When it comes to health data in developing nations, many of us are facing big, gaping holes – and I’m not referring to pit latrines. I’m talking about the lack of data reported on traditional healthcare services, which constitute a significant portion of healthcare provision around the world. According to the WHO, in some nations as much as 80% of the population primarily uses traditional health care. But we have very little data on these practices and few nations have national polices regarding traditional medicine. This makes it very difficult to monitor and evaluate traditional services. And without this data, there are certainly gaps in our health statistics.
As health researchers, we can all agree that we are missing something. But we may not agree on the solution. Governments and researchers have utilized a handful of methods to attempt to gather better data on traditional healthcare provision. The most notable methods include (1) training and/or regulating traditional healthcare providers, (2) the use of knowledge brokers, such as community health workers, to bridge data divides, and (3) the use of secondary source indicators to estimate data. As far as I can tell, no one has been hugely successful or inspired mass replication. So where does that leave us?
It leaves me wondering whether we should take a cue from Esther Duflo and Abhijit Banerjee, authors of Poor Economics. Duflo and Banerjee argue that individuals respond to incentives. Based on this theory, we need to assess the incentives of the “gatekeepers” of the missing data – a.k.a. the traditional healers. What incentives – or disincentives – might they have to cooperate with governments and researchers in their efforts to gather traditional health data?
The disincentives are obvious. There is long-standing dissonance between modern science and traditional healthcare. Over the years, scientists have accused traditional providers of harming patients with false information and ineffective treatments, among other things. Naturally, traditional healers have responded with anger and fear of de-legitimization. As the modern world grows more interested in traditional, alternative, and herbal-based healthcare methods, traditional providers have developed new fears of intellectual property theft. This is all to say that traditional healthcare providers have strong impediments to cooperation.
Certainly the incentives for cooperation are less obvious. But they do exist. And you get a glimpse of them when you visit the websites of various councils and organizations of traditional healers. These organized groups of practitioners state their objectives in no uncertain terms. They seek professional legitimacy and political support that cement their positions in society. This includes legal protections, professionalization, and national policies on traditional medicine. Assuming that the views expressed on these websites represent the general views of legitimate traditional healers (perhaps a big assumption), we can begin to understand the traditional healers’ individual and group incentives. This knowledge can help us imagine a framework that includes traditional health workers in data collection efforts.
Perhaps the key to gathering traditional health data is the creation of data collection processes that recognize traditional healers’ desires for legitimacy. In providing healers with paths to legitimacy, public health officials and researchers might achieve real collaboration – and finally fill those elusive data gaps. I’m not entirely sure what these new processes and “paths” should look like. What about you? Do you have a vision of this future or an alternative idea for addressing the data gap?
Rebecca Hornbach is a dual masters' candidate in Global Policy Studies and Public Health at The University of Texas at Austin.