Doctors, sangomas can work together – but not everyone agrees

At weddings in Bushbuckridge, Mpumalanga, Selby Mawelele mixes Shangaan disco tunes.

At his homestead in nearby New Forest village, he mixes herbs “to treat psychiatric disorders, diabetes, constipation, cast out evil spirits ... and help estranged couples love each other again”.

When they need healthcare, 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 do for other health workers in the country 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 September 21. 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 unsure. 

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) 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 hand in hand with doctors and nurses at the level of primary care, which, according to 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.” 

But not everyone agrees with putting formal rules in place. 

Zanele Mazibuko, spokesperson of the Traditional Healers Organisation (THO), says that 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, and 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 like Mawelele, and according to Mbhele, the council will be working closely with amakhosi (local chiefs) to certify healers and confirm to them that “we know this healer, we've trained him, we’ve seen him practice 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 in order 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 on the books, and R500 per 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. 

But in the THO’s view, the fees will be “unaffordable” and Mazibuko says 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”.  

Research shows that power struggles and mistrust are common in efforts to get traditional and Western medicine systems working together.

But Ryan Wagner, a senior research fellow at Agincourt   – a rural health research unit run jointly by the SA Medical Research Council and Wits University – says this needn’t be the case. 

He’s 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. Since 2015, he’s been working with practitioners in Bushbuckridge to understand how the two health systems can work together to “improve patients’ health and finding common ground”.  

But for effective cooperation, Wagner says trust between traditional healers, medical doctors and nurses is essential.

 “Ultimately, both systems strive to improve the health and wellbeing of people, and by working together, we can get there faster,” he concludes.

BHEKISISA centre for health Journalism.