People use traditional medicine to meet their health care needs in developing countries and
medical pluralism persists worldwide despite increased access to allopathic medicine.
Traditional medicine includes a variety of treatment opportunities, among others, consultation
with a traditional healer or spiritual healer and self-treatment with herbal medicine or
medicinal plants. Reliance on traditional medicine varies between countries and rural and
urban areas, but is reported to be as high as 80% in some developing countries. Increased
realization of the continued importance of traditional medicine has led to the formulation of
policies on the integration of traditional medicine into public health care. Local level
integration is already taking place as people use multiple treatments when experiencing
illness. Research on local level use of traditional medicine for health care, in particular the use
of self-treatment with medicinal plants, is however scarce. Thus, this thesis contributes to
understanding the extent of traditional medicine use as well as why people use it in rural areas
in developing countries. This is important for the formulation of inclusive health care policies
which can address the health care needs of people.
Using Nepal as a case, the specific objectives of this thesis are; 1) to quantify the reliance on
traditional medicine for health care as well as study the determinants of this reliance in rural
Nepal; 2) to increase the understanding of why people use traditional medicine for health care
in rural Nepal. A mixed methods research design was employed and data were collected in
2012 through 54 semi-structured interviews, 10 group discussions and a household survey in
571 households. Data collection took place in three sites in Nepal representing differences in
access to health care and medicinal plants as well as in livelihoods and ethnicities of the
populations.
The three papers in this thesis address traditional medicine within the pluralistic medical
fields of Nepal from different levels of analysis. The first paper consider the various treatment
opportunities available to people and contributes to increasing the understanding of how
people conceptualize these and how treatment seeking practices are interpreted and
experienced differently among people. The second paper quantifies reliance on traditional
medicine and medicinal plants whereas the third paper addresses one specific form of
traditional medicine and explores self-treatment with medicinal plants and the various ways
this treatment is used to fulfill health care and social needs.
The findings show that traditional medicine plays an important role in health care in rural
areas in Nepal due to its continued utilization as well as through the ways traditional medicine
is conceptualized and used to fulfill health care and social needs. Using the concept of
therapeutic landscapes, this study suggests that the value of traditional medicine to people and
the ways they conceptualize treatments which are “traditional” reflect other
conceptualizations than the “modern/traditional” dichotomy. People conceptualized
treatments through notions related to time and place, positioning treatments on spectrums
ranging from home treatments to city treatments as well as from past to present. Through their
conceptualizations and practices of treatment seeking people engaged in creating and
sustaining pluralistic therapeutic landscapes variously influenced by everyday contexts and
structural constraints.
This study found that traditional medicine was used as a treatment in 31% of illness episodes
during a one month recall period and self-treatment with medicinal plants was the most
important type of traditional medicine used as it was used in 22% of illness episodes. Overall,
78% of households reported to sometimes use self-treatment with medicinal plants to treat ill
household members. Importantly, this study points to the potential under-reporting of selftreatment
with medicinal plants as many treatments with medicinal plants were reported as
common sense treatments rather than as self-treatment with medicinal plants. This study
found that being rich was a significant determinant of both use of traditional medicine and
self-treatment with medicinal plants. This study hence questions the often held assumption
that poor people are most reliant on traditional medicine. Other determinants of traditional
medicine use included age, gender of household head, education and having a chronic illness
as well as whether someone in the household held knowledge about medicinal plants.
Self-treatment with medicinal plants was used in various ways reflecting the various health
care and social needs, this treatment was intended to fulfill. Self-treatment with medicinal
plants was used in five main ways; as the preferred, the pragmatic, the convenient, the
compelled and the auxiliary treatment. Prevalence of use and ways of using self-treatment
with medicinal plants varied among sites reflecting differences in social and health care needs
as well as everyday realities and people’s experiences of social development or the lack
thereof.

This thesis expands understandings of the relations between access to various types of health
care and use of traditional medicine. It questions often held assumptions about the availability
of traditional medicine and about medicinal plants being easily accessible, showing that there
was little access to traditional healers and Ayurvedic medicine in the sites and that many
people considered medicinal plants less accessible than other types of treatment.
Finally, this thesis points out the need for policy makers to address both the current
inequitable access to allopathic medicine and to providers of traditional medicine as well as
how to enable people’s practices of self-treatment with medicinal plants in order to fulfill
their varied health care and social needs.