Traditional health practitioners’ knowledge and perceptions on South African traditional medicine regulations in the Free State

Abstract

In Africa, approximately 80% of the population relies on traditional medicine (TM) for primary health care. According to South Africa’s Traditional Health Practitioners Act No.22 of 2007 (THPs Act), traditional health practitioners (THPs) are individuals registered in one or more THP categories. These practitioners transfer indigenous knowledge (IK) across generations, utilising it to address, heal, and eliminate human ailments. It has been hypothesised that most of the practicing THPs in South Africa are not registered according to the THP’s Act and do not adhere to current regulatory policies. This may potentially expose patients to various risks associated with TM, including herb-herb, herb-food, and herb-drug interactions. These issues may result in patients presenting with complications arising from medical pluralism, wherein individuals seek treatment from multiple health care systems or practitioners, often combining Western and alternative therapeutic approaches. The Department of Health (DoH) has introduced the legislation to regulate the practice of THPs and the use of TM to ensure the efficacy, safety and quality of their health care services. The THPs Act outlines the registration, regulations, and training of THPs. However, compliance with the Act is not widespread among the THPs organisations it aims to regulate. The South African Health Products Regulatory Authority (SAHPRA), a division of the DoH, plays a role in regulating TM by enforcing specific requirements that users must adhere to. Although these frameworks exist, a unified and efficient system that aligns all key players, DoH, SAHPRA, and THPs is still lacking to enhance collaboration and partners that are best suited to protect the patient. This absence results in difficulties implementing and regulating traditional health practices in a consistent manner. This exploratory qualitative pilot study aimed to investigate the knowledge and perceptions of THPs regarding the regulation of TM in the Free State. Methods: A snowball sampling technique was employed to identify a total of 30 THPs, of whom 28 met the inclusion criteria to participate in the study. The criteria included THPs who were 18 years and above, able to give consent, used TM as part of their practices, are native Sesotho speakers of South Africa and reside in the Free State province. Data was collected using an interview guide with semi-structured interviews alongside open-ended questions, which allowed the selected THPs to freely share their views, providing an in-depth understanding of their perspectives. Thematic analysis was used to analyse and interpret the data, enabling the identification of key themes and providing valuable insights into the THPs' perspectives on TM regulation. Results and discussion: A total of 28, Sesotho speaking THPs were recruited in the study, 28.57% (n=8) of whom were males and 71.43% (n=20) who were females. The THPs’ highest levels of education included elementary, primary, and secondary school education, equally represented at 32.14% (n=9) respectively and tertiary education at 3.57% (n=1). All THPs interviewed in this study were registered with the Traditional Healers Organization (THO) and reported accessing TM from various sources, including foothills, forests, herbal stores, mountains, riverbanks, waterfalls, and wells. A portion of the THPs (46.43% (n=13)) were aware of potential side effects of TM and outlined strategies for managing them. The majority of the THPs reported limited knowledge of the THPs Act (71.43% (n=20)). This lack of awareness can be attributed, in part, to the lower education levels among THPs, which pose challenges in fully understanding the registration process outlined in the Act. The attitudes of the THPs toward the THPs Act and TM regulation varied, with some THPs expressing willingness to comply with TM regulations under conditions that will ensure the protection of their indigenous knowledge (IK) and practices from exploitation. None of the THPs (35.71% (n=10)) who supported SAHPRA’s involvement in the registration and approval of TM had applied for TM registration. Prominent themes included THPs’ lack of awareness of the THPs Act and TM legislation, acknowledgement of side effects with the use of TM and THPs' practice being oral communication, guided by IK and ancestral guidance during patient consultations. Conclusion: Most THPs were unaware of the THPs Act and the regulatory body SAHPRA. A large portion of the study participants recognised the value of integrating Western and traditional health care systems. Despite lacking experience and comprehensive knowledge on TM regulation, the THPs expressed a willingness to enhance their professional practices by working collaboratively with the DoH for safety, quality, and efficacy of TM. Awareness of THPs’ knowledge and perceptions towards TM regulation can lead to better engagement in the registration process enacted in the THPs Act.