Integrating traditional healers into the emergency care continuum in Uganda: a missed opportunity?

Abstract

Traditional healing systems remain central to healthcare delivery in many low- and middle-income countries, including Uganda, where they are deeply embedded within community health-seeking practices. At the same time, Uganda continues to face significant challenges in developing an effective and coordinated emergency care system, with delays in accessing timely care contributing to preventable morbidity and mortality. Traditional healers are frequently the first point of contact for patients, including those with acute and potentially life-threatening conditions. Despite their accessibility and influence, they remain largely excluded from formal emergency care planning. This paper explores the potential for integrating traditional healers into Uganda's emergency care continuum by repositioning them as Tier-1 emergency care actors within community-based response systems. We propose a structured, systems oriented model that emphasizes basic emergency training in danger-sign recognition, clearly defined referral pathways, bidirectional collaboration with biomedical providers, and integration within existing health system frameworks. The model highlights the importance of governance, certification, monitoring, and pilot implementation to ensure feasibility and accountability.However, integration carries important risks, including misdiagnosis, delayed referral, harmful practices, and regulatory challenges. To address these concerns, the proposed approach emphasizes a limited scope of practice focused on early recognition and referral, supported by safeguards such as standardized training, supervision, and policy oversight.This conceptual framework aims to inform future research, pilot programs, and policy discussions on strengthening emergency care systems in Uganda and similar settings. With careful implementation, integrating traditional healers into Tier-1 emergency care structures may reduce delays, improve referral systems, and enhance patient outcomes.