Traditional healers are the primary source of care for the socio-economically poor. Many rural people rely on traditional healers for a variety of health issues. It is not uncommon for people to seek treatment from local traditional healers before taking recourse to distant health facilities. In some cases, they may even bypass local health facilities to see distant healers. I remember a man from a rural neighbourhood who fell from a tree and broke his arm while cutting twigs for his goats. He went to see a distant healer. When I asked why he chose a vaidya over a hospital, he replied, “I barely had Rs1,200. How could I visit a hospital with so less money?”

At times, traditional healers serve as the last resort. An elderly man in a village recently recovered from what he called “black jaundice”. He elaborated, “I had pain in my stomach. I was not yellowish, and I had no idea about black jaundice. I consulted doctors from three different hospitals. The first two doctors gave medicines for gastritis and the last gave medicines for kidney disease. I was sceptical because I couldn’t see how a vaidya’s jadi-buti could cure what doctors’ medicine couldn’t. I took all the prescribed medicines but my condition did not improve. I was tired, weak and bedridden. One of my neighbours insisted on seeing a vaidya. I had little hope. My goodness, the decoction and powder given by the vaidya worked for me.”

Relevance of traditional healers

The healers, such as those mentioned above, practice herb-based medicine and are consulted for physical problems and specific conditions such as fracture, jaundice, joint pain, and stomach problems. Some practice spiritual healing and are consulted for spiritual, emotional, and psychosocial problems; others practice traditional midwifery and massage. The Department of Ayurveda and Alternative Medicine has classified traditional healers into three categories: (i) herbal healers, (ii) spiritual healers, and (iii) traditional midwives.

Traditional healers provide some form of health care to those who live in rural areas and are underserved by the official healthcare system. They have local acceptance and serve as an immediate source of care. Even in urban areas, traditional healers offer an affordable alternative to expensive healthcare options. They are much more accessible than the private practitioners. Unlike many private practitioners who are profit-oriented, healers are service-oriented. They see healing practice as sewa and are praised for their non-profit motive. Most of them do not charge money for their service and accept whatever is given out of happiness. They are often compensated with an amount required for the preparation of medicines. Furthermore, some healers address specific health needs that people may not be able to meet through official healthcare providers.

Official legitimacy

So far, 36 member states of the World Health Organisation (WHO) have regulated traditional healers. WHO recognises traditional healers, bonesetters, herbalists, and birth attendants as indigenous traditional medicine providers.

Nepal’s Department of Ayurveda and Alternative Medicine (DOAA) recognises traditional healers as paramparagat upacharak. Traditional healers represent the oral tradition of health knowledge. They lack formal education or institutional training and practice outside the boundary of official legitimacy. DOAA has recently drafted a registration standard called Paramparagat Upacharakko Suchikaran Mapdanda (Namuna Masyauda) to facilitate the registration of traditional healers at the local level. The Draft Standard defines paramparagat upacharak as “those who provide treatment at their home based on knowledge, skills, technology, and experience acquired from ancestral or gurukul traditions, examining patients to determine the cause, nature, and condition of the disease, and using or processing various herbs, minerals, and animal products found naturally at the local level.”

The Draft Standard recognises only those healers who treat specific diseases by using certain herbs or resources. These healers must have gained healing knowledge through at least 15 years of closeness to ancestors or gurus, who have adopted traditional healing as their main occupation. They must have a clear understanding of the cause and symptoms of the disease to be treated and in case of using herbs or materials, the healers should have a sound knowledge of the place and resource along with properties, functions, collection method and time, processing, storage, supply and usage. The healers are allowed to manufacture the medicine required for them to treat patients but are barred from using patent medicines manufactured by other companies. They are not allowed to advertise their services and products.

The Draft Standard is an important step toward legitimising traditional healers. However, the standard appears to be restrictive for most traditional healers who practice healing as a part-time service rather than their main occupation. Though the standard makes it mandatory to be registered to provide healthcare services, many healers will likely continue to serve as informal providers. The standard also appears to be restrictive to those who are not associated with ancestral or gurukul traditions of herbal healing.

Supporting traditional healers

Traditional healers should be recognised as paramparagat upacharak and provided with training, equipment, seeds, and saplings to set up home herbal gardens. They should be facilitated to form their associations at local, provincial, and national levels. These associations can be facilitated and supported to work as a self-regulatory body. An institution of traditional healers should be established to promote training and research activities. Some healers could be mobilised as Ayurveda health volunteers, similar to those Female Community Health Volunteers. Governments can and should plan activities to improve and ensure the safety, efficacy, and quality of services the traditional healers provide.

Modern health care for the rural poor is analogous to the fruit hanging over the sky, which neither falls to the ground nor can be caught by the poor. Rural people are deprived of both modern and traditional health care services. Traditional medicine such as Ayurveda, Homeopathy, and Naturopathy has not yet reached rural areas. What is available and accessible to rural people in the form of traditional medicine is the services provided by traditional healers. However, traditional healers lack legitimacy, and people have concerns over the erosion of local health traditions. Making health care services accessible to rural poor is important, but that should not come at the cost of local health traditions. It is also crucial to revitalise local health traditions, legitimise traditional healers and link them with the public healthcare system.