Practitioners will have to pay registration fees to the council every year and show proof of being appropriately trained for the type of service they offer. (Photo supplied)
Gogo Selby Mawelele mixes Shangaan disco tunes at weddings in Bushbuckridge in Mpumalanga.
At his home in New Forest village, he mixes herbs “to treat psychiatric disorders, diabetes, constipation, cast out evil spirits and help estranged couples love each other again”.
About 70% of South Africans — mostly in rural areas — visit sangomas like Mawelele first before they go to a medical doctor, or they don’t go to a health clinic at all.
But new rules “expected to start [being enforced] early in 2025” will see izangoma (diviners) and other traditional healers having to register with the Interim Traditional Health Practitioners Council, to align their work to a more formal system, says spokesperson and chairperson of the registration, education and accreditation committee, Sheila Mbhele.
The council will oversee how traditional healers operate, in a similar way as the Health Professions Council of South Africa and the South African Nursing Council does for other health workers such as doctors, dentists, dietitians and nurses.
The draft regulations, which were published in June, are meant to set standards for practitioners’ training and practice and closed for public comment on 21 September.
Practitioners will have to pay registration fees to the council every year and show proof of being appropriately trained for the type of service they offer.
Health department spokesperson Foster Mohale said this week that “processes for finalisation [of the regulations] are ongoing” and that they “will be implemented on proclamation”, although when exactly this will be is not clear.
The suggested rules come more than 15 years after the Traditional Health Practitioners Act was passed into law in 2007.
Moving away from traditional medicine being seen as witchcraft, the modern law is in line with the World Health Organisation’s (WHO’s) view of treating health problems based on indigenous know-how and customs passed on through generations being an alternative to Western medicine, which relies on evidence from scientific studies.
And, says the health department, formalising traditional medicine will allow healers to work with doctors and nurses at the level of primary care.
This, says Mohale, links to the WHO’s Alma-Ata Declaration of 1978 about countries committing to offer everyone this type of health service and so working towards universal health coverage.
He explains: “In working together like this, their role in fighting major diseases such as HIV can be identified.”
Regulation, registration and reticence
But not everyone agrees with putting formal rules in place.
Zanele Mazibuko, spokesperson of the Traditional Healers Organisation (THO), says although the regulations “will protect the sector against charlatan healers, more consultation is needed”.
At the heart of this reticence are the requirement for registration fees and practitioners’ having to submit proof that they are trained.
For example, under the new regulations, someone who wants to work as an isangoma or herbalist has to be at least 18 years old and will have to have had 12 months’ training in diagnosing conditions, collecting and storing herbs and preparing treatments, as well as doing traditional consultations.
Those who want to work as traditional birth attendants or surgeons must be 25 or older and have had one year (birth attendant) or two years (surgeon) of training to learn the ropes in their field of practice.
Training will be handled by experienced healers such as Mawelele. Mbhele says the council will work closely with amakhosi (local chiefs) to certify healers and confirm that “we know this healer, we’ve trained him, we’ve seen him practise and we’ve visited him”.
She notes that the health department will also be involved and that they “have their own processes to track the training of traditional healers”.
Having to pay yearly registration fees to get a practice number “similar to that of doctors” has also caused unhappiness among healers.
Applicants who can show evidence of their education will have to pay R1 000 for the first year and R500 a year afterwards. Amathwasa (student healers) will have to pay R200 at first and then R100 a year afterwards, while their tutors will have to pay R5 000 upon first registration and then a yearly renewal of R1 500.
With the period for public comment now having closed, the council will start to formally accredit and register healers who qualify for registration.
But in the THO’s view, the fees will be “unaffordable” and, says Mazibuko, although healers “are ready to be taken seriously and integrated in the healthcare sector, this must be without Eurocentric methods dominating and dictating our traditional practices”.
Mbhele counters: “[Even though the period for public comment has closed], people can still ask the council to come [to them] to be shown areas where [we] need to do things right.”
Can sangomas help SA to tackle HIV?
Research shows that power struggles and mistrust are common in efforts to get traditional and Western medicine systems working together.
For example, in a study from KwaZulu-Natal that explored healers’ views on formal registration, practitioners said they were sceptical about the process and saw no benefits, except for their work being officially recognised. Moreover, registration fees were seen as a tactic to bolster the government’s tax revenue.
Elsewhere in Africa ( 39 countries have policies around traditional healing in place), an analysis of 22 studies shows that when indigenous medicine is part of the formal health system, mistrust and rivalry between conventional doctors and traditional healers stem mostly from doctors considering themselves superior and seeing their role as having to teach healers, and not accepting the spiritual aspects of traditional healing.
But Ryan Wagner, a senior research fellow at Agincourt, a rural health research unit run jointly by the South African Medical Research Council and the University of the Witwatersrand, says this needn’t be the case.
He is leading a five-year study on having traditional healers offer HIV testing and counselling to clients and connecting them to clinics for treatment if their result is positive.
Wagner has been working with practitioners in Bushbuckridge since 2015 to understand how the two health systems can work together to “improve patients’ health and finding common ground”.
Mawelele is one of this group of 15 traditional healers. In the past year, he has referred more than 40 patients to local clinics for testing as part of the pilot project.
Getting tested is the first step towards achieving the 95-95-95 goals — the world’s strategy to end Aids as a public health threat by 2030 — because if someone tests positive for HIV, they can start taking ARVs immediately (this is the second number in the series of 95s).
The 95-95-95 goals aim to, by the end of 2025, have 95% of people with HIV diagnosed. Of those, 95% must be on treatment, and of the 95% people on treatment, 95% must be virally suppressed, which means the levels of HIV in their bodies have dropped to such low levels (as a result of treatment) that they can no longer transmit the virus to others.
In the Ehlanzeni district, in which Bushbuckridge is located, about 75% of people with HIV were on treatment by the end of 2023, which is close to the national figure of about 78% for the second 95 of the series (according to the Thembisa model, which the health department uses).
Says Mawelele: “A lot of my patients come to me first as they don’t want to stand in long queues at the clinic. They say there’s more privacy here and no one judges them.”
Working together
Having conventional and traditional systems work together is possible, research shows.
For example, a study from rural Uganda, where it’s easier for communities to access traditional services than an HIV clinic, found that when an indigenous healer offered people an HIV test, everyone agreed to, compared with only about a quarter of people who did so when they were sent to a clinic to get tested.
For effective cooperation, Wagner says trust between traditional healers and medical doctors and nurses is essential.
“Distrust can only be broken down through frank engagement in safe spaces. Ultimately, both systems strive to improve the health and wellbeing of people, and by working together, we can get there faster.”
This story was produced by the Bhekisisa Centre for Health Journalism. Sign up for the newsletter.
