Traditional healers say patients they refer to public clinics can fall through the cracks because the two health systems don’t communicate effectively.
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,” says Nkunzi.
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 according to Nkunzi they are sometimes left without the basic materials needed to apply what they have learnt.
“Training without resourcing transfers responsibility without transferring capacity,” she says.
Nkunzi says cooperation can also be undermined by the attitudes traditional practitioners and their patients encounter at public health facilities.
“Some healthcare workers discourage patients from using traditional medicine, sometimes describing it as unsafe or even ‘demonic’,” she says.
According to Nkunzi this can 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.
Mdletshe says there are examples of successful collaboration around TB. He says traditional health practitioners taking part in some programmes are encouraged to screen clients for TB symptoms and refer those who may have the disease to public health facilities.
He says the Department of Health has also provided referral letters to traditional health practitioners.
But Mdletshe says 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.”
He says the quality of relationships between traditional practitioners and the health system also varies between provinces, districts and individual facilities. According to Mdletshe 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 says.
Mabena says many patients already use both systems, including people with conditions such as high blood pressure, making collaboration important for safer and more coordinated 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 coexist.
“The policy is being developed in line with guidance from the World Health Organization’s Global Traditional Medicine Strategy 2025–2034,” says Mohale.
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.
A 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.
The researchers argued that stronger regulation and scientific evaluation of traditional medicines could help build trust and improve collaboration between traditional and biomedical healthcare.
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.”
