4 - Soins de santé primaires et médecine traditionnelle - à propos du développement des concepts de santé publique en Afrique *
Corresponding Author(s) : BICHMANN Wolfgang
Africa Development,
Vol. 5 No. 2 (1980): Africa Development
Abstract
* Une première version anglaise de cet article fut publiée dans Social Science and Medicine, Vol. 13 B, 1979, 175-182.
Traditional health care has received attention lately in connec tion with WHO's «Primary Health Care»—strategy. This article tries to outline the significance of traditional medicine for the care of African populations. Within each society, differently conceptualized medical systems coexist. As Unshuld showed with his theory of professiona lization, nowhere does there exist a successful and complete integration of different medical systems. In the African context, apart from different forms of collaboration, we find a deliberate subordination of traditional healers and their knowledge under the dominating concept of cosmopo litan medicine.
As Primary Health Care is thought to provide medical services accessible and acceptable to the local community, the author raises the question: why have there been real efforts to improve health services for rural populations on a nation-wide scale only in the seventies, although evidence has existed for more than ten years? The author advances the hypothesis that the economic function of a traditional rural sector in the reproduction of the labour force has been menaced by progressive degradation of living-standards there, and that the «basic needs»—development approach together with the Primary Health Care-strategy and the attempts at revaluation of traditional medicine, are aimed at preventing a collapse of the traditional rural sector. This would imply, that the emancipatory development approach, inherent in the original Primary Health Care strategy has been lost.
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- (1) Promotion of national health services relating to Primary Health Care. WHO Off. Ree. No. 226, Separate Printing, Geneva, 1976. Djukanovic V. Mach E. P. Alternative approaches to meeting basic health needs in develo ping countries. A joint WHO/UNICEF study. Geneva, 1975. Primary Health Care. A joint WHO/UNICEF report. Geneva and New York, 1978.
- (2) WHO Chronicle 32,425-430,1978.
- (3) Mahler H. Health care for all by the year 2000. WHO Chronicle 29,253-1975.
- (4) cf. Document AFR/RC22/8. In Long-term Health Planning for the African Region 1975-2000. WHO Regional Office for Africa, Brazzaville, 1974. AFR/PHA/133,8 October, 1974.
- (5) 30th World Health Assembly. WHO Chronicle 31, 270 1977. cf. Médecine Traditionnelle. L'Enfant en milieu tropical, No. 122, 1979. cf. Rifkin S. Public Health in China — is the experience relevant to other less developed countries? Soc. Sei. Med. 7,245-257,1973. cf. Rifkin S. andKaplinsky R. Health strategy and development planning: lessons from the People's Republic of China. /. Devel. Stu. 9,213-232,1972/73. (6) Pflanz fait une différenciation entre système profane, système semi-professionel et système professionel. cf. Pflanz, M. Gesundheitsverhalten. In: Der Kranke in der modernen Gesellschaft (Edited by Mitscherlich, A. et al.), pp. 283-289. Kiepenheuer & Witsch, Köln-Berlin (West) 1967.
- (7) Correspondant au «Système Médical Local», cf. Dunn F. L. Traditional Asian medicine and cosmopolitan medicine as adaptive systems. In Asian Medical Systems (Edited by Leslie C.),p. 133. University of California Press, Berkeley, 1977.
- (8) Unschuld P. U. Professionalisierung im Bereich der Medizin. Entwurf zu einer historisch-anthropologischen Studie. Saeculum 25,251—274,1974. Unschuld P. U. Professionalisierung und ihre Folgen. In Krankheit, heilung, Heilkunst (Edited by Schipperges H., Seidler E. & Unschuld P. U.), pp. 517-555. Alber, Freiburg/Br., 1978.
- (9) Dunn: «Systèmes Médicaux Régionaux», op.cit.
- (10) cf. Kleinman A. M. Toward a comparative study of medical systems: an integrated approach to the study of the relationship of medicine and culture. Sei., Med. Man 1,55-65,1973.
- (11) cf. Leslie C. Introduction. In Leslie C. (Ed.) op.cit., p. 2.
- (12) Riley J. N. Western medicine's attempt to become more scientific: examples from the United States and Thailand. Soc. Sei. Med. 11,551,1977.
- (13) Vyshlid J. Development of health services in the African region: a short historical review. In An Integrated Concept of Public Health Services in the African Region. AFRO Technical Papers No. 2, pp. 13-26. WHO Regional Office for Africa, Brazzaville, 1970. Bichmann W. Die Problematik der Gesundheitsplanung in Entwicklungsländern. Medical Thesis University of Heidelberg 1977. Lang, Frankfurt, p. 199,1979. (14) Faute de place il n'est pas possible de donner des exemples pour cette assertation ici. cf. aussi: Good, Hunter, Katz et Katz: The interface of dual sys tems of health care in the developing world: Towards health policy initiatives in Africa. Soc. Sei.&Med. 13 D, 146,1979.
- (15) Vysohlid J. op.cit., p. 17 Beck A. History of the British Medical Administra tion of East Africa 1900-1950. Cambridge, Mass., p. 200,1970. Coquery Vidrovich C. and Moniot H. L'Afrique Noire de 1800 à nos jours. PUF, Paris p. 169,1974.
- (16) cf. Bichmann W., Hartog R. and Schultz U. «Westliche» Medizin in Ländern der Dritten Welt am Beispiel Tanzania: Ein Trojanisches Pferd des Neo Kolonialismus. In Jahrbuch für Kritische Medizin, Vol. 2, pp. 170—192, 1977. Argument, Sonderband AS 17, Berlin (West), 1977.
- (17) Unschuld P. U. Western medicine and traditional healing systems: competi tion, cooperation or integration? Ethics Sei. Med. 3,5,1976. (18) Unschuld P. U. Medico-cultural conflicts in Asian settings. Soc. Sei. Med. 9, 307, 1975. Unschuld P. U. Professionalisierung und ihre Folgen, op.cit., p. 543, von Ferber C. Soziologie für Mediziner, pp. 3 and 40, Springer, Berlin 1978.
- (19) Schenda R. Das Verhalten des Patienten im Schnittpunkt professionalisierter und naiver Gesundheitsversorgung. In Handbuch der Sozialmedizin, Vol. III (Edited by Blohmke M., von Ferber C., Kisker K. and Schaefer H.), pp. 31— 45. Stuttgart, 1976. Unschuld P. U. Die konzeptuelle Uberformung der individuellen und kollektiven Erfahrung von Kranksein. In Schipperges H. et al. (Eds.), op.cit., p. 495.
- (20) Kleinman A. M., op.cit., p. 59. Becker-Pfleiderer B. Kranksein in fremden Kulturen. Medizin, Mensch, Gesellschaft 2,132,1977.
- (21) Unschuld P. U. Die konzeptuelle Uberformung..., op.cit., p. 501.
- (22) Bernauer U. Partizipation. Eine gesundheitspolitische Strategie in Latein amerika. Analyse ihrer Abläufe und Bedingungen am Beispiel Chile. Phil. Thesis, University of Freiburg/Br., p. 144,1977.
- (23) Shehu U. Health care in rural areas. AFRO Technical Papers No. 10, p. 29. WHO Regional Office for Africa, Brazzaville, 1975. Diesfeld H. J. Medizin in Entwicklungsländern. Deutsches Arzteblatt 73, 1118—1120 et 1178— 1181,1976.
- (24) cf. par exemple les références dans : Brandl, L. Arzte und Medizin in Afrika. Afrika—Verlag, Pfaffenhofen/Ilm, pp. 139—200,1966.
- (25) Brandl, L. A short history of ethnomedicine in tropical Africa. Ethnome dizinll, 198-210,1972/73.
- (26) Spencer, R. F. Embryology and obstetrics in preindustrial society. In:Landy D., (Ed.) Culture, disease, healing. Macmillan, New York - London, p. 297, 1977. cf. Imperato, P. J. African Folk Medicine. York Press, Baltimore, 1977, chapter 15.
- (27) cf. Brandl, L. Arzte und Medizin ..., op.cit., p. 73. aussi Weisz, J. R. East African medical attitudes. Soc. Sei. Med. 6, pp. 323-333,1972.
- (28) Fortes, M. Foreward, p. XIII. In Social Anthropology and Medicine (ed. Loudon, J. B.) Academic Press, London, 1976.
- (29) African Traditional Medicine. AFRO Technical Report Series No. 1, p. 15. WHO Regional Office for Africa, Brazzaville, 1976
- (30) Jahn Janheinz. Afrikanische Medizin. Mimeograph, Schloß Eschenau bei Heilbronn, n.d., p. 21. Lesson J. Social Science and Health Policy in pre industrial society. Int. J. Health Services 4, 434, 1974. Collomb H. Public health and psychiatry in Africa. In Biomedical Lectures 1970-71 series. AFRO Technical Papers No. 4, p. 64. WHO Regional Office for Africa, Brazzaville, 1972.
- (31) Jores A. Praktische Psychosomatik, p. 21. Huber, Bern, 1976.
- (32) Jahn J., op.cit. d'Almeida, T. L'Afrique et son médecin, p. 26. Editions Clé, Yaoundé1974.
- (33) Lambo T. A. The African mind in contemporary conflict. WHO Chronicle 25,343-353,1971. Lambo T. A. The village of Aro. In Medical Care in Developing Countries, Chap. 20 (Edited by King M.) Oxford University Press Nairobi, 1966. Collomb H. op.cit., pp. 61-70. Collomb H. Rencontre de deux systèmes de soins. A propos des thérapeutiques de maladies mentales en Afrique. Soc. Sei. Med. 1,623-633,1973.
- (34) Haaf E. Heilende Kirchen in Ghana. Curare 1, 73—84, 1978. cf. Little K. West African Urbanization, p. 37. Cambridge University Press, Cambridge 1966. cf. Lloyd T. C. Africa in Social Change, p. 245. Penguin, Harmonds worth, 1972.
- (35) Djukanovic V. and Mach E. P. op.cit., p. 93.
- (36) WHO/UNICEF : Primary Health Care (1978), op.cit., p. 10. cf. Newell K.W. Health Care development as an agent of change. WHO Chronicle 30,181— 187, 1976. On a pu assister à une réorientation vers les «besoins essentiels» dans les stratégies de développement en général : cf. Oldenbruch G. Zur Strategie der Erfüllung von Grundbedürfnissen. German Foundation for International Development. DSE, Bad Honnef, (DSE-Dok-Nr. 967 C), 1978. cf. also Schwefel D. Bedürfnis-orientierte Planung und Evaluierung. Deutsches Insti tut für Entwicklungspolitik, 1977. cf. Adeniyi-Jones O. Community involve ment: new approaches. WHO Chronicle 30,8-10,1976.
- (37) L'agent de santé communautaire. Guide d'action, guide de formation, guide d'adaptation. Edition expérimentale. OMS(WHO), Genève, 1977. Bryant J. H. Community health workers. The interface between communities and health care systems. WHO Chronicle 32, 144, 1978. Primary health care. AFRO Technical Report Series No. 3, p. 52. WHO Regional Office for Africa Brazzaville, 1977.
- (38) Velimirovic H. and B. The role of traditional birth attendants in health ser vices. Curare 1,85—96,1978. Nicolas D. D. et al. Attitudes and practices of traditional birth attendants in rural Ghana: implications for training in Africa. Bull. WHO 54, 346, 1976. Bayoumi A. The Training and activity of village midwives in the Sudan. Trop. Doct. 6,118-125,1976.
- (39) cf. Flahault D. The relationship between community health workers, the services and the community. WHO Chronicle 32,149-153,1978. (40) Traditional Medicine and its role in the development of health services in Africa. Document AFR/RC26/TD/1. WHO Regional Committee for Africa, 26th session, Kampala 8-15 September, 1976.
- (41) ibid., p. 2.
- (42) cf. Health manpower development. The problems of the health team. AFRO Technical Report Series No. 4, p. 7. WHO Regional Office for Africa, Brazzaville, 1977. cf. aussi: Traditional medicine and health services development in Africa. WHO Chronicle 30,512,1976.
- (43) cf. WHO: Traditional medicine and its role . . ., op.cit., p. 16. cf. Comité Consultatif Régional de la Recherche Médicale en Afrique. Rapport de la première session, p. 7. Document ICP RPD 001, AFR/MR/4. Brazzaville 15-18 Novembre 1976. cf. Phytopharmacopée et médecine traditionnelle. Envir. Afric. 20, Octobre 1978, Supplément : kviga mayele.
- (44) Dunlop D. W. Alternatives to «modern» health delivery systems in Africa: Public Policy issues of traditional health systems. Soc. Sei. Med. 9, 584, 1975.
- (45) cf. Good C. M. Traditional medicine: an agenda for medical geography. Soc. Sei. Med. 11,705-713,1977. cf. Foster G. Medical anthropology and inter national health planning. Soc. Sei. Med. 11, 535, 1977. cf. Good, Hunter, Katz, op. cit.
- (46) International Conference on Primary Health Care, Alma Ata, USSR, 6—12 September 1978. Report of the Regional Director for Africa. WHO, Document ICPHC/ALA/78.4 (1 April 1978), p. 4 and 10.
- (47) Unschuld P. U. Western medicine . . ., op.cit., Unschuld P. U. Professionalisierung und ihre Folgen ..., op.cit., p. 543.
- (48) Tsung-Yi Lin and Wegman M. E. Present status and future perspectives. In Public Health in the People's Republic of China (Edited by Wegman M. E. et al), p. 269. Josiah Macy Jr. Foundation, New York, 1973. Li Wang V. Training of the barefoot doctor in the People's Republic of China: from prevention to curative sector. Int. J. Hlth Serv. 5,475-488, 1975. cf. Kong ming New, P., Louie New, M. The Barefoot Doctors of China: Healers for all seasons. In: Landy, D. (ed.), op.cit., p. 503-510.
- (49) Unschuld, P. U. Western medicine ..., op.cit., p. 10.
- (50) Référence à la dichotomie chaud/froid chez les Songhai en Afrique occiden tale: cf. Bisilliat. Village diseases and bush diseases in Songhay: an essay in description and classification with a view to a typology, p. 560. In Loudon J. B. (Ed.), op.cit.
- (51) cf. Diesfeld H. J. Die Bedeutung des Dialogs zwischen Heilkunst und Völker kunde für die Gesundheitsplanung in Entwicklungsländern. In Ethnomedizin Beiträge zu einem Dialog zwischen Heilkunst und Völkerkunde (Edited by Rudnitzki G., Sehiefenhövel W. and Schröder, E.), pp. 7—12. Ethnologische Abhandlungen Nr. I.D. Kurth, Barmstedt, 1977.
- (52) Bhatia J. C. et al. Traditional healers and modem medicine. Soc. Sei. Med. 9, 19, 1975. cf. Landy, D. Role Adaptation: Traditional Curers under the impact of Western Medicine. In: Landy, D. (ed.) op.cit., p. 468—481.
- (53) WHO; L'agent de santé communautaire...,op.cit., p. 2.
- (54) Unschuld P. U. Konfliktanalyse in medizinischen Transfersituationen. In Rudnitzki G. et al. (Ed.), p. 83, op.cit.
- (55) Foster G. op.cit., p. 529.
- (56) cf. Nchinda T. C. Traditional and western medicine in Africa: collaboration or confrontation? Trop. Doct. 6, 134, 1976. cf. Morgan R. W. Migration as a factor in the acceptance of medical care. Soc. Sei. Med. 7, 865-873, 1973. cf. The promotion and development of traditional medicine. Report of a WHO Meeting. Tech. Rep. Ser. 622, WHO Geneva 1978, pp. 17—18. cf. Good, Hunter, Katz, op.cit., p. 146.
- (57) There is much evidence from Latin America, cf. Roemer M. I. Organizational issues relating to medical priorities in Latin America. Soc. Sei. Med. 9, 93-96,1975.
- (58) World Bank. Health Sector Policy Paper, Chap. 3, p. 61. Washington, D.C. March 1975.
- (59) cf. Navarro V. The underdevelopment of health or the health of under development: An analysis of the distribution of human health resources in Latin America. Int. H. Hlth Serv. 4,5-17,1974.
References
(1) Promotion of national health services relating to Primary Health Care. WHO Off. Ree. No. 226, Separate Printing, Geneva, 1976. Djukanovic V. Mach E. P. Alternative approaches to meeting basic health needs in develo ping countries. A joint WHO/UNICEF study. Geneva, 1975. Primary Health Care. A joint WHO/UNICEF report. Geneva and New York, 1978.
(2) WHO Chronicle 32,425-430,1978.
(3) Mahler H. Health care for all by the year 2000. WHO Chronicle 29,253-1975.
(4) cf. Document AFR/RC22/8. In Long-term Health Planning for the African Region 1975-2000. WHO Regional Office for Africa, Brazzaville, 1974. AFR/PHA/133,8 October, 1974.
(5) 30th World Health Assembly. WHO Chronicle 31, 270 1977. cf. Médecine Traditionnelle. L'Enfant en milieu tropical, No. 122, 1979. cf. Rifkin S. Public Health in China — is the experience relevant to other less developed countries? Soc. Sei. Med. 7,245-257,1973. cf. Rifkin S. andKaplinsky R. Health strategy and development planning: lessons from the People's Republic of China. /. Devel. Stu. 9,213-232,1972/73. (6) Pflanz fait une différenciation entre système profane, système semi-professionel et système professionel. cf. Pflanz, M. Gesundheitsverhalten. In: Der Kranke in der modernen Gesellschaft (Edited by Mitscherlich, A. et al.), pp. 283-289. Kiepenheuer & Witsch, Köln-Berlin (West) 1967.
(7) Correspondant au «Système Médical Local», cf. Dunn F. L. Traditional Asian medicine and cosmopolitan medicine as adaptive systems. In Asian Medical Systems (Edited by Leslie C.),p. 133. University of California Press, Berkeley, 1977.
(8) Unschuld P. U. Professionalisierung im Bereich der Medizin. Entwurf zu einer historisch-anthropologischen Studie. Saeculum 25,251—274,1974. Unschuld P. U. Professionalisierung und ihre Folgen. In Krankheit, heilung, Heilkunst (Edited by Schipperges H., Seidler E. & Unschuld P. U.), pp. 517-555. Alber, Freiburg/Br., 1978.
(9) Dunn: «Systèmes Médicaux Régionaux», op.cit.
(10) cf. Kleinman A. M. Toward a comparative study of medical systems: an integrated approach to the study of the relationship of medicine and culture. Sei., Med. Man 1,55-65,1973.
(11) cf. Leslie C. Introduction. In Leslie C. (Ed.) op.cit., p. 2.
(12) Riley J. N. Western medicine's attempt to become more scientific: examples from the United States and Thailand. Soc. Sei. Med. 11,551,1977.
(13) Vyshlid J. Development of health services in the African region: a short historical review. In An Integrated Concept of Public Health Services in the African Region. AFRO Technical Papers No. 2, pp. 13-26. WHO Regional Office for Africa, Brazzaville, 1970. Bichmann W. Die Problematik der Gesundheitsplanung in Entwicklungsländern. Medical Thesis University of Heidelberg 1977. Lang, Frankfurt, p. 199,1979. (14) Faute de place il n'est pas possible de donner des exemples pour cette assertation ici. cf. aussi: Good, Hunter, Katz et Katz: The interface of dual sys tems of health care in the developing world: Towards health policy initiatives in Africa. Soc. Sei.&Med. 13 D, 146,1979.
(15) Vysohlid J. op.cit., p. 17 Beck A. History of the British Medical Administra tion of East Africa 1900-1950. Cambridge, Mass., p. 200,1970. Coquery Vidrovich C. and Moniot H. L'Afrique Noire de 1800 à nos jours. PUF, Paris p. 169,1974.
(16) cf. Bichmann W., Hartog R. and Schultz U. «Westliche» Medizin in Ländern der Dritten Welt am Beispiel Tanzania: Ein Trojanisches Pferd des Neo Kolonialismus. In Jahrbuch für Kritische Medizin, Vol. 2, pp. 170—192, 1977. Argument, Sonderband AS 17, Berlin (West), 1977.
(17) Unschuld P. U. Western medicine and traditional healing systems: competi tion, cooperation or integration? Ethics Sei. Med. 3,5,1976. (18) Unschuld P. U. Medico-cultural conflicts in Asian settings. Soc. Sei. Med. 9, 307, 1975. Unschuld P. U. Professionalisierung und ihre Folgen, op.cit., p. 543, von Ferber C. Soziologie für Mediziner, pp. 3 and 40, Springer, Berlin 1978.
(19) Schenda R. Das Verhalten des Patienten im Schnittpunkt professionalisierter und naiver Gesundheitsversorgung. In Handbuch der Sozialmedizin, Vol. III (Edited by Blohmke M., von Ferber C., Kisker K. and Schaefer H.), pp. 31— 45. Stuttgart, 1976. Unschuld P. U. Die konzeptuelle Uberformung der individuellen und kollektiven Erfahrung von Kranksein. In Schipperges H. et al. (Eds.), op.cit., p. 495.
(20) Kleinman A. M., op.cit., p. 59. Becker-Pfleiderer B. Kranksein in fremden Kulturen. Medizin, Mensch, Gesellschaft 2,132,1977.
(21) Unschuld P. U. Die konzeptuelle Uberformung..., op.cit., p. 501.
(22) Bernauer U. Partizipation. Eine gesundheitspolitische Strategie in Latein amerika. Analyse ihrer Abläufe und Bedingungen am Beispiel Chile. Phil. Thesis, University of Freiburg/Br., p. 144,1977.
(23) Shehu U. Health care in rural areas. AFRO Technical Papers No. 10, p. 29. WHO Regional Office for Africa, Brazzaville, 1975. Diesfeld H. J. Medizin in Entwicklungsländern. Deutsches Arzteblatt 73, 1118—1120 et 1178— 1181,1976.
(24) cf. par exemple les références dans : Brandl, L. Arzte und Medizin in Afrika. Afrika—Verlag, Pfaffenhofen/Ilm, pp. 139—200,1966.
(25) Brandl, L. A short history of ethnomedicine in tropical Africa. Ethnome dizinll, 198-210,1972/73.
(26) Spencer, R. F. Embryology and obstetrics in preindustrial society. In:Landy D., (Ed.) Culture, disease, healing. Macmillan, New York - London, p. 297, 1977. cf. Imperato, P. J. African Folk Medicine. York Press, Baltimore, 1977, chapter 15.
(27) cf. Brandl, L. Arzte und Medizin ..., op.cit., p. 73. aussi Weisz, J. R. East African medical attitudes. Soc. Sei. Med. 6, pp. 323-333,1972.
(28) Fortes, M. Foreward, p. XIII. In Social Anthropology and Medicine (ed. Loudon, J. B.) Academic Press, London, 1976.
(29) African Traditional Medicine. AFRO Technical Report Series No. 1, p. 15. WHO Regional Office for Africa, Brazzaville, 1976
(30) Jahn Janheinz. Afrikanische Medizin. Mimeograph, Schloß Eschenau bei Heilbronn, n.d., p. 21. Lesson J. Social Science and Health Policy in pre industrial society. Int. J. Health Services 4, 434, 1974. Collomb H. Public health and psychiatry in Africa. In Biomedical Lectures 1970-71 series. AFRO Technical Papers No. 4, p. 64. WHO Regional Office for Africa, Brazzaville, 1972.
(31) Jores A. Praktische Psychosomatik, p. 21. Huber, Bern, 1976.
(32) Jahn J., op.cit. d'Almeida, T. L'Afrique et son médecin, p. 26. Editions Clé, Yaoundé1974.
(33) Lambo T. A. The African mind in contemporary conflict. WHO Chronicle 25,343-353,1971. Lambo T. A. The village of Aro. In Medical Care in Developing Countries, Chap. 20 (Edited by King M.) Oxford University Press Nairobi, 1966. Collomb H. op.cit., pp. 61-70. Collomb H. Rencontre de deux systèmes de soins. A propos des thérapeutiques de maladies mentales en Afrique. Soc. Sei. Med. 1,623-633,1973.
(34) Haaf E. Heilende Kirchen in Ghana. Curare 1, 73—84, 1978. cf. Little K. West African Urbanization, p. 37. Cambridge University Press, Cambridge 1966. cf. Lloyd T. C. Africa in Social Change, p. 245. Penguin, Harmonds worth, 1972.
(35) Djukanovic V. and Mach E. P. op.cit., p. 93.
(36) WHO/UNICEF : Primary Health Care (1978), op.cit., p. 10. cf. Newell K.W. Health Care development as an agent of change. WHO Chronicle 30,181— 187, 1976. On a pu assister à une réorientation vers les «besoins essentiels» dans les stratégies de développement en général : cf. Oldenbruch G. Zur Strategie der Erfüllung von Grundbedürfnissen. German Foundation for International Development. DSE, Bad Honnef, (DSE-Dok-Nr. 967 C), 1978. cf. also Schwefel D. Bedürfnis-orientierte Planung und Evaluierung. Deutsches Insti tut für Entwicklungspolitik, 1977. cf. Adeniyi-Jones O. Community involve ment: new approaches. WHO Chronicle 30,8-10,1976.
(37) L'agent de santé communautaire. Guide d'action, guide de formation, guide d'adaptation. Edition expérimentale. OMS(WHO), Genève, 1977. Bryant J. H. Community health workers. The interface between communities and health care systems. WHO Chronicle 32, 144, 1978. Primary health care. AFRO Technical Report Series No. 3, p. 52. WHO Regional Office for Africa Brazzaville, 1977.
(38) Velimirovic H. and B. The role of traditional birth attendants in health ser vices. Curare 1,85—96,1978. Nicolas D. D. et al. Attitudes and practices of traditional birth attendants in rural Ghana: implications for training in Africa. Bull. WHO 54, 346, 1976. Bayoumi A. The Training and activity of village midwives in the Sudan. Trop. Doct. 6,118-125,1976.
(39) cf. Flahault D. The relationship between community health workers, the services and the community. WHO Chronicle 32,149-153,1978. (40) Traditional Medicine and its role in the development of health services in Africa. Document AFR/RC26/TD/1. WHO Regional Committee for Africa, 26th session, Kampala 8-15 September, 1976.
(41) ibid., p. 2.
(42) cf. Health manpower development. The problems of the health team. AFRO Technical Report Series No. 4, p. 7. WHO Regional Office for Africa, Brazzaville, 1977. cf. aussi: Traditional medicine and health services development in Africa. WHO Chronicle 30,512,1976.
(43) cf. WHO: Traditional medicine and its role . . ., op.cit., p. 16. cf. Comité Consultatif Régional de la Recherche Médicale en Afrique. Rapport de la première session, p. 7. Document ICP RPD 001, AFR/MR/4. Brazzaville 15-18 Novembre 1976. cf. Phytopharmacopée et médecine traditionnelle. Envir. Afric. 20, Octobre 1978, Supplément : kviga mayele.
(44) Dunlop D. W. Alternatives to «modern» health delivery systems in Africa: Public Policy issues of traditional health systems. Soc. Sei. Med. 9, 584, 1975.
(45) cf. Good C. M. Traditional medicine: an agenda for medical geography. Soc. Sei. Med. 11,705-713,1977. cf. Foster G. Medical anthropology and inter national health planning. Soc. Sei. Med. 11, 535, 1977. cf. Good, Hunter, Katz, op. cit.
(46) International Conference on Primary Health Care, Alma Ata, USSR, 6—12 September 1978. Report of the Regional Director for Africa. WHO, Document ICPHC/ALA/78.4 (1 April 1978), p. 4 and 10.
(47) Unschuld P. U. Western medicine . . ., op.cit., Unschuld P. U. Professionalisierung und ihre Folgen ..., op.cit., p. 543.
(48) Tsung-Yi Lin and Wegman M. E. Present status and future perspectives. In Public Health in the People's Republic of China (Edited by Wegman M. E. et al), p. 269. Josiah Macy Jr. Foundation, New York, 1973. Li Wang V. Training of the barefoot doctor in the People's Republic of China: from prevention to curative sector. Int. J. Hlth Serv. 5,475-488, 1975. cf. Kong ming New, P., Louie New, M. The Barefoot Doctors of China: Healers for all seasons. In: Landy, D. (ed.), op.cit., p. 503-510.
(49) Unschuld, P. U. Western medicine ..., op.cit., p. 10.
(50) Référence à la dichotomie chaud/froid chez les Songhai en Afrique occiden tale: cf. Bisilliat. Village diseases and bush diseases in Songhay: an essay in description and classification with a view to a typology, p. 560. In Loudon J. B. (Ed.), op.cit.
(51) cf. Diesfeld H. J. Die Bedeutung des Dialogs zwischen Heilkunst und Völker kunde für die Gesundheitsplanung in Entwicklungsländern. In Ethnomedizin Beiträge zu einem Dialog zwischen Heilkunst und Völkerkunde (Edited by Rudnitzki G., Sehiefenhövel W. and Schröder, E.), pp. 7—12. Ethnologische Abhandlungen Nr. I.D. Kurth, Barmstedt, 1977.
(52) Bhatia J. C. et al. Traditional healers and modem medicine. Soc. Sei. Med. 9, 19, 1975. cf. Landy, D. Role Adaptation: Traditional Curers under the impact of Western Medicine. In: Landy, D. (ed.) op.cit., p. 468—481.
(53) WHO; L'agent de santé communautaire...,op.cit., p. 2.
(54) Unschuld P. U. Konfliktanalyse in medizinischen Transfersituationen. In Rudnitzki G. et al. (Ed.), p. 83, op.cit.
(55) Foster G. op.cit., p. 529.
(56) cf. Nchinda T. C. Traditional and western medicine in Africa: collaboration or confrontation? Trop. Doct. 6, 134, 1976. cf. Morgan R. W. Migration as a factor in the acceptance of medical care. Soc. Sei. Med. 7, 865-873, 1973. cf. The promotion and development of traditional medicine. Report of a WHO Meeting. Tech. Rep. Ser. 622, WHO Geneva 1978, pp. 17—18. cf. Good, Hunter, Katz, op.cit., p. 146.
(57) There is much evidence from Latin America, cf. Roemer M. I. Organizational issues relating to medical priorities in Latin America. Soc. Sei. Med. 9, 93-96,1975.
(58) World Bank. Health Sector Policy Paper, Chap. 3, p. 61. Washington, D.C. March 1975.
(59) cf. Navarro V. The underdevelopment of health or the health of under development: An analysis of the distribution of human health resources in Latin America. Int. H. Hlth Serv. 4,5-17,1974.