|Boateng et al. ||Ghana||In the year 2001, a council was instituted in Ghana to standardize the practice of TM in the country. In order to legalize this, a policy on the practice of TM was entrenched in 2005 to that effect.||2001||19||Patients at the orthodox medicine unit were not aware of the TM clinic in the hospital. Participants viewed the integrated health system in diverse ways.||Level of usage was low because there was no policy to regulate and publicize the integrated system.||Level of satisfaction among participants was varied, as views reported were contradictory, but perceived satisfaction was high.||Participants stated that the integrated system will be more acceptable if modern medical technologies such as research into efficacy, dosage, standardization, and laboratory services are properly introduced in TM practice.||“Not aware of operation of TM clinic. Some ailments require TM” (Client 2, orthodox unit); “Frequently, we become confused collaboration and integration. It is not entirely integrated” (key informant); “The flow of information is good. We have the prescribers’ assembly. They agree on what to be done. They make delivery on what has happened” (OMP 2).|
|Agbor and Naidoo ||Cameroon||In 1981, Cameroon formally recognised and integrated TM into the health system, but the recognition was not controlled by the MOH. In July 1995, a governmental declaration with the registration number (95-040) mandated traditional practitioners in Cameroon to form local and national associations to regulate the practice of TM.||1981||39||Patients perceive the integrated system as an orthodox health system tolerating traditional care. Therefore, knowledge on integration was low.||Usage of the integrated system is low because of inadequate scientific evaluation problems in TM practice.||Perceived satisfaction was high, but actual satisfaction was low, because the level of integration was low.||Low acceptance of practitioners within the system was because 71% had no professional education as most were trained through apprenticeships and only had primary education.|| |
|Agyei-Baffour et al. ||Ghana||Formulation of policy on TM practice in 2005. Creation of the TM Practice Council (TMPC) in 2007 and official TM integrated in 2012.||2005||15||42.2% of participants were aware of the existence of the herbal medicine unit in the study settings.||Usage was moderate, since 42.2% of participants used TM within the health facilities. Additionally,|
13% believed that a positive recommendation of TM within the integrated system may increase usage of the system.
|Participants were satisfied with the integrated system, as 53% of the respondents indicated that their preferences for TM had increased due to its operation within a hospital setting.||Acceptance of the integrated system was higher among participants with a high socio-economic status than those reported to have a low income.|| |
|Ahenkan et al. ||Ghana||The passing of the TM Act in 2000.||2000||20||Awareness of regulations governing TM practice was low as participants, especially TMPs, reported not having knowledge about rules and ethics governing their practice.||Level of usage was reported to be low, particularly among orthodox medicine practitioners, since they were unhappy about people seeking medical care from TMPs. OMPs were unprepared to prescribe TM to clients.||Scarcity of trained TMPs was reported among participants, which was seen to be a disincentive to the integrated system.||Level of acceptance was low among orthodox medicine practitioners due to the exclusion of TM in the medical school curriculum. However, acceptance was high among TMPs due to their positive attitude towards integration.||“I feel bad, especially when you have the ability to treat a disease but the client kind of seeks care from TMPs” (medical doctor)|
“Who will prescribe TM even if they are added in national drug list? If we’re to prescribe them, then they must be included in what we studied at medical school.” (medical doctor)
“Because I don’t have equipment to diagnose to know what really causes an ailment, normally I tell my patients to first go to the clinic to get examined, it makes my work easier.” (TMP)
|Appiah et al. ||Ghana||Inauguration of Bachelor of Science degree (BSc) in TM at Kwame Nkrumah University of Science and Technology (KNUST) in 2001. Creation of the TM Directorate in Ghana’s Ministry of Health in 2001. Health policy on the safe practice of TM in 2005. Establishment of TM units in selected hospitals in Ghana.||2001||19||Participants were aware of the existence of an integrated system and perceived it to be a step in the right direction, but they reported that administration of the integration procedure needed to be intensified.||Usage of the integrated health system was reported to be low since the national health cover did not embrace TM products and services.||Participants were displeased at the pace of the integration process. Satisfaction was low because participants felt the integrated system should be more efficient than it was at the time of the survey.||Acceptance of the integrated system was high among participants. This was because they recommended that the number of health facilities with TM units should be increased.||“There’s a need to introduce a good legislative procedure.” (Participant 2)|
“The government should accelerate TM units so that teaching, municipal and district health centres will have them” (Participant 7)
“Since the hospital board has not defined the exact role the TM unit are to play, TM services are financed by clients through cash and carry system”. (Participant 11)
|Awodele et al. ||Nigeria||In 1999, during an ECOWAS special health conference in Abuja Nigeria, the President of the Federal Republic put forth the TM development program and urged for its integration into the formal health system plan.||1999||21||Awareness was low because an intervention put in place to aid collaboration was not well-known among participants.||The lack of regulatory protocol to push the integration agenda has contributed to minimal usage of the system.||Low level of satisfaction due to inadequate support from policy makers.||64% of the participants were willing to succumb to regulations governing the integration process. This depicted a high acceptance among participants.|| |
|Campbell-Hall et al. ||South Africa||Approval of the Traditional Health Practitioner Bill||2003||17||Participants were aware of the existence of the integrated health system.||Usage of the system was moderate since participants were aware of the existence of the system and accessed both concurrently or one at a time.||Level of satisfaction was low. Client felt services offered by TMPs are not effective. OMPs also thought that the services offered by TMPs were interfering with their activities. A communication barrier was reported as a challenge to integration.||Acceptance was low among OMPs because they felt clients accessing both health care causes a challenge in the management of infirmities. TMPs were marginalized in the system, but they were willing to learn improved ways of offering care to clients.||“We started by accessing OM, then proceeded to TMP but utilising TM made the condition worse so stopped and returned to OM.” (client)|
“There is a rift in terms of coordination, interpretation, communication and method of offering health care to clients.” (OMP)
|Falisse et al. ||Burundi||Burundi rejuvenated TM practice in the 1980s by seeking UNDP’s support. At the same period, TMPs formed organisations and united with the government to create the Centre for Research and Promotion of TM in Burundi (CRPMT). From 2002 to 2004, an Integrative Medicine (IM) entity was created in the Burundi’s Ministry of Health (MOH) and it paved the way to the lawful practice of integrated health care.|
Finally, a declaration (number: 100/253/2014) made by government was circulated to guide the practice of IM.
|2002||18||91% of orthodox practitioners were aware of the integrated system.||Usage of the system was low because of lopsided power dynamics within the integrated health system.||Satisfaction was low due to poor credibility resulting from inadequate measures to get rid of quack TM practitioners and an unfriendly relationship between TMPs and churches.||Level of acceptance was low among orthodox practitioners as only 19% supported formal integration.|
Acceptance rate among health users was high as 93% supported integration.
|“A few days ago, we had twin brothers in the paediatric unit, their health was not improving and the parents asked whether they could take them to a TMP. Certainly, we disallowed. Hence, they ran away with the children.” (OMP 2)|
“Not long ago, the Catholic Church organised a parade led by a cross of Jesus, the aim was to wipe out healers and their practices. I am surprised. The priest-healer of Bururi, is he not Catholic? And is he not curing people himself?” (TMP 1)
“Presently, children go to school and they get taught that TM does not heal. And they have a bad image of AM. But they are wrong.” (TMP 1)
|Gyasi et al. ||Ghana||The MOH in partnership with the Ghana Federation of TMPs endorsed a strategic plan for the promotion of TM practice (2000–2004). The plan comprised the formation of a comprehensive training program in TM; in line with this strategy, the KNUST is presently running a BSc degree in TM. Again, the Centre for Scientific Research into Plant Medicine has been in operation since 1975 to promote TM practice.||2000||20||Study participants were aware of the existence of integration between the two health systems, but admitted that the system was not effective.||Patronage of integrated health services was low because of a weak referral system.||Satisfaction was low among orthodox practitioners due to inadequate credibility backing TM practice, whereas health care users were satisfied with the system.||Acceptance was high among health care users, but unpopular among TMPs and orthodox medicine practitioners.||“When I told a midwife that I have utilised TM to ease my morning sickness like extreme vomiting, she was upset with me, and ordered me to go and access care somewhere else. You see! One nurse also blamed me of not acting properly having used TM, meanwhile the TM was efficient.” (Health user 1)|
“I don’t refer my clients to the traditional healers and I don’t think it’s the right thing to do at the moment. This is because I can’t guarantee the quality of care they (the healers) will provide to the poor and the helpless patients. I know most of the healers depend on spirits, deities and witchcrafts which cannot be explained in the medical language I understand. If I don’t understand and also can’t be sure of the treatment outcomes of the patients, then there is no need to refer them to see a traditional healer for their problems.” (Health professional 1)
|Kaboru et al. ||Zambia||Institution of the Traditional Health Practitioners Association of Zambia||Not stated||-||Awareness was low, as 24% of participants reported of knowing and having experience with the integrated health system.||Usage was reported to be moderate among TMPs as 53% reported directing their clients to seek orthodox health care. The reverse was reported among OMPs, because only 4% recommended TM to clients.||Perceived satisfaction was high among TMPs since 97% perceived their practice to be important in the health system.||Perceived acceptance was reported to be high among participants as 77% of OMPs and 97% of TMPs thought there was the possibility for OMPs to learn from TMPs. On the other hand, 97% of OMPs and 90% of TMPs reported a likelihood to learn from OMPs.|| |
|Madiba ||Botswana||Enactment of the national health policy of Botswana stipulating the nature of integration through common grounds for learning and communication between the two health systems.||1995||25||Level of awareness was low, because merely 18.6% of participants knew about the existence of an integration policy. However, knowledge about client usage of TM was moderate, at 50%.||Usage of the system was recounted to be low since 90% of participants registered their unwillingness to refer clients to TMPs.||Satisfaction was also minimal because 70% of participants were not pleased with TM practice.||Acceptance of the integrated system was low due to skewed power relations, where OMPs felt their role in the system was superior and they were unprepared to welcome TM. About 73% of participants had at no time cooperated with TMPs. Likewise, only 6% of participants perceived TMPs as co-workers.|| |
|Maleluka and Ngoepe ||South Africa||The Government of South Africa enacted a law on Traditional Health Practitioners (THP) Act in 2007 to serve as the foundation of TM practice and promote integration. Another measure was the creation of the Institution of Traditional Health Practitioners Council of South|
Africa (THPCSA) to guide the activities of practitioners.
|2007||13||Both practitioners knew of the existence of the integrated system. This was evident in the interaction between healers and orthodox practitioners (training and referrals).||Level of usage was low as participants reported of referring clients to hospitals, but they did not receive referrals from hospitals.||Low satisfaction echoed in the views of participants as they claimed that integration was one-sided.||Level of acceptance was low as TMPs felt marginalized. Again, orthodox practitioners did not accept the activities of the healers.||“Integration is skewed because health facilities do not refer clients to us but we do refer clients to health centres.” (Respondent A)|
“After referring clients to hospitals nurses sometimes fight with both clients and TMPs enquiring why they (clients) consulted TMPs first instead of going to the hospitals.” (Respondent C)
“I had a rapport with our local health centre and we had challenges when it came to issues of payment.” (Respondent E)
|Nemutandani et al. ||South Africa||Dissemination of Traditional Health Practitioners Act (Number 22)||2007||13||Level of awareness among participants regarding the existence of the Traditional Health Practitioners Act was low.||Usage was low, because TM practice was perceived to compromise the standard of health that should be delivered to clients.||Satisfaction was reported to be low among participants as some were concerned about the level of medical knowledge of TMPs.||Acceptance was also recounted to be low among study participants.||“Does it mean that TMPs are health employees like us? What is happening? Yet, we were not once asked about the Act. How will it function?” (Medical services manager 3)|
“If TMPs are rightly educated, we will collaborate with them as treatment supporters. Won’t TMPs combine the treatment with medicinal plants?” (Physician 1)