Subscribe to reports

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

Comments 9

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. And as we discovered, with a little sleuthing, they stem from a book published thirty years ago.

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

© 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 9
  1. 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.

    +1
    -2
    vote
  2. By @SigRandburg

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

    +2
    0
    vote
  3. 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.

    vote
  4. By Shaun

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

    vote
  5. 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

    vote
  6. By Stuart Thomson

    Hello All

    My apologies for breaking up the party, but the recent celebrated report, titled: “Do 80% of South Africans regularly consult traditional healers?” and in particular its cheeky conclusion, that: “The claim is unsubstantiated and false”, is itself unsubstantiated and false and as such is a case of the pot calling the kettle black..

    Kate Wilkinson’s research is fatally premised upon her now also oft repeated claim that the myth of 80% population consultation with and preference for Southern African traditional healers originates from an unsubstantiated and ill-repeated WHO statement.

    Whilst the “about 80%” figure used by the WHO is the most cited for its deemed authority, Kate’s assumption that because that did not in turn cite a reference to evidentiary data, it is unsubstantiated, is tantamount to asking which came first: the chicken or the egg, since a source need not cite ever further references if it is itself the source of the estimate.

    That said, a call for data based on evidence is certainly not unreasonable. Such information might conceivably be archived and because it cannot be readily retrieved 30-years later, does not per se render the phenomenon unsubstantiated, nor the estimate “false”. Indeed, the fault may well lie with the capabilities or intentions of the sleuth.

    Whilst I cannot vouch for the WHO, I can do so for myself.

    I co-authored (Popat A, Shear N, Malkiewicz I, Stewart M, Steenkamp V, Thomson S, & Neuman M) a peer-reviewed paper (“The toxicity of Callilepis laureola, a South African traditional herbal medicine”. Clinical Biochemistry 34 (2001) 229–236) for which I researched and wrote the introduction (and provided the botanical samples for experimental analysis).

    In the second paragraph thereof (http://www.gaiaresearch.co.za/Assets/Images/Pdf/impila.pdf) I stated:

    “IN SOUTH AFRICA, IT IS ESTIMATED THAT BETWEEN 60 TO 85% OF THE NATIVE POPULATION USE TRADITIONAL MEDICINE”.

    The lower estimate was referenced by me to Van Wyk B, Van Oudtshoorn B, & Gericke N (“Medicinal plants of South Africa”. Briza Publications, 1997). This source was unsubstantiated by any reference or data.

    The higher estimate was referenced by me to Wainwright J & Schonland M (“Toxic hepatitis in black patients in Natal”, South African Medical Journal 51(1977) 571–3). This source, however, is definitive.

    Whilst my research interest is focused on estimating mortalities, my own 85% usage estimate is substantiated by sufficient hard data from which to reasonably extrapolate to the South African population as a whole.

    In this regard, bearing in mind that no mandatory statute of limitations applies to the vintage of a reference of this nature, which substantially pre-dates the WHO references, I quote from one likely root of the estimate:

    “Over the past 17 years the Department of Pathology of the Durban Medical School has carried out some 20,000 necropsies on Black subjects over 1 month of age. During this period 383 deaths were directly attributable to acute liver necrosis. In 235 cases the lesion was a diffuse centrilobular zonal necrosis.”

    “In cases of zonal necrosis the symptoms relating to liver disease are of short duration, jaundice is mild or absent, and the history may reveal the administration of a herbal remedy. For these reasons we have come to the conclusion that primary centrilobular zonal liver necrosis is of toxic origin.”

    “Apart from the medico-legal cases, the necropsy rate in recent years has been only 23% and since many cases of toxic liver necrosis have been unsuspected clinically, there is no doubt that many deaths due to this cause remain undiagnosed.”

    “When this department undertook the histopathological investigations at all hospitals in Natal, it became evident that many such deaths were erroneously ascribed to cardiac failure. Careful history-taking may reveal that a herbal remedy has been administered.”

    “IT IS KNOWN* THAT ABOUT 85% OF ADULT ZULUS ADMITTED TO OUR HOSPITAL HAVE CONSULTED WITCHDOCTORS BEFORE ATTENDING THE HOSPITAL, AND THAT CONSULTATION OF TRADITIONAL PRACTITIONERS SUCH AS INYANGAS, ISANGOMAS AND HERBALISTS IS WIDESPREAD.” (*A Zulu staff member, Mrs S Ngcobo, carried out the sociological investigations)

    “However, patients and relatives are reluctant to divulge details of any previous treatment when questioned by a doctor, so that, while for many years we have suspected herbal intoxication, we have failed singularly in the past to discover which toxic plants have been used.”

    “Callilepis laureola root was identified at the Natal Herbarium and aqueous extracts produced liver necrosis in rats. “

    My Comments:

    Here you have a realistic estimate in excess of that quoted as the WHO, published by eminent country-specific authorities (both are highly qualified medical researchers, professors and the lead author, Head of department) and based on hard data published several years before Bannerman’s referenced 1983 WHO publication. I would hazard to suggest that Wainwright and Schonland are likely, at least partly, a source of the WHO figure of 80%.

    Clearly, in light of the above, the 80% figure is not unsubstantiated nor false.

    The additional data-collecting efforts cited by Wilkinson are laudable, but are seriously limited by a well-acknowledged reluctance by individuals, families and communities to divulge details of their traditional health practices, in particular when a suspicion of bias, ridicule or suggested ignorance or worse, culpability, is raised, even indirectly during such queries.

    I trust that this communication informs and advances the debate and thereby, our appreciation of the magnitude of potential morbidities and mortalities arising from the true extent of this ethno-socialogical phenomenon, which ought not to be trivialised for any political or pecuniary agenda.

    Yours sincerely

    Stuart Thomson
    Director, Gaia Research Institute, Knysna

    +1
    0
    vote
  7. 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.

    vote
  8. By Leif Petersen

    Your investigation raises an important point i.e.: “that 80% of South Africans use traditional healers as their primary source of health care is unsubstantiated”. This is no doubt correct, but I would argue more broadly that linking traditional healers with primary health care and comparing their role to western trained medical doctors is in many respects disingenuous.

    My issue here is the conflation of services of traditional healers as givers of ‘primary health care’. Simply comparing the services of medical doctors and traditional healers is overly simplistic – for whilst both treat human conditions, they largely operate in quite different domains – with traditional healers critical in serving cultural demands that “western medicine” does not address. This article and much of the research within it considers GP and traditional healer services as largely competitive with each other. Conversely I would argue that BOTH serve essential roles in South African society and comparing one against the other is not necessarily useful.

    In my PhD research on this topic consumers make very clear distinctions between ‘medical’ problems and ‘cultural’ problems. Of the 219 Black respondents I questioned in a household study of their last 12 months of activity, 68% reported visiting a clinic, 50% visited a traditional healer, 30% visited both a traditional healer and a clinic, and 62% reported using traditional medicine in the period.

    To demonstrate the extent of non-competitiveness between the family GP and traditional healers, in my research, of the 19 traditional medicines of greatest consumer demand, 17 were reportedly used for cultural ailments, including enhancing luck in love and careers, appeasing ancestors, and avoiding problem situations. These social / cultural circumstances cannot be resolved in a 15 minute consultation with a GP or a script from the pharmacist.

    I think many of the issues around mixing these two quite different professions together result from poor questioning and much misunderstanding. The 2011 General Household Survey by Stats SA asks participants whom they would consult in case of ‘illness’. To me, the term ‘illness’ brings to mind a physical condition of being unwell for which I would go to the doctor (thus the very low 0.1% who claim to visit a traditional healer if they are ill). This makes sense as traditional healers are not primary health providers. Only if there was a question in the survey that asked about ancestor worship, or even about issues of a more psychological nature would the true role of traditional healers be revealed.

    So, whilst the figure of 80% of South Africans visiting traditional healers as primary health care is indeed false, I believe that the premise of the article and some of the research that feeds a misleading debate in link-making between primary health care (clinics and GPs) and cultural health services (traditional healers) which are actually two quite separate activities.

    +1
    0
    vote
  9. 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.

    +1
    -1
    vote

Your email address will not be published. Required fields are marked *

*

*

Africa Check encourages frank, open, inclusive discussion of the topics raised on the website. To ensure the discussion meets these aims we have established some simple House Rules for contributions. Any contributions that violate the rules may be removed by the moderator.

Contributions must:

  • Relate to the topic of the report or post
  • Be written mainly in English

Contributions may not:

  • Contain defamatory, obscene, abusive, threatening or harassing language or material;
  • Encourage or constitute conduct which is unlawful;
  • Contain material in respect of which another party holds the rights, where such rights have not be cleared by you;
  • Contain personal information about you or others that might put anyone at risk;
  • Contain unsuitable URLs;
  • Constitute junk mail or unauthorised advertising;
  • Be submitted repeatedly as comments on the same report or post;

By making any contribution you agree that, in addition to these House Rules, you shall be bound by Africa Check's Terms and Conditions of use which can be accessed on the website.

*