The South African Traditional Health Practitioners Act
1
defines traditional health practice as performance of a function,
activity, process, or service based on a traditional philosophy that
uses indigenous African techniques and principles that include
traditional medicine or practice, including the physical or mental
preparation of an individual for puberty, adulthood, pregnancy,
childbirth, and death. Traditional health practitioners who are
registrable under this Act include herbalists (
izinyanga or
amaxhwele), diviners (
izangoma or
amagqirha), traditional surgeons (
iingcibi) who mainly do circumcisions, and traditional birth attendants (
ababelethisi or
abazalisi).
1 In total, there were about 190 000 such practitioners in 2007.
2
Spiritual or faith healers, at least equally if not more prevalent and
important than are traditional health practitioners in South Africa,
were not included.
2
Analysis
of nationally representative population-based surveys in South Africa
from 1995 to 2007 showed that use in the past month of a traditional
health practitioner seemed to have decreased over the past 13 years.
Surveys from 1995 and 1998 found a 3·6–12·7% use of a traditional
practitioner, while surveys from 2005 to 2007 showed 0·1% or less use of
such a health practitioner.
3
Although population-based surveys indicate a decline in use of
traditional practitioners, health-facility-based and other surveys
suggest that use of such practitioners (ranging from 6% to 39%) still
has an important role in health-care delivery in South Africa, covering a
wide range of conditions from complex supernatural or psychosocial
problems, mental disorders,
4
chronic diseases such as cancer, diabetes, hypertension, and stroke,
childhood health problems, acute conditions, snake bites, generalised
pain, and HIV and other sexually transmitted infections to hearing
impairment.
3
Fai fominyen (traditional healers) in South African ritual
Fai Fominyen
On
the basis of data from national demographic and health surveys,
traditional birth attendance in the 5 years before the survey has also
decreased in women aged 20 years and older, from 1·4–2·2% in 1998 to
0·4–1·3% in 2003, but it increased for women aged younger than 20 years
from 0·7% in 1998 to 1·4% in 2003.
3
In a nationally representative population-based survey in 2002, the
prevalence of traditional male circumcision was 24·8% (more than medical
male circumcision at 13·2%).
3
An overall decline of traditional health practice could be attributed
to an increase in physical and cultural accessibility and acceptability
of biomedical medicine. Traditional health practice is a private
practice component of health care, being funded out of pocket.
Patients
see no conflict in seeking both allopathic and traditional African
healing for their ailments, as doctors diagnose and treat the pathology
while traditional healers establish what is wrong with the body–mind
complex and importantly who or what (mostly harmful spirits) made the
person ill (done mainly by
isangomas). Ensink and Robertson
5
found that most African patients and their families interpret mental
health problems in terms of a combination of indigenous, psychosocial,
and other causes. So, traditional health practice is about ameliorating
the cause and identifying who might have placed a bad spell or caused an
illness or accident. This is why the two systems can coexist so easily,
but is also part of the tension between the two systems. For example,
Kahn and Kelly
6
explored how psychiatric nurses manage apparent incompatibilities
between their practice of western psychiatry and the use of traditional
healing services: such systems coexist pluralistically in their
experience. However, when questioned about possible cooperation between
these systems, respondents gave views inconsistent with their
pluralistic world-view and promoted psychiatry's hegemony.
The
purpose of the Traditional Health Practitioners Act is to establish the
Interim Traditional Health Practitioners Council of South Africa, to
provide for the registration, training, and practices of traditional
practitioners, and to serve and protect the interests of those who use
these services. This process still has a long way to go. Regulation is
key to professionalising and protecting the reputation of traditional
health practice. However, there is no common diagnostic nomenclature,
therapeutic method, or curriculum, and thus attempts to create
accreditation have failed. Traditional healing is still unregulated
because there is no established accreditation procedure. This opens the
door to charlatans who give traditional healing a bad name. There has
not been much enthusiasm in terms of integrating the two systems in a
manner that allows cross-referral and joint care. Devenish
7
notes that: “Although the Department supports a system of collaboration
on Primary Health Care and HIV and AIDS prevention and education, at
present the Department does not support referrals from the formal health
system to traditional healers, principally because of a lack of
research and regulation around the dosage and efficacy of traditional
treatments.” Some studies have shown the possible role of traditional
practitioners in adherence to tuberculosis treatment,
8 HIV prevention,
9 and antiretroviral drugs for prevention of mother-to-child transmission of HIV.
10
Not much has followed to evaluate this role rigorously for possible
scale-up. Harmful practices, such as enemas for babies with diarrhoea
and male circumcision with one instrument on more than one patient, need
to be eliminated; and positive aspects of their care (eg, the use of
African potato to treat infections) need to be encouraged after being
scrutinised scientifically.
11
South
Africa has made important steps towards inclusion of traditional care
into the national health-care system by a traditional medicine
directorate within the Department of Health, a traditional medicine
research institute, postgraduate education in herbal science, and a
draft policy for the institutionalisation of African traditional
medicine, including a national institute. However, it seems that
traditional medicine and allopathy will remain fairly separate and
parallel in South Africa. Yet there should be limited cooperation
between the two when appropriate.
12
I declare that I have no conflicts of interest.
Traditional health practitioners in South Africa
References