Traditional healers, who say patients they refer to public clinics can fall through the cracks because the two health systems don’t communicate effectively, are calling for better mutual synchronicity and collaboration, reports Health-e News.
Nozuko Nkunzi, a traditional health practitioner from Lusikisiki in the Eastern Cape, says South Africa’s plans to integrate traditional medicine into the public healthcare system will mean little without a clear referral pathway.
“Traditional health practitioners are expected to refer patients into the public health system, yet there are no clear referral pathways, shared protocols or practical training on how practitioners from the two knowledge systems should work collaboratively,” she says.
Her concerns come after South Africa marked African Traditional Medicine Day on 31 August, with the Department of Health highlighting the role of traditional medicine in the country’s healthcare system.
She says government has provided some practitioners with training on patient care, hygiene, prevention and health-system collaboration, but they are sometimes left without the basic materials needed to apply what they have learnt.
“Training without resourcing transfers responsibility without transferring capacity,” she points out, adding that co-operation can also be undermined by the attitudes encountered by traditional practitioners and their patients at public health facilities.
“Healthcare workers often discourage patients from using traditional medicine, describing it as unsafe or even ‘demonic’,” she says, which can then discourage patients from telling healthcare workers about the traditional medicines they are taking.
Referrals don’t always work both ways
Patrick Mdletshe, deputy chairperson of the KZN Civil Society Forum, says traditional health practitioners are increasingly recognised as partners in South Africa’s response to HIV, TB and sexually transmitted infections, and that there are examples of successful collaboration around TB.
He adds that traditional health practitioners taking part in some programmes are encouraged to screen patients for TB symptoms and refer those who may have the disease to public health facilities.
The Department of Health has also provided referral letters to traditional health practitioners, but the referral process can be one-directional.
“A traditional practitioner may refer a patient to a clinic but receive little or no feedback about whether the person was seen, diagnosed or started on treatment.”
The quality of relationships between traditional practitioners and the health system also varies between provinces, districts and individual facilities, and Mdletshe said integration can become a “tick-box” exercise with little meaningful engagement in some areas.
Dr Ntloleng Mabena, a GP and public health specialist with an interest in social medicine, says there has historically been a lack of understanding and collaboration between Western medicine and traditional African healing.
“Traditional medicine is often viewed negatively because its methods and medicines are not well understood within the formal healthcare system,” says Mabena.
Rather than treating the two systems as competing, she believes they should work together through communication, mutual learning and referrals.
“Traditional healers should know when to refer patients to hospitals, while healthcare professionals should understand traditional practices and engage respectfully with traditional healers,” she suggests.
Many patients already use both systems, she noted, including people with conditions like high blood pressure, making collaboration important for safer and more co-ordinated care.
Full inclusion of traditional medicine not possible yet
The Department of Health says full inclusion of traditional medicine into the national healthcare system will only be possible once its draft policy on African Traditional Medicine is approved.
Department spokesperson Foster Mohale says the policy is intended to provide a framework for including African Traditional Medicine in South Africa’s healthcare system and allowing conventional and traditional medicine to co-exist.
The policy is being developed in line with guidance from the World Health Organisation’s Global Traditional Medicine Strategy 2025–2034.
The department says one of the main complaints it receives from both members of the public and traditional health practitioners is that integration is taking longer than expected.
An earlier study published in Complementary Therapies in Clinical Practice also found that traditional health practitioners were not adequately integrated into South Africa’s mainstream health system, with the researchers arguing that stronger regulation and scientific evaluation of traditional medicines could help build trust and improve collaboration between the traditional and biomedical sectors.
Nkunzi says integration should not mean traditional medicine is simply incorporated into the existing biomedical system.
“Integration cannot mean absorption,” she says. “Traditional health practitioners should be able to maintain their own knowledge systems while developing appropriate standards for safety, ethics, competence and accountability.”
Study details
Utilisation of traditional medicine and its integration into the healthcare system in Qokolweni, South Africa: prospects for enhanced universal health coverage
Sianga Mutola, Ngambouk Vitalis Pemunta, Ngo Valery Ngo et al.
Published in Complementary Therapies in Clinical Practice in May 2021
Abstract
Despite the WHO providing a framework for the integration of traditional medicines into the health systems with pandemics like HIV/Aids and the Covid-19, most countries are yet to adopt the recommendations. This study explored why the integration of traditional medicines with the biomedical healthcare system in Qokolweni in Eastern Cape, South Africa was stalling. The research employed qualitative research methods; participant observation and in-depth ethnographic interviews of community members, traditional healers, and nurses. The study found that: traditional medicines are widely used in Qokolweni due to accessibility and long-built trust; the practice is broad and not certified. To achieve the integration of traditional medicine into the conventional health systems, the central government needs to show political will by setting up regulatory strategies that provide for the scientific evaluation and certification of traditional medicines. This will build confidence among biomedical scientists and health practitioners, thereby fostering easy collaboration and integration.
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