Broad Support Among Stakeholders for Collaboration Between Traditional Bonesetters and Formal Healthcare: A Qualitative Study in a Resource-Limited Setting

Extremity fractures are increasingly common in Sub-Saharan Africa. In many resource-limited settings, patients with fractures have historically sought out traditional bonesetters (TBSs) and continue to do so, in part due to the undercapacity of existing orthopedic facilities. This qualitative study investigates key stakeholder perspectives on intersectoral collaboration between the formal healthcare system and TBSs in treating extremity fractures in the Rorya district, Tanzania. We combined focus group discussions and semi-structured interviews with four key stakeholder groups: patients with previous fractures, TBSs, hospital staff, and local government representatives. Questions concerned stakeholder experience, advantages of TBS and hospital care, perspectives on collaboration, and potential facilitators and/or barriers. Transcripts were analyzed using thematic analysis and inductive coding. Between June 2022 and August 2023, 35 TBSs, 9 patients with previous fractures, 5 hospital staff members, and 2 government representatives were interviewed. Participants unanimously recognized the need for collaboration between TBSs and hospitals. Identified barriers included TBSs' motivation for hospital referral, poor customer care at hospitals, and limited understanding of fracture management in hospitals by TBSs and patients. Implementation of a collaborative triage and referral system was most commonly suggested. This study summarized all relevant perspectives on intersectoral collaboration. A combined approach of a joint triage and referral system, augmented by community education and TBS training, may enhance the quality and accessibility of fracture care and potentially serve as a model for regions facing similar challenges. Further research is needed to evaluate the feasibility and effectiveness of such initiatives in practice.