receive timely and appropriate care for a range of illnesses, thus promoting community health and benefiting traditional and biomedical practitioners alike.