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Do 80% of S. Africans regularly consult traditional healers? The claim is false

Comments 11

Africa Check republished this report on 05/12/13 after South Africa’s Supreme Court of Appeal cited in a ruling in late November the claim that “up to 80 per cent of South Africans” rely on traditional healers. The earlier version of the report can be seen here.

Do 80% of South Africans regularly consult traditional healers? Do most black South Africans choose traditional healers over medical doctors and primary healthcare facilities? The claims are false.

Researched by Kate Wilkinson

Do 80% of South Africans regularly use traditional healers? And are sangomas the first point of medical contact for 80% of black South Africans? It is a claim that crops up with some regularity but is never substantiated with any hard data.

Earlier this year, for instance, the BBC News website carried an article about traditional healers in South Africa which claimed that sangomas “remain the first point of contact for physical and psychological ailments for about 80% of black South Africans according to authorities”. Which authorities, the article didn’t say.

A 2012 article in the South African Medical Journal went further, suggesting that “some 80% of South Africans use traditional medicine to meet their primary healthcare needs”. The claim has also been made in general terms about the population of Southern Africa and the African continent.

The roots of the claim

So where did the claim originate and is there any truth to it?  GroundUp, a South African community journalism project, asked us to investigate. 

Our starting point was the World Health Organisation (WHO). A fact sheet on traditional medicine published by the body in 2008 is often cited when the claim is made. “In some Asian and African countries,” it states, “80% of the population depend on traditional medicine for primary health care.” The fact sheet does not include any evidence to substantiate the statement.

However, the fact sheet does contain a link to the WHO’s Traditional Medicine Strategy 2002–2005. Perhaps the answer could be found there?  In the document the World Health Organisation claims – without providing a reference – that “in Africa up to 80% of the population uses TM [traditional medicine] to help meet their health care needs”.

Later in the document it states that “about 80% of the population of African Member States use TM to help meet health care needs”. For this claim it references another WHO publication: Promoting the Role of Traditional Medicine in Health Systems: a Strategy for the African Region 2001–2010.

The first source of healthcare

In this document, the WHO repeats the claim: “The World Health Organization estimates that 80% of the population living in rural areas in developing countries depend on traditional medicine for their health care needs.” The report refers to a book called Traditional Medicine and Healthcare Coverage, which was published by the WHO in 1983. The book is also referred to by other WHO reports, including a 2001 progress report on traditional medicine in the African region which again states: “Traditional medicine is the first source of health care for about 80% of the population in developing countries”.  Could the book hold the answer?

After hunting high and low, Africa Check finally managed to track down a copy in the University of the Witwatersrand Medical School library. And there it was: Chapter 28 – The role of traditional medicine in primary health care. It was written by Robert Bannerman, who served as WHO regional advisor and at one time managed the WHO’s traditional medicine programme.

On page 320, Bannerman wrote: “In many of these developing countries primary health care devolves on the healer, herbalist, traditional midwife, and other traditional practitioners. These are the health workers that offer services to the disadvantaged groups that total about 80% of the world’s population and have no easy access to any permanent form of health care.”

A 30-year-old claim

The trail ends there. Bannerman provided no evidence, no references and no data to support his claim. But somehow, like many such claims, it took on a life of its own. The WHO’s propensity to recycle research in report after report may have helped.

The only thing that has changed over the past three decades is the wording used by those making the claim. While the 2008 fact sheet states that in some Asian and African countries, 80% of the population is dependent on traditional medicine for their primary health care, the Traditional Medicine Strategy document suggests that 80% of the African population uses traditional medicine to “help meet their health care needs.” The 2011 progress report claims that “traditional medicine is the first source of health care for about 80% of the population in developing countries”.

Nicoli Nattrass, a professor of economics and director of AIDS and Society Research Unit at the University of Cape Town, told Africa Check that she had also tried to track down the source of the WHO’s claim. “I agree that the use of traditional healers is vastly exaggerated… And the much cited number of 80% of Africans using traditional medicine cannot be linked to any survey.  Both I and [another researcher] tried to source data for that claim, including writing to the WHO, and neither of us got anywhere. Yet that claim continues to be cited.”

Africa Check contacted the WHO’s Zurich media office for comment. We were asked to email our questions to them. They subsequently referred our query to the WHO regional office in Africa. We have yet to receive a response.  Our questions to the WHO’s South African office have also gone unanswered.

How many South Africans visit traditional healers?

A 2011 General Household Survey found that while 70.7% of South African households favoured public clinics and hospitals, almost a quarter (24.3%) of households said they would first consult a private doctor. The least favoured options were traditional healers (0.1%) and pharmacies (0.3%).

Further analysis showed that 81.3% of black South African households first consulted public sector health facilities, 17.2% first consulted private sector health facilities and only 1.5% first consulted “other” health facilities, which include spiritual healers and traditional healers. Interestingly, 1.5% of white South African households reported that they consulted “other” health facilities first.

These statistics disprove the claim that 80% of black South Africans will first seek the assistance of a sangoma for health care. Contrary to this claim, surveys show that most black South Africans will first seek care from a public health facility.

It also clearly shows that the WHO’s claim that “traditional medicine is the first source of health care for about 80% of the population in developing countries” is not applicable to South Africa. Surveys show that about 70% of the South African population use public health facilities as their first source of health care.

“Low traditional healer utilisation rates”

The 2003 South Africa Demographic and Health Survey, published by the South African Medical Research Council and the Department of Health, asked respondents if they had consulted a traditional healer in the last 30 days. Out of 8,115 respondents, 5.2% reported to have sought care from a traditional healer and 6% reported to have sought care from a faith healer. 38.6% of respondents reported consulting with a public sector health facility, 29.7% reported consulting with a private sector health facility and 12.3% consulted a pharmacist.

A study published in 2011 found “relatively low traditional healer utilisation rates” among the 21,593 household members surveyed. Only 1.2% of the survey participants reported using traditional healers in the last month. In black households this figure increased to 1.4%. The study also found that: “Concurrent use of traditional and allopathic providers is common: more than half the people who visited a traditional healer in the previous month had also used allopathic services.”

Similar findings have been recorded in Nigeria. A Comparative Assessment of Herbal and Orthodox Medicines in Nigeria found that “… only 41% of the respondents took herbal medicines as their first drug of choice. This is contrary to the widely held view in literature that 80% of the population in developing countries takes only herbal medicines”.

Conclusion – The claim is unsubstantiated and false

The claim that 80% of South Africans – or 80% of black South Africans – use traditional healers as their primary source of health care is unsubstantiated. Surveys conducted in South Africa clearly show that the first source of health care for most South Africans remain public health-care facilities. This is also true of the black South African population.

The exaggerated claim can be traced back through a number of WHO documents which unquestioningly recycle the statement made by Bannerman in 1983.  Unfortunately, it is the claim’s association with the WHO that lends it such credibility.

Edited by Julian Rademeyer

Update: South Africa’s Supreme Court of Appeal has cited the claim that “up to 80 per cent of South Africans” rely on traditional healers for their “physical, spiritual and emotional well-being” in a landmark judgment which found that a sick certificate from a traditional healer has the same standing as certificate from a qualified medical doctor “for the purposes of sick leave”.

The judgment, which was delivered on 29 November 2013, and reported in The Times newspaper on 5 December 2013, stated that it is “beyond dispute…that as part of these belief systems people resort to traditional healers for their physical, spiritual and emotional well-being”. It continued: “The World Health Organisation (WHO) observes that up to 80 per cent of South Africans meet these needs through the use of traditional medicine…”

The claim is false. Africa Check debunked it in this report - first published on 31 July 2013.

The court's reliance on this apocryphal story is an example of how unsubstantiated claims can have far-reaching consequences if repeated blindly. 05/12/13.

© Copyright Africa Check 2013. You may reproduce this report or content from it for the purpose of reporting and/or discussing news and current events, subject to providing a credit to "Africa Check a non-partisan organisation which promotes accuracy in public debate and the media. Twitter @AfricaCheck and www.africacheck.org".

Comment on this report

Comments 11
  1. By Margaret

    I wonder how the latest research was conducted? If only health care was wanted, you may find that clinics are popular. But what about other things? to get strength before and interview? To find out who caused someone’s bad luck? Sangomas are not only healers. They have other, social functions too

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  2. By Sinethemba

    I just thought about this article when I heard the news today the the Supreme Court (SCA) has basically ordered employers to accept sick notes from traditional healers. According to the Times article the court cited this very claim of 80%. Making decisions on bad stats or information, often repeated until believed to be factual, can have major consequences.

    http://www.timeslive.co.za/thetimes/2013/12/05/healers-on-par-with-mds
    “Noting that 80% of South Africans met their “physical, spiritual and emotional wellbeing” needs through the use of traditional medicine, the court held that a traditional healer’s sick note should be considered the equivalent of a doctor’s.”

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  3. By TM

    I guess I would have to ask exactly who was surveyed, how the survey was conducted, and who conducted the survey. I do believe that in rural areas the traditional healer is the first point of contact—particularly for minor ailments. If this survey focused on urban, more well to do South Africans, then the results are what one would expect.

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  4. By Peter Mansfield

    Well done. Keep up the good work. We need a lot more fact-checking in South Africa.

    It is interesting how urban (and rural) myths once planted by an “authority” live one and on.

    I recall an Urban Foundation error in the 1980′s that led to the organisation describing Durban as the “second fastest growing city in the world”. The myth lived in for decades.

    I suggest that at least in part, this phenomenon is caused by newspaper editorial writers continually referring back to what they wrote last time, and then recycling it.

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  5. By @SigRandburg

    Ask SA’s biggest employers what percentage of their recognised “sick notes” come from “traditional healers” instead of real doctors.

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  6. By Africa Check

    Thanks Shaun. In answer to your question, traditional surgeons would be included in the broad category of traditional practitioners. However initiates undergo ritual circumcision, not as a result of an illness, but as a cultural practice.

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  7. By Africa Check

    Stuart, thank you for your comment. We stand by our report.

    We would question how a limited study done in the 1970s in Kwazulu-Natal could possibly be extrapolated to refer to South Africa as a whole in 2013.

    Also, if the numbers of South Africans who consult traditional healers are as high as you claim, why do so few report visiting traditional healers in the Statistics South Africa general household survey? Surely the survey figures would be much higher, even if a large number of people were reluctant to divulge details of treatment?

    Another survey, which asked respondents if they had visited a traditional healer in a particular month, found that 5.2% reported to have sought care from a traditional healer and 6% reported to have sought care from a faith healer. Although higher than the 2011 household survey results, they are nowhere near the figures you suggest.

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  8. By Shaun

    As a matter of interest, would circumcision schools fall into the category of “traditional healers”?

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  9. By Letsonya Kgomo

    WHO must substantiate their claim, if they can’t, it will mean every thing they have ever published is far from the truth

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  10. By Africa Check

    Thank you for your comment, Leif. You raise some very interesting points.

    For the sake of clarity, our research looked primarily at the BBC’s claim and the WHO’s multiple claims, which linked traditional healer usage and primary health care. However, the 2011 study we cited did acknowledge that concurrent usage of traditional healer and allopathic providers was common.

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  11. By Spokes

    It is still a tradition for a vast majority of South Africans in rural areas to consult traditional healers. It is different in urban areas where people view themselves as “civilised” and thus use Western medication. Another factor is the availability of clinics and hospitals in rural areas which is still a challenge for the government. – See more at: http://www.africacheck.org/reports/do-80-of-south-africans-regularly-consult-traditional-healers-the-claim-is-false/#sthash.3glbQcaE.dpuf

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