Beyond the biomedical: Collaborating with traditional and faith healers to strengthen skin NTD care in Liberia

This is the authors' abstract. We don't add key points for this paper.

Introduction In Liberia, traditional and faith healers hold significant influence in the management of neglected tropical diseases (NTDs) as they are often the first point of contact. Despite their central role in community care, traditional and faith healers are rarely engaged as partners within formal NTD programmes. This study evaluated a participatory intervention, co-designed with traditional and faith healers as partners, to identify symptoms of NTDs for early referral, addressing stigma and provide basic psychological support. Methods We conducted a participatory qualitative study in three counties in Liberia. At baseline, focus group discussions (FGDs), reflective diaries with traditional and faith healers and in-depth interviews (IDIs) with persons affected by skin NTDs were conducted. A co-designed training was delivered to 588 healers, including recognising symptoms, referral pathways, basic psychological support and addressing stigma. Reflective diaries were maintained alongside the intervention as process evaluation. At endline, FGDs, IDIs and key informant interviews with Ministry of Health stakeholders were conducted. Data was analysed thematically using a framework approach. Results Participants reported increased awareness of skin NTDs, perceived improvements in referral practices and strengthened collaboration between formal and informal actors. Dialogue and supervision were identified as critical to building trust. However, challenges related to remuneration and sustainability remain. Conclusion Integrating informal healthcare providers into health systems offers a holistic, culturally embedded and person-centred approach to strengthening NTD care. Collaboration can lead to early case detection and timely referral, reducing delays in treatment. Further research on supporting and sustaining ethical and equitable partnerships is required.