Role of traditional healers in health and healthcare access: a multi stakeholder perspective from a tribal block of central India

Access to health care among tribes is a significant challenge. Traditional healers have acted as a major resource for healthcare provision since the earliest ages of humanity. Efforts to create an entry point through them require a detailed understanding of their role, beliefs, and treatment approaches. This study aimed to capture the role of traditional healers in improving access to health care and their practices from the perspectives of the community, health care providers and traditional healers. This study was part of an implementation research project aimed at improving access to healthcare among the tribal population in Maharashtra in 2021. In-depth interviews with traditional healers and health care providers were conducted by trained field assistants in participant’s homes and facilities. An interview guide with open-ended questions explored perceptions of disease, treatment approaches, reasons for preference and challenges in utilizing public health facilities. With consent, interviews were audio recorded, verbatim transcripts prepared, and three independent reviewers inductively coded the data, and emerging themes were identified. A total of 32 health care providers, 24 key informants, and nine traditional healers participated. All traditional healers interviewed were men aged 40–65 years with experience ranging from four to 35 years. Many practice a healing as a part-time job, attributed disease to black magic and lifestyle factors. Dietary restrictions, purgation, and topical herbal medicines were common treatment approaches. They claimed their role as the first point of contact for healthcare, a health guide, an escorting agent, and a link between the tribal Community and the health system. Round-the-clock availability, convenient time, affordability, and respectful attitudes were reasons they were preferred. Lack of awareness, economic vulnerability, preference for private services, and limited trust in the public health system were shared as reasons for poor utilization of services from public facilities. Health care providers viewed health seeking from traditional healers as illegal and a deterrent to timely care. With their close geographical and cultural association, and credible and affordable service provision, traditional healers can act as an entry point to improve health access among the tribal population and achieve universal health coverage.