The role of informal health providers in the management of neglected tropical diseases in Liberia: A participatory investigation

Background: Informal health providers (e.g. traditional and faith healers) are the first point of contact for many persons affected by skin Neglected Tropical Diseases (NTDs) due to varying beliefs and perceptions, yet, they are typically not considered within interventions designed to support persons affected. Despite this neglect, most informal providers are already using their existing roles within communities to support persons affected with care. We sought to investigate the role of informal providers in the management of NTDs in Liberia using participatory approaches to understand and identify ways to improve equitable and effective care for people affected by skin NTDs. Methods: Qualitative and participatory data were collected from two purposively selected counties in Liberia: Grand Gedeh and Lofa. Key informant interviews (6), photovoice (16), and vignettes (32) with traditional and faith healers and informal drug sellers sought to understand their roles in providing care for people affected by skin NTDs. Analysis was conducted using a thematic framework approach. Findings: Health beliefs influenced care seeking from informal providers and/or biomedical care. Informal providers provide persons affected with holistic support, including physical, psychosocial, spiritual, social and financial. This care, based on their respective underlying health beliefs and cultural norms, is driven by perceptions of poor quality of the formal or biomedical health system. During care provision, traditional and faith healers emphasised referring persons affected to the health facility as part of their roles. Conclusion: Understanding the roles of informal providers in the management of skin NTDs is important in reducing the burden of NTDs. Informal providers are trusted by their communities and seen as a primary contact to provide care. They expressed willingness to collaborate with the formal health system. Training them on identification and referral, and basic psychosocial support would enhance early referral and collaboration between formal and informal health systems.