Achieving the Millennium Development Goals

Combating HIV/AIDS

Experience of the Tanga AIDS Working Group

Summary

In Tanzania, The Tanga AIDS Working Group (TAWG) has one goal: to alleviate suffering from HIV/AIDS using indigenous knowledge (IK). The group has treated over 5000 AIDS patients with herbs prescribed by local healers. The impact has been most significant in alleviating the opportunistic diseases brought on by the AIDS virus. The patients who have responded most positively have lived longer, by up to five years. The Tanga regional hospital has allocated a floor to TAWG workers to enable them to test patients for HIV, treat them and provide counseling. They have also set up an information centre in town, which conducts active AIDS awareness campaigns and offers a support network to people living with AIDS. With support from the World Bank’s IK for Development Program, TAWG  has organized community-to-community exchanges, involving their healers, people living with AIDS and staff working with patients to provide medical care and alternative income generating opportunities, in exchanges of IK with other communities in Tanzania.

The Challenge

By end-2000, 36.1 million men, women and children were living with HIV/AIDS around the world and 21.8 million had died, according to UNAIDS. Sometime in early 2003, HIV infected its 50 millionth African. AIDS is now the primary cause of death in Africa and it has had a devastating impact on villages, communities and families across the continent.

In the early 1990s, annual deaths from AIDS were estimated at 20-30,000 or 5-7% of all deaths in Tanzania. A World Bank Country Study in 1997 estimated that by the year 2010, the number of HIV – infected people in Tanzania will reach 6-17% of the population.

Over 80% of Africans rely on traditional medicine in Africa. There are one hundred local healers for every modern health practitioner.  Healers use traditional medicine to treat a wide range of infectious diseases, from cancer to HIV/AIDS.

In the coastal region of Tanga in Tanzania, there are over 670 traditional healers. They use local medicinal plants to treat various ailments, including the opportunistic infections related to the AIDS virus. Healers are accessible, affordable and have credibility among the community.

As in most parts of Africa, traditional medicine remains a relatively untapped resource in the overall struggle against AIDS. Modern doctors, Ministries of Health and even National AIDS Commissions have paid little heed to the traditional health sector.

Traditional medicine in Africa is still perceived to be ‘voo-doo’ as it is not well documented or scientifically validated. For this reason, scientists continue to doubt the efficacy of time tested practices of traditional healers.

In order to successfully arrest the AIDS epidemic, it is crucial to bridge the yawning gap between traditional and modern health sectors. The Tanga AIDS Working Group is a success story that points to what can be acheived by leveraging traditional and modern knowledge systems  to help combat HIV/AIDS.

The Tanga AIDS Working Group

From 1992 to 1998, there were 4,792 cases of AIDS reported in the Tanga Region, which reflects the high infection rates in the region. The work of the Tanga AIDS Working Group (TAWG) is critical to areas such as Tanga where little if anything is offered for HIV prevention and care services.

TAWG was founded on a partnership between healers who had treatments for the opportunistic infections related to the AIDS virus and doctors dedicated to the welfare of their patients. With the collaboration of traditional healers, three efficacious herbal remedies were developed for the treatment of a variety of ailments commonly associated with HIV/AIDS.

A homecare service was initiated for HIV/AIDS patients and their families. This involved TAWG staff monitoring the general health of patients, administering the traditional medicines and providing counseling services. Homecare provides greater privacy and confidentiality to help overcome the stigma related to AIDS, compared to being in a open hospital environment. This has become the backbone of TAWG’s daily activities.

Through collaborating with modern doctors, TAWG acquired a floor in the Tanga Regional Hospital. In 1994, the organization became an officially registered NGO,  with the Regional AIDS Coordinator on its Board of Directors. Today, TAWG has become the referral center for patients who come to the hospital for testing, treatment, or counseling. This reflects a healthy partnership between the traditional and modern health sectors.

In order to help prevent the spread of the disease, TAWG set up a Community Health Information  and Care Centre (CHICC) located in the heart of the business district in downtown Tanga. The Centre is staffed by nurses trained as counselors and community educators. The Centre has books and pamphlets of AIDS, shows educational videos to the general public and conducts regular educational seminars with youth groups, health care workers, healers and people living with AIDS.

The CHICC helped set up a support group for HIV-positive people called SHDEPHA+ (Service Health and Development for people with HIV/AIDS). The group meets twice a week to share experiences, comfort each other, and discuss ways to live positively. They have recently begun to produce handicrafts as a means of generating alternative income.

Project Impact

An evaluation study on the Tanga AIDS Working Group conducted by  McMillen et al in 2000, suggests that the medicines administered by TAWG work. A number of patients have reported that the herbal medicines help to increase appetite and weight gain, stop diarrhea, reduce fever, eliminate oral thrush, resolve skin rashes and fungus, cure herpes zoster and clear ulcers. Most patients reported seeing results within 7-30 days of beginning treatment.

The study indicates that many patients have experienced significant improvement in the quality of life, as well as a longer life than could have been expected in the absence of these herbal medicines.  Patients have been reported to be able to return to their jobs with the help of the treatment, which in some cases has helped prolong lives by up to seven years.

Many of TAWG’s clients claim that traditional treatment was the only medicine that gave them results.  Most patients had already been treated with conventional biomedicines, with limited results. Many patients expected to improve with Western medicines, but did not, and have thus resorted to the herbal treatment offered by TAWG because it brings relief with few side effects. 

An often cited ‘side effect’ of traditional medicine treatment is increased appetite, which can be difficult if patients do not have enough food to eat!

TAWG has collected detailed anecdotal evidence from patients, documenting the extent to which the treatment is helping to improve their lives. TAWG has several clients like Mary:

“It was January 1999, when Mary came to visit her sister in Tanga. She hardly recognized her because Mary looked so thin and sick. She could not even walk. Mary remembers that she had skin rashes, oral thrush, diarrhea, high fever, cough and body aches.

The next day Mary was taken to the TAWG clinic at the Bombo regional hospital, where she was tested for AIDS. Mary was found to be HIV positive. The nurse consoled her and told her about TAWG’s  traditional medicines that help people live longer.

For the following months, Mary was attended to by TAWG’s homecare team. They monitored her condition, brought her medicines. They helped her sister understand more about AIDS and how to care for Mary. Three months later, Mary was able to go to TAWG’s office for check ups on her own. Her appetite returned, she regained her strength and was able to return to daily activities such as cooking, cleaning and fetching water.

Mary says that the herbal medicines are best at treating fungus, stomach problems, fevers and cough, especially when modern hospital medicines do not work. Mary has joined the support group SHDEPHA+ and says her fellow members help keep her spirits high.”

The holistic approach adopted by TAWG has benefited the entire community in Tanga. The healers for instance, have been trained as HIV/AIDS counselors, peer educators, condom distributors and better health care providers. They have a better understanding of HIV/AIDS, can sensitize communities and refer patients with complications that they cannot manage.

According to the Regional AIDS Control Coordinator, the Tanga AIDS Working Group is treating over 10% of all confirmed AIDS cases in the entire region. Modern medicine is also given to patients who visit TAWG, but not for free, unlike the herbal remedies.

Lessons Learned

Ø      A critical mass of complementary activities is needed to achieve maximum impact. TAWG has developed a holistic approach to the AIDS epidemic that goes full circle. This starts with the testing of patients, who once found to be HIV positive are provided with herbal treatment, counseling, home care, a support group for people living with the disease and through this network the means to seek alternative incomes. TAWG has also trained healers to distribute condoms and set up an information center to promote active AIDS awareness campaigns.  

Ø      TAWG built on existing infrastructure and local capacity including traditional knowledge systems. The traditional healers knowledge of local culture, values and their ability to connect the traditional and  modern practices was important to the project. Indeed the project started at the grassroots with the traditional knowledge held by the healers, and improved it by connecting them with the Tanga regional hospital and training them as counselors.

Ø     If healers are equipped with knowledge on how to identify HIV/AIDS, how it is contracted, spread and can be prevented, they can advise their patients and other community members.

Ø    The key to success is identifying knowledgeable healers and cultivating relationships with them. TAWG achieved this by treating the healers as professionals, allowing them access to the hospital and paying a fair price for their time and plants.

Ø      Leveraging traditional and modern knowledge systems can increase impact. For example, TAWG brought together traditional and modern health practitioners and inculcated mutual understanding and trust that has enhanced the effectiveness of HIV/AIDS treatment and prevention.

Ø     Success also depends on an NGOs knowledge of and integration into the communities with whom it works. The hard work of TAWGs caring and dedicated staff has enabled a trusting relationship to develop between clients, staff, traditional healers and community members.

Ø      Decentralization is probably the most critical precondition for success: decentralized medical services staff have more direct exposure and contact to traditional practitioners and can appreciate their strengths and limitations, can learn from them and address problems of charlatanry in cooperation with the serious practitioners.

Ø      Adequate public investment is a precondition to achieve decentralization; while cost sharing by patients increases sustainability of decentralized services, when addressing poverty, especially in rural areas even maintenance of decentralized health services may require transfers.

Ø      Sustaining the impact requires an assured flow of transfers to support project activities.  In the case of TAWG,  a number of donors including the World Bank have provided much needed resources to enable the NGO to continue and expand its activities to other parts of the country.

Ø     The work of groups such as TAWG are an example of how positive results can be achieved in the fight against AIDS by using local, culturally relevant expertise and resources to provide low-cost care and prevention for people living with AIDS.

Ø   In order to scale up and replicate best practices such as the Tanga AIDS Working Group, it is critical to provide technical and financial assistance to help validate the efficacy of the traditional treatments. This will help forge partnerships with the scientific community and ultimately lead to mainstreaming traditional medicine as a valuable resource to combat HIV/AIDS and other infectious diseases.

Replication and Scaling Up

The Tanga AIDS Working Group experience has clear potential for replication and scaling up. The generic lessons could be applied in other regions of Tanzania as well as in other countries.  However, it is important to keep in mind that any replication and or scaling up will have to adapt the basic approach to the local conditions. Such adaptation is critical to leveraging maximum impact.

The unique feature of the TAWG model is its holistic approach to tackling HIV/AIDS on several fronts: 

Efforts are underway to scale up TAWG’s experience to other parts of Tanzania and possibly other regions of Africa. For example, The World Bank Indigenous Knowledge for Development Program supported a community-to-community exchange of experiences between healers, people living with AIDS and staff working with patients with similar communities across the country.

The community exchanges were conducted in three seminars to exchange knowledge around themes associated with HIV/AIDS to improve the skills and knowledge base of all concerned. Thus, within the 3 regional communities (Tanga, Arusha, Moshi) there were 3 sub-communities, representing Traditional Healers, care givers and people living with HIV or AIDS, PLWHA. Each of these areas received special focus as the core theme of one of the seminars. For the Tanga seminar the focus was on the care givers. What are the issues in HIV/AIDS care? What are the problems? What are the special skills that are needed, for example in counseling? This was tackled from the perspectives of those who receive care and those who are primarily concerned with treatment, the Traditional Healers.

For the Moshi seminar the focus was on the traditional healers and the aim was to draw out as much information as possible from the participating healers. The healers described what medicines they are using, what infections they are treating and what sort of improvements the medicines bring about in their patients.

The focus for the third community exchange was on people living with HIV or AIDS, PLWHA, and the content covered a range of medical, psycho-social and legal issues, before moving towards the development of a framework for positive action by PLWHA themselves.

The seminars helped raise awareness about the work being done by TAWG among different communities in Tanzania. This led to the formation of a working group of practitioners, called TAKIA ( covering Tanga, Kilamanjaro and Arusha) to monitor downstream and follow-up activities. The group is implementing a strategy to establish and maintain linkages between traditional healers, homecare providers, PLWHA and hospital personnel. In addition, 21 plant remedies were collected by TAWG from Moshi and Arusha and some of these have been tested to establish efficacious agents and incorporated into TAWG’s treatment program.

The IK Program has also helped incorporate the TAWG model into the World Bank supported Multi-country HIV/AIDS Program for Africa (MAP).  In countries such Guinea, Ghana, Ethiopia and Burundi, traditional healers are being incorporated into national AIDS programs that have a country wide impact.

A critical challenge is to leverage local and global knowledge systems to effectively resolve development challenges. To facilitate this process, the IK Program brokered a partnership between the Tanga AIDS Working Group  and the US National Institutes of Health to cooperate on the scientific validation of the efficacy of these herbal treatments.

For further information on these activities contact Siddhartha Prakash (Email: Sprakash@worldbank.org, Phone: 1-202-473 5863).

Web Links: to reports on the Tanga AIDS Working Group:

BBC Report on TAWG

TAWGs Community Exchange Program

World Bank brokers partnership between TAWG and US-NIH

UN AIDS Report on TAWGs Best Practices