Exploring self-reliance in primary healthcare from peoples’ perspectives among families using traditional medicine: A case study from southern India

Main Article Content

Shivanand Savatagi
NS Prashanth
Unnikrishnan Payyappallimana
John DH Porter
Upendra Bhojani
Harini Nagendra

Abstract

Introduction: Self-reliance consists of using available resources, making informed decisions, and responsible health and lifestyle practices. The complex nature of healthcare practices by the people necessitates the quest for understanding self-reliance in primary healthcare. In LMICs, around 70% in India and approximately 80% in sub-Saharan African countries use traditional medicine for primary healthcare. Because of its emphasis on local resources, context, culture, and other determinants, traditional medicine potentially enables self-reliance in primary healthcare. The study explored the meaning of self-reliance in primary healthcare from peoples’ perspective among families using traditional medicine in a Southern Indian site.


Methodology: We conducted case study research in HD Kote, a taluka in Mysore district of Karnataka in Southern India, from September 2021 to April 2022. We selected 30 study participants using purposive sampling and the data was collected through in-depth interviews. Data was subjected to thematic analysis using QDA Miner lite 2.01 version software.


Results: The study identified following themes: 1) perception of health and illness, 2) healthcare pathways, 3) negotiation between the environment and self in the emergence of self-reliance, and 4) efficiency and authenticity as a means to choose healthcare approach. Pathways to healthcare decisions were influenced by various cultural, social, religious, health system, and individual level factors. Self-reliance emerges from an individual through negotiation between the self, the environment, and the social context in which they live.


Conclusion: The meaning of self-reliance was navigated within healthcare practices, choices, and the context in which an individual lived. Capturing people’s perspectives and local views addresses the gap in scientific understanding by situating these perspectives within the broader context of the health system, particularly in relation to self-reliance and the role of individuals. Understanding self-reliance through studies of this kind is critical to contributing to a people-centered health system for India to achieve the goal of universal health coverage.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Savatagi S, Prashanth N, Payyappallimana U, Porter JD, Bhojani U, Nagendra H. Exploring self-reliance in primary healthcare from peoples’ perspectives among families using traditional medicine: A case study from southern India . J Community Syst Health [Internet]. 2025 Oct. 26 [cited 2026 Apr. 2];2(1). Available from: https://journals.ub.umu.se/index.php/jcsh/article/view/1207
Section
Original research
Author Biographies

NS Prashanth, Center for Health Systems, Institute of Public Health, Bengaluru, India

Director, Institute of Public Health Bengaluru

Unnikrishnan Payyappallimana, The University of Transdisciplinary Health Sciences and Technology, Bengaluru, India

Professor

The University of Trans-disciplinary Health Sciences and Technology, Bengaluru

John DH Porter, The University of Transdisciplinary Health Sciences and Technology, Bengaluru, India; London School of Hygiene and Tropical Medicine, London, England

London School of Hygiene and Tropical Medicine, UK, London

Upendra Bhojani, Center for Health Systems, Institute of Public Health, Bengaluru, India

Institute of Public Health Bengaluru

References

Narasimhan M, Allotey P, Hardon A. Self care interventions to advance health and wellbeing: a conceptual framework to inform normative guidance. BMJ. 2019;l688.

Conner M, Norman P, editors. Predicting health behaviour: research and practice with social cognition models. 2. ed., repr. Maidenhead: Open Univ. Press; 2007. 385 p.

Savatagi SB, Srinivas PN, Payyappallimana U. Factors influencing the emergence of self‑reliance in primary health care using traditional medicine: A scoping review. Indian J Public Health. 2022;66(2).

Bayer, White Ribbon Alliance. Self-Care: Better Daily Health for Individuals and Societies. 2018. p. 35.

Levin LS, Idler EL. Self-care in health. Annu Rev Public Health. 1983;4:181–201.

World Health Organization. Declaration of Astana: From Alma-Ata towards universal health coverage and the Sustainable Development Goals [Internet]. Astana, Kazakhstan: World Health Organization; 2018 Oct 25–26 [cited 2025 Oct 05]. Available at: https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf.

World Health Organization. Declaration of Alma-Ata [Internet]. 1978 [cited 2025 Oct 5]. Available at: https://www.who.int/publications/i/item/WHO-EURO-1978-3938-43697-61471.

Shivanand B, Tushara M, Unnikrishnan P, Krishnamurthy J. Do integrative approaches to health contribute to self-reliance in primary healthcare? reflections from a community case study in Kerala, India. Health Psychol Behav Med. 2022;10(1):1124–35.

Ministry of Health and Family Welfare, Government of India. National Health Policy 2017 [Internet]. New Delhi: MoHFW; 2017 [cited 2025 Sep 23]. Available at: https://www.nhp.gov.in/nhpfiles/national_health_policy_2017.pdf.

Bajpai N, Dholakia RH. Improving the Performance of Accredited Social Health Activists in India: Working Paper No. 1 [Internet]. Mumbai: Columbia Global Centers | South Asia; 2011 May [cited 2025 Sep 23]. Available at: https://academiccommons.columbia.edu/doi/10.7916/D8988G63.

Scott K, George AS, Ved RR. Taking stock of 10 years of published research on the ASHA programme: examining India’s national community health worker programme from a health systems perspective. Health Res Policy Syst. 2019;17(1):29.

Baru RV. Private Health Care in India: Social Characteristics and Trends. New Delhi: Sage Publications Pvt Ltd; 1998. 184 p.

Patwardhan B. Bridging Ayurveda with evidence-based scientific approaches in medicine. EPMA J. 2014;5(1):19.

World Health Organization. WHO global report on traditional and complementary medicine 2019 [Internet]. Geneva: World Health Organization; 2019 [cited 2025 Sep 22]. 226 p. Available at: https://iris.who.int/handle/10665/312342.

Bode M. Taking traditional knowledge to the market: The commoditization of Indian medicine. Anthropol Med. 2006;13(3):225–36.

Tilburt J. Herbal medicine research and global health: an ethical analysis. Bull World Health Organ. 2008;86(8):594–9.

Ministry of Health and Family Welfare, Government of India. National Policy on Indian Systems of Medicine & Homoeopathy [Internet]. New Delhi: Government of India; 2002 [cited 2025 Sep 23]. Available at: https://www.india.gov.in/national-policy-indian-systems-medicine-homoeopathy-ayush.

Mehrotra RP, Saxena SA. Status and role of Ayush and local health traditions under the National Rural Health Mission: report of a study. New Delhi; 2010. 308 p.

World Health Organization. WHO traditional medicine strategy: 2014-2023 [Internet]. Geneva: World Health Organization; 2013 [cited 2025 Sep 22]. 76 p. Available at: https://iris.who.int/handle/10665/92455.

Krupa J, Sureshkumar J, Silambarasan R, Priyadarshini K, Ayyanar M. Integration of traditional herbal medicines among the indigenous communities in Thiruvarur District of Tamil Nadu, India. J Ayurveda Integr Med. 2019;10(1):32–7.

Pandve HT, Pandve TK. Primary healthcare system in India: Evolution and challenges. Int J Health Syst Disaster Manag. 2013;1(3):4.

World Health Organization and Unicef. Vision for primary health care in 21st century [Internet]. [cited 2019 Jul 17]. Available at: https://www.who.int/docs/default-source/primary-health/vision.

Harris KM. An integrative approach to health. Demography. 2010;47(1):1–22.

Sharma K, Ramachandran A, Patel A. Scope of integrative approach in present era. J Ayurveda Integr Med Sci. 2024;9(9):56–67.

Bhuyan KK. Health promotion through self-care and community participation: Elements of a proposed programme in the developing countries. BMC Public Health. 2004;4(1):11.

Oyebode O, Kandala NB, Chilton PJ, Lilford RJ. Use of traditional medicine in middle-income countries: a WHO-SAGE study. Health Policy Plan. 2016;31(8):984–91.

Kleinman A. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88(2):251-8.

Bodeker G, Kronenberg F. A Public health agenda for traditional, complementary, and alternative medicine. Am J Public Health. 2002;92(10):1582–91.

WHO Traditional Medicine Strategy: 2002-2005 [Internet]. [cited 2021 Jun 7]. Available at: http://digicollection.org/hss/en/d/Js2297e/.

James PB, Wardle J, Steel A, Adams J. Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review. BMJ Glob Health. 2018;3(5):e000895.

Lowe J. The self-reliance of the Cherokee male adolescent. J Addict Nurs. 2003;14(4):209–14

Oyebode O, Kandala NB, Chilton PJ, Lilford RJ. Use of traditional medicine in middle-income countries: a WHO-SAGE study. Health Policy Plan. 2016;31(8):984–91.

Webber D, Guo Z, Mann S. Self-care in health: we can define it, but should we also measure it? Glob Adv Health Med. 2013;6.

Reviving local health knowledge for self-reliance in primary healthcare. Available at: https://www.researchgate.net/publication/331231120_Reviving_local_health_knowledge_forself_reliance_in_primary_health_care. Accessed on 18th September 2020.

World Health Organization, Regional Office for the Western Pacific. People-centred health care: a policy framework. Manila: World Health Organization, Western Pacific Region; 2007.

National Health Systems Resource Centre, Government of India. AB-HWC Report – FINAL – May 13 [Internet]. New Delhi: NHSRC; [cited 2023 May 3]. Available at: https://nhsrcindia.org/sites/default/files/2022-07/AB-HWC%20Report%20-%20FINAL%20-%20May%2013.pdf.

Ministry of AYUSH, Government of India. AYUSH Health and Wellness Centres: Operational Guidelines [Internet]. New Delhi: Ministry of AYUSH; [cited 2023 Jun 12]. Available at: https://cdn.ayush.gov.in/wp-content/uploads/2021/06/AYUSH-HWC_Operational-Guideline_English.pdf.

National Health Mission, Government of India. Operational Guidelines for Comprehensive Primary Health Care (CPHC) [Internet]. New Delhi: NHM; [cited 2023 Jun 12]. Available at: https://www.nhm.gov.in/New_Updates_2018/NHM_Components/Health_System_Stregthening/Comprehensive_primary_health_care/letter/Operational_Guidelines_For_CPHC.pdf.

Asgari-Jirhandeh N, Zapata T, Jhalani M. Strengthening primary health care as a means to achieve universal health coverage: experience from India. J Health Manag. 2021;23(1):20–30.

Roy S, Hegde HV, Bhattacharya D, Upadhya V, Kholkute SD. Tribes in Karnataka: Status of health research. Indian J Med Res. 2015;141(5):673–87.

Mahishi P, Srinivasa BH, Shivanna MB. Medicinal plant wealth of local communities in some villages in Shimoga District of Karnataka, India. J Ethnopharmacol. 2005;98(3):307–12.

Swami Vivekananda Youth Movement (SVYM). SVYM [Internet]. Mysuru: SVYM; [cited 2021 Apr 21]. Available at: https://svym.org/site/.

The University of Trans-Disciplinary Health Sciences and Technology (TDU). TDU [Internet]. Bengaluru: TDU; [cited 2021 Apr 21]. Available at: https://tdu.edu.in/home/tduhomepage2/

Karuna Trust. Karuna Trust – 30 years of Integrated Rural Development [Internet]. Mysuru: Karuna Trust; [cited 2021 Apr 21]. Available at: https://www.karunatrust.org/.

Bullington J. Body and self: a phenomenological study on the ageing body and identity. Med Humanit. 2006;32(1):25–31.

Gabre M, Wireklint Sundström B, Olausson S. ‘A little good with the bad’: Newly diagnosed type 2 diabetes patients’ perspectives on self-care: A phenomenological approach. Nord J Nurs Res. 2019;39(1):20–8.

Biodiversity Hotspots in India [Internet]. [cited 2022 Aug 12]. Available at: http://www.bsienvis.nic.in/database/biodiversity-hotspots-in-india_20500.aspx.

UNESCO. Nilgiri Biosphere Reserve, India [Internet]. 2019 [cited 2022 Aug 12]. Available at: https://en.unesco.org/biosphere/aspac/nilgiri.

Mathapati S. Diversity of medicinal plants flora of old Mysore district, Karnataka, India [Internet]. [cited 2021 Apr 5]. Available at: https://www.academia.edu/15138069/_Diversity_of_medicinal_plants_flora_of_old_Mysore_district_Karnataka_India.

Hull VJ. The right to health care: building on traditional self-reliance in village Java. Hum Rights Q. 1981;3(2):61.

Martínez N, Connelly CD, Pérez A, Calero P. Self-care: A concept analysis. Int J Nurs Sci. 2021;8(4):418–25.

World Health Organization, Regional Office for South-East Asia. Self-care in the context of primary health care: Regional Report 2009 [Internet]. New Delhi: WHO; 2009 [cited 2019 Aug 13]. Available at: http://apps.searo.who.int/PDS_DOCS/B4301.

Census India. Heggadadevankote Taluka Population, Religion, Caste, Mysore district, Karnataka [Internet]. [cited 2021 Dec 15]. Available at: https://www.censusindia.co.in/subdistrict/heggadadevankote-taluka-mysore-karnataka-5573

Crowe S, Cresswell K, Robertson A, Huby G, Avery A, Sheikh A. The case study approach. BMC Med Res Methodol. 2011;11(1):100.

Yin RK. Case Study Research: Design and Methods. 3rd ed. Thousand Oaks, CA: Sage Publications; 2003.

Braun V, Clarke V. One size fits all? What counts as quality practice in (reflexive) thematic analysis? Qual Res Psychol. 2021;18(3):328-52.

QDA Miner Lite. QDA Miner Lite 1.2 [Internet]. [cited 2022 Jun 23]. Available at: https://qda-miner-lite.software.informer.com/1.2/.

Birt L, Scott S, Cavers D, Campbell C, Walter F. Member Checking: A Tool to Enhance Trustworthiness or Merely a Nod to Validation? Qual Health Res. 2016;26(13):1802–11.

Sheikh K, George A, Gilson L. People-centred science: strengthening the practice of health policy and systems research. Health Res Policy Sys. 2014;12(1):19.

Kleinman A. Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research. San Francisco: University of California Press; 1980. p. 9.

Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55(1):68–78.

Makgahlela M, Mabidilala M, Lesolang N, Jidong DE, Monera-Penduka TG. Using traditional medicine to help with bereavement loss and coping: an interpretative phenomenological analysis of traditional healers’ experiences. JMHTEP. 2022;17(2):145–58.

Khatri S, Sinha A. Traditional medicine in India: present status and future prospects. Ayushdhara. 2018;5(4):1775–82.

Howard C, Smith L, Hall N, Jackson K, Willis E, Kelly J, et al. Neoliberalism and Indigenous health: A scoping review. Global Health. 2022;18:63.

Sundararaman T, Muraleedharan VR. Community health workers: scaling up for universal health coverage. Indian J Public Health. 2015;59(3):171–7.

Patwardhan B, Tillu G. Policy-promoted integrative health care in India: Challenges and way forward. J Ayurveda Integr Med. 2024;15(1):100718.

Self-Care-Readiness-Index-Report-1.pdf [Internet]. [cited 2022 May 24]. Available at: https://selfcarepromise.org/wp-content/uploads/2021/09/Self-Care-Readiness-Index-Report-1.pdf.

Harnett S, Morgan-Daniel J. Health literacy considerations for users of complementary and alternative medicine. J Consum Health Internet. 2018;22(1):63–71.

Basappa SS. Self-care or delay in seeking healthcare: Reflections from the field. Ecol Econ Soc. 2021;4(2):159–64.

Wilhelm M, Euteneuer F. Does health literacy make a difference? Comparing the effect of conventional medicine versus homeopathic prescribing on treatment credibility and expectancy. Front Psychol. 2021;12:581255.

Kleinman A. Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry. Berkeley: University of California Press; 1980.

Waldram JB. Anthropology of healing: New directions. New York: Routledge; 2015.

World Health Organization. WHO global report on traditional and complementary medicine 2019. Geneva: World Health Organization; 2019.

Payyappallimana U, Venkatasubramanian P. Exploring knowledge domains in Ayurveda: A case for integrative healthcare. J Ayurveda Integr Med. 2016;7(4):241-4.

Kneck Å, Klang B, Fagerberg I. Learning to live with illness: experiences of persons with recent diagnoses of diabetes mellitus. Scand J Caring Sci. 2011;25(3):558–66.

World Health Organization, Special Programme of Research D and Research Training in Human Reproduction (World Health Organization), World Health Organization, Reproductive Health and Research. WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights [Internet]. 2019 [cited 2020 Apr 30]. Available at: https://www.ncbi.nlm.nih.gov/books/NBK544164/.

Mathpati MM, Payyappallimana U, Shankar D, Porter JD. Population self-reliance in health and COVID-19: the need for a 4th tier in the health system. J Ayurveda Integr Med. 2022;13(1):100354.