1. Introduction

Public hearings were held in the provinces earlier this year, during which stakeholders and members of the public were consulted as to how to regulate the practice of traditional healers. The findings of these hearings are currently being considered by the National Assembly Portfolio Committee on Health.

It is estimated that traditional healers are used by 80% of South Africans, and that about 60% of South African babies are delivered by traditional birth attendants. Herbal medication is the most common therapeutic method used by traditional healers. Other methods include psychosocial counselling, simple surgical procedures, rituals and symbolism.

Traditional healers are regarded as an important national health resource. In some parts of the country, they are available where western trained personnel are lacking. They share the culture, beliefs and values of their patients. They are widely accepted and respected. In addition, many are skilled in interpersonal relations and counselling. Traditional healers cater for the complete person, within the family and community context.

The World Health Organisation has called for the recognition of traditional healers. In 1977, the 30^th World Health Assembly adopted a resolution to promote traditional medicine worldwide. A year later at Alma Ata, it was declared that African traditional healers should be part of the primary health care team.

In South Africa, traditional healers have no legal status and are not officially recognised as health care personnel. The only legislation which relates indirectly to traditional healers is the Witchcraft Suppression Act of 1957. This Act sought to outlaw the practice of traditional healing. Reports of ritual killings, in which traditional healers seemed to have been indirectly involved, led to the establishment of a Commission of Inquiry into Witchcraft Violence in March 1995. The Commission’s report was submitted to the MEC for Safety and Security for the Northern Province. These events highlighted the need to regulate the activities of traditional healers.

In the 1970s in Kwazulu, traditional healers were encouraged to form associations, so as to facilitate registration and licencing. A number of organisations dealing with issues related to traditional healers do now exist, but a common code of conduct has not been adopted and standards for training have not been set.

Some attempts have been made at collaboration between traditional healing and biomedicine. However, there are few opportunities for building a mutual understanding between conventional biomedical professionals and traditional healers. Training in basic preventive medicine is not widely available for traditional healers and traditional healing is not part of the curriculum of doctors and nurses. Referrals between conventional and traditional practitioners are uncommon. Moreover, because traditional healing is not a regulated profession, members of the public have no recourse in cases of malpractice.

2. Towards a new legislative framework for traditional healers?

The Government’s policy for transformation of the National Health Service, outlined in the White Paper for the Transformation of the Helath System in South Africa, states that " traditional practitioners and traditional birth attendants should not, at this stage, form part of the public health service, but should be recognized as an important component of the broader primary health team. The regulation and control of traditional healers should be investigated for their legal empowerment. Criteria outlining standards of practice and an ethical code of conduct for traditional practitioners should be developed to facilitate their registration."

In order to elaborate on this policy framework, the National Department of Health requested that public hearings take place. These were organized by provincial legislatures in May and June 1997. The purpose of the hearings was to get comments on three issues:

1. a Statutory Council for traditional healers
2. the issuing of medical certificates by traditional healers, and
3. the medical aid coverage of care provided by traditional healers

The National Council of Provinces (NCOP) Select Committee on Social Services received reports of the hearings from seven of the nine provinces and has since produced a summary report. This has been submitted to the National Assembly Portfolio Committee on Health, which is now meeting to discuss how to carry the process forward.

The formats of the seven provincial reports vary and they are therefore difficult to summarize. However, they are fairly comprehensive and contain much interesting information. Reports were not received from the Northern Cape and North West Province.

3.1.Process

The table below summarises information available in the reports regarding how each Provincial Standing Committee organised hearings. This includes information about how the hearings were advertised, when and where they were held, how many people attended, and who made submissions to the hearings.

TH* = Traditional Healers

3.2.1. Summary of the provincial reports

The status of the different provincial reports varies. Some reports contain specific recommendations of the standing committee or recommendations made by individuals or organisations at the hearings. Other reports limit themselves to ‘comments’ or ‘responses from the hearings’. In provinces where hearings were held in several different areas, the views expressed varied from one meeting to the next. The overall trends are as follows:

A Statutory Body

• All reports support the establishment of a statutory body. Gauteng and KwaZulu-Natal both commented on the process by which this body should come into existence: they recommended that an Interim Council or Interim Statutory Body should be set up until a national Act is passed which will give formal recognition to traditional healers and to their Statutory Body.
• Mpumalanga suggested there should be both a Provincial and a National Council, as is the case with the House of Traditional Leaders.
• Proposals for membership of this body varied. Some recommended that only traditional healers should be members, and that professionals from other fields, intellectuals, researchers and academics should be excluded. Various categories were identified as belonging to the profession of tradititional healer: diviners, herbalists, traditional midwives/traditional birth attendants, traditional surgeons (Gauteng & E.Cape); vendors of Muthi (Abachayi), prophets, Abathandazi, Inyanga, Izangoma (Mpumalanga). Other reports contain suggestions for broader representation on the body, which could include faith healers; traditional leaders; nurses and medical doctors.
• The suggested roles of the body included regulation of the training and practice of traditional healing, accreditation, registration, liaison with other professional groups, setting a code for research, setting of a ceiling for tarrifs, establishment of a code of good ethics and practice.

Medical certificates and Medical Aid

• Some provincial reports gave unqualified support for issuing of certificates by traditional healers and coverage of traditional healers by medical aid (Mpumalanga, Free State).
• Some reports qualified their support, suggesting that the statutory body should regulate certificates and claims.
• The Gauteng Standing Committee did not make direct recommendations on certificates and medical aid. It suggested that the proposed Interim Council should 'consider the recommendations within the constraints of our available national resources'
• The W. Cape Standing Committee commented that medical certificates should be limited to short periods and to minor illnesses.

Other suggestions

• The Witchcraft Act should be repealed with immediate effect and traditional healers want to be called ABALAPHIBOMDABU (traditional healers), not witchdoctors (Mpumalanga)
• THs should be represented in parliament or Government (Mpumalanga)
• THs request workshops on Primary Health Care in order to work hand in hand with health workers (Mpumalanga). THs should become acquainted with western thinking in medicine and vice versa.
• Cleanliness and sterilisation should be promoted (W. Cape)
• THs want to be helped by the Government to improve their surgeries, to be allocated wards in hospitals, and to be provided with a meeting place (Mpumalanga, N. Province)
• Where necessary, patients should be given ‘pass-outs’ from hospital so that they can receive treatment from traditional healers (Mpumalanga).
• The rights and well-being of patients and especially children must be seriously addressed (Gauteng)
• Land should be made available for growing traditional medicines (N. Province). Collaboration between Inyangas’ Associations and the Parks Board should be encouraged, to enhance nature conservation and establish healing gardens and farming projects (KwaZulu- Natal).
• THs should benefit from the sales of traditional medicines.
• The Government should deal with the issue of non South African citizens organising in the province (N. Province).

3.2.2.The NCOP report summarises the recommendations of the provincial reports as follows:

1. The Government should formally recognise the role of traditional healers.

2. A Traditional Healers’ Council should be established with powers equivalent to the South African Medical and Dental Council. This Council should:

   • facilitate co-operation among traditional healers, medical professionals and the government
   • set up norms, standards and training procedures with regard to the practice of traditional healing
   • establish an accreditation process for traditional healers
   • develop mechanisms to curb abuse of medical certificates issued by traditional healers.

3. Some form of standardisation of traditional healers should take place, coupled with education and training programmes.

   Registration and co-ordination of the activities of traditional healers should take place at provincial level.

   There should be recognition of and access to traditional healers under the Medical Schemes Act.

4. Some issues raised in the reports

The consultation process so far has been led by the provinces. This has allowed many members of the public and interested stakeholders to participate in hearings, especially traditional healers, who often practice in rural areas. The challenge facing the National Assembly Portfolio Committee will be to make sure that the recommendations it makes reflect these views. Will it support recommendations for an interim body which could pave the way for closer consideration of the issues raised? Will it recommend that traditional healers be allowed to issue medical certificates and be covered by medical aid schemes?The committee will then be responsible for monitoring the way in which the Department of Health carries its recommendations forward, in terms of policy development, and implementation. If this process is shown to be successful, could it be used as a model for clarifying the role of community health workers in the national health system?

Providing an enabling policy and legislative framework should be a step towards integrating traditional healers into the national health system. Efforts will then need to be made to create an environment of trust and respect between traditional healers and conventional biomedical professionals as a precursor to greater collaboration and mutual referral.

5. The Way Forward

Hearings are likely to be organised by the National Assembly Portfolio Committee after the parliamentary recess, in early October. The Committee Clerk, Janine Forster, can be contacted for details at (021) 403 37 38.  

For more information, please contact Jane Mathieson at (021)696 4873 or by e-mail at philaw @wn.apc.org. PHILA is supported by a grant from the Henry J. Kaiser Family Foundation.

PHILA

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