Calling for cross-sector engagement with traditional health practitioners in South Africa

Traditional health practitioners (THPs) are recognised for their roles in maintaining indigenous knowledge and cultural practices, and providing healthcare in local communities, however they have received less recognition as custodians of the environment. Representations of THPs being responsible for wildlife losses has resulted in perceptions that the traditional health and conservation sectors are working in opposition. We argue that THPS are underrepresented in environmental governance and need to be included in conservation decision-making. A two-day workshop with South African THPs was held to explore the role THPs can play in wildlife conservation and reducing wildlife consumption. Our findings highlighted THPs’ roles in communities, misconceptions hindering trust and collaboration with the conservation sector, the importance THPs place on biodiversity and environmental protection. Workshop attendees wanted greater communication and collaboration between THPs, conservationists, and decision makers; and to be recognised as environmental custodians and rectify misconceptions regarding wildlife product usage. In this short communication we aim to open important dialogues between the THPs and the conservation sector in South Africa and advocate for a more collaborative way forward in conservation decision making.

Introduction

The United Nations World Health Organization (WHO) defines traditional medicine as “the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, used in the maintenance of health and in the prevention, diagnosis, improvement or treatment of physical and mental illness”, and encourages countries to develop their traditional medicine (WHO, 2024, 2020). In South Africa, the service provided by traditional health practitioners (THPs) is particularly important for black communities, often as first caregivers, as 72-80% of black South Africans seek treatment from them (Groner et al., 2022; King, 2012; Van Wyk, n.d).

An Interim Council of Traditional Health Practitioners of South Africa (ITHPC) was established under the Traditional Health Practitioners Act, 2007 with the objective to formalise and professionalise traditional health services and promote interest through research, education and training. The ITHPC serves as a regulatory body with an estimated 200,000 active THPs in South Africa (Zuma et al., 2016), although a comprehensive national register of THPs is absent.

THPs are recognised for their roles in maintaining cultures and indigenous knowledge, but have received less recognition as environmental custodians (Mathibela et al., 2015; Zuma et al., 2016). Media articles, particularly, tend to ascribe wildlife losses to traditional medicine practices (Carnie, 2022), possibly due to a combination of limited public understanding of the use of traditional African medicine (King, 2012), narratives by some wildlife authorities (Segawa, 2016), and attention on the conservation decline of certain high-profile species used in traditional medicine in South Africa and beyond (Soewu et al., 2019), such as the decline of pangolin populations linked to their commercial exploitation for traditional Chinese medicine (Wang et al., 2023). South African traditional medicine ingredients include wild animal and plant species, and the percentage of local communities utilising THP services can lead to the consumption of unsustainable quantities. Groner et al. (2022) estimated that annually more than 70,000 tonnes of plant material is consumed for this purpose in South Africa.

Despite growing recognition of the importance of collaborative knowledge generation with the engagement of multiple stakeholder groups in the pursuit of solutions to complex problems such as the ongoing biodiversity crisis (Gerlak et al., 2023), and the THPs as an important stakeholder given the sector’s consumption of wildlife, conservation decision making in South Africa is primarily undertaken by professional conservationists and wildlife management authorities to the exclusion of local and indigenous communities (Holmes-Watts and Watts, 2008). Calls to include Traditional Ecological Knowledge (TEK) (Mekonen, 2017) in biodiversity decision making have increased due to recognition of valuable knowledge contributions (IPBES, 2019).

Following such calls to acknowledge and address the inclusion of South African THPs in conservation stakeholder dialogues, a two-day workshop was co-hosted by Organisation A and Organisation B/C in Johannesburg in November 2023 to initiate engagement with this key stakeholder group on conservation issues. Critical questions explored included the role of THPs in South Africa, their regulations and knowledge exchange as well as how wildlife products are used in practice and future adaptations for product usage. We outline the main findings of the workshop and advocate for a more collaborative way forward in which THPs are further recognised as environmental stewards and custodians.

Methodology

The initial objective for the workshop was to understand South African THPs’ wildlife usage and bring together multiple stakeholders including THPs, conservation organisations, wildlife management authorities to identify possible wildlife conservation collaborations. However, after reviewing the limited existing relations between the THPs and the authors’ organisations and the even more limited existing relations between the THPs and other conservation stakeholders, it was decided that a workshop engaging only with THPs would better act as a pilot for future cross-sectoral engagement, encourage more open and honest discussions to obtain a better understanding of the landscape of THP work in South Africa and their wildlife product usage. This resulted in a more focused participant recruitment.

THPs were invited through Organisation A’s established contact with members of the THP community and expanded using a snowball method in which the established contact sent a request for participation to their network. The sample included 22 THPs with wide-ranging expertise (from trainee THPs, to emerging THPs with less than 10 years working experience, and senior practitioners) from urban and rural backgrounds from six of the nine South African provinces. All interested individuals were provided with an information and consent form via email and/or WhatsApp, and confirmed their consent before and at the start of the workshop.

The exploratory workshop aimed to develop an open and cooperative relationship and obtain a better understanding of the role THPs can play in wildlife conservation and reducing wildlife consumption. The COM-B model posits that behaviour is influenced by the person’s capability, motivation and opportunities (West and Michie, 2020). A semi-structured group discussion guide was prepared (Appendix A) to map out the following:

● The environmental and social context of THPs’ practices including relevant policies and regulations.

● The THPs’ knowledge about wildlife species and how such may be used in their practices.

● The THPs’ views on the sourcing of wildlife including the captive breeding of wildlife, especially the captive breeding of lions in light of current government processes to phase out the commercial captive lion industry (Chetty et al., 2024).

● Motivation factors for potential changes in THPs’ usage of wildlife and their active participation in conservation, such as their role and identity, intentions and beliefs about consequences.

These discussions were audio recorded and transcription notes were taken by two researchers in attendance. Sections that directly addressed the points above were transcribed verbatim. The texts were coded using thematic analysis to extract commonalities across the dataset with the aid of NVivo14 software. The coding and themes were cross-checked between the first two authors for consistency.

Findings

THPs’ roles in South African communities

The THPs identify with multiple roles, including doctors, counsellors, and as an integral part of cultural beliefs, traditions and values. Traditionally, THPs were respected and seen as authorities of culture and the environment, but many THPs at the workshop felt they had lost this respect and authority.

“There is a huge fundamental role that THPs play, and there is a place where Christianity or Westerners does not get to, particularly for a black child … we are the see-ers, we are the psychologists, we are the psychiatrists, we are the pharmacists, we are the doctors. We are the persons that encapsulates all that.” (Female THP 1)

“THPs are the first point of contact as far as health issues are concerned … we need to understand that black people are still very much in touch with their cultures, cultural beliefs and their norms. We are a very crucial, integral part of that, and hence we become the first point of contact.” (Male THP 1)

“We have lost our position as the authority of culture, of the environment, of just being who we are supposed to be, which is the people in the community who are respected.” (Female THP 2)

Becoming a THP is not a career choice. Individuals are chosen by their ancestors through “the calling” for having a special gift. Hence, the specialisation of individual THPs varies widely, making the sector diverse and complex. Nevertheless, all THPs share the purpose to heal, guard the environment, and guide people:

“You are governed by those who have been before you, and whatever gifts they bring down upon you. That is why each person will be a different type of healer. But the umbrella is that you are meant to heal.” (Female THP 2)

Attendees strongly identify THPs as guardians of the environment:

“We are the ones who are the custodians of the environment.” (Female THP 3)

“Animals are getting extinct, which is not what we stand for, you understand, anything that is getting extinct or being overused. We are actually the custodians of nature.” (Male THP 2)

Misconceptions regarding THPs

There was a strong perception of injustice, including resentment amongst the participants. The THPs felt disregarded by the government on issues including environmental protection. The negative impacts of colonialism were highlighted, including how the declaration of traditional medicine as witchcraft caused the loss of knowledge, stigma against THPs, and the decline of practices.

“We have been put and shut into corners … In 1978, a resolution was taken that all the African Union Member States ought to start processes to facilitate the application and usage of traditional medicine, and they must develop an indigenous knowledge system charter. Today, we’ve got the IKS suddenly hosting whatever it is that they’re hosting and yet we are the custodians of the indigenous knowledge systems, we are not involved…” (Male THP 1)

“1958 [1957], Witchcraft Suppression Act, that was a monster … That law was so heavy, it was horrible, it was hell. Because it was really monitored,and you will be prosecuted, you will be banned, and I mean BANNED. It was hell.” (Male THP 3)

Several attendees stated that THPs have been unfairly blamed in the context of wildlife product consumption and illegal trade. THPs wanted to send a clear message to the conservation sector and the public that they are not villains and want to influence people to respect and protect nature.

“THPs have been painted with a very wrong brush, that we are the monsters that are finishing the animals and things like that. And we are not.

… Most of the time, many of us don’t even have access to these animals. Zero access … I have never seen a THP with a rhino horn, I don’t think they even know how that thing is. But when the rhinos are diminishing, the THPs would be at the forefront of being accused.” (Male THP 3)

The importance of the environment and wildlife use

A majority of attendees were highly concerned about pollution and the decline of wildlife.

“We lack respect for our environment. It shows in things like littering … Remember it’s a give and take. As much as you need those plants from the soil, respect the soil so it can give you the plant.” (Female THP 2)

As users of natural ingredients, attendees want to conserve wildlife partly to sustain their practices:

“…it will be very sad if in the next decade or two, there will be no lions any more. So we need to protect, it is our responsibility as THPs, we are the users. We need to be part of it, in terms of protecting and conserving, so that tomorrow we are able to get the supplies.” (Male THP 4)

And they want to conserve wildlife partly because wild animals are traditionally considered sacred and reincarnations of ancestors:

“In African beliefs it is that when one soul leaves, it finds a new home and it can be an animal, which then comes back to us.” (Female THP 4)

THPs do not consider themselves significant consumers of wild animal species. Animal parts can be kept and used over a long time and often passed down generations. Certain species, such as the African lion (Panthera leo), are reserved for royal use and only on special occasions.

“[talking about the bone bag] But if you are lucky, then it gets passed down to you. So it gets passed down from your grandparents, your parents, and you will pass it down” (Male THP 3)

“We don’t use it [lion] very often. As much as you can use it for royals, you don’t use it very often. Because I think we are the least consumers of the lions.” (Male THP 5)

Furthermore, the use of lion derivatives is limited in quantity. One THP referred to a small jar of lion fat:

“If I have this lion [fat], I can use it for a year or more.” (Female THP 5)

An important tool used by THPs is the bone bag containing a specific set of bones from terrestrial and aquatic wildlife. Species can include lion, leopard (Panthera pardus), cheetah (Acinonyx jubatus), elephant (Loxodonta africana), hyena (Hyaenidae spp), aardvark (Orycteropus afer), monkeys (Cercopithecidae spp), antelopes (Bovidae spp), Nile crocodile (Crocodylus niloticus), tortoises (Testudinidae spp), and certain seashells. The exact bag composition may differ between individual THPs and regionally.

“We use quite a lot of animals. We have a THPs’ bag of bones … The bones are used for diagnostics … [proceeds to list the animals].if you are in Eastern Cape, you may then not be using the bones of the ocean animals that are not found there. You will find that you have alternatives. You may not even use the bones, you may use bone lookalikes, structures from plants, or other elements in the ocean.” (Male THP 3)

The attendees recognised that sellers of muthi (traditional medicine ingredients) are unregulated and constitute a problem for the THP and conservation sectors. Some voiced concern that THPs often do not know the source and authenticity of the muthi sold, which is important to its healing properties. The attendees expressed interest in collaborating with conservation organisations to map how wildlife are currently extracted for muthi, and to help regulate the muthi supply chain to ensure sustainable and legal practices.

“Many animals and plants may be taken without people following proper handling processes. Especially bones, animal skins etc are mostly sold, those sellers should be part of this [forum/discussion] to engage them … Who are taking the bones, and skins, and bark and muthi, selling them to the traders who sell them to us? And we don’t know the process of people bringing the muthi to the market.” (Female THP 6)

How THPs view the captive lion breeding industry

Only two THPs stated they had benefited from the commercial captive lion breeding industry in South Africa. THPs overall did not view the captive lion industry as beneficial to the country and local communities, though some THPs saw the government’s intended closure of the industry as an opportunity to access lion products, in particular the more scarce products. They disagreed with selective and inbreeding practices, as changing the lion gene pool was considered unnatural and unethical.

“I am very happy that we have started embarking on the journey of phasing out the issue of captivity. We should never at any given point in time look and view nature as a point of profiteering. ‘Cause that for me becomes a drive for greed, and that’s when we start killing and stealing and doing all the funny stuff. We are the custodians of nature, we can never find joy from an opportunity of creating an economy out of such.” (Male THP 1)

Discussion

The findings corroborate existing literature on the integral role of THPs in the continuation of important cultural practices (Mathibela et al., 2015; Zuma et al., 2016) and providing a necessary point of contact for those seeking guidance on physical, mental and spiritual matters (Thobakgale et al., 2024). The THPs’ strong identification as custodians of not only culture but the environment, and their connections with local communities make them a valuable stakeholder group to mobilise community-based conservation efforts.

When exploring the environmental and social context of THPs’ practices, significant time was taken up by the attendees to voice their frustration over repeated stigmatisation of THPs through legislation and media reports. This resulted in a lack of time to cover some of the questions in the prepared guide such as those on reducing the use of wildlife or changing to substitutes, but the authors felt it was important for the long-term engagement with this stakeholder group to allow them to speak freely. The grievances voiced by the attendees reaffirms the hurdle of creating trust between THPs and other conservation stakeholders when the THP community is often overlooked in national and international strategies on biodiversity protection and sustainable development (Xaba et al., 2022; Chebii et al., 2020). To progress towards collaborative, multisectoral efforts to preserve biodiversity, targeted efforts by policy makers, conservation organisations and other stakeholders to reduce alienation and encourage THP participation are desirable.

Biodiversity loss reduces climate resilience, while climate change and pollution are causing millions of deaths globally (Ihsan et al., 2024). As such, any overexploitation that threatens the survival of wildlife species undermines traditional medicine’s goal to improve human wellbeing. Despite the fact that the attendees were unanimous in their belief that each THP only uses small quantities of wildlife products, the large number of active THPs in South Africa suggests the quantity of wildlife products consumed by the sector can be significant (Nieman et al., 2019). Attendees recognised that little is currently known about the scale and nature of the muthi trade, how wildlife products are sourced, making this a topic of further investigation. This became important in light of poaching for species like vultures (Mashele et al., 2021), and the sourcing of products from captive-bred lions - which may be considered impure and undesirable by the THPs. While only two THPs stated they had benefited directly from the captive lion industry (Green et al., 2022), there may be a reporting bias, and it is possible that some attendees have benefited unknowingly given the limited knowledge of the source of the muthi sold at markets. Research and engagement with muthi traders remains crucial for wildlife conservation and the sustainability of THP practices, as buying from markets is often the only option for THPs to obtain muthi even though this may not be desirable, ethical, sustainable or legal.

Our findings are limited by the small sample size of the workshop attendees, however, it provided some important insights. With reportedly over 200,000 THPs (Zuma et al., 2016) across South Africa, future research would benefit from expanding the sample size and scope. This workshop primarily focused on the usage of wildlife products, especially from lions, but may be expanded to include further fauna and flora. It became evident that the THPs wanted solutions regarding the unregulated nature of the sector, lack of consultation in policy decisions, and the lack of recognition. These issues were outside the scope of the two-day workshop and warrant further attention. We hope to be able to build on the relations from this workshop to conduct follow-up research and workshops to further develop relationships between THPs, the conservation sector and decision makers to improve conservation impacts in the future.

Despite limitations, the workshop elicited valuable lessons in collaboration and engagement across sectors for the benefit of protecting biodiversity and cultural practices. Desired future collaborative steps include forums for regular exchange between THPs and stakeholders on environmental issues and dispelling misconceptions regarding THPs’ environmental impacts, and facilitated engagement with South African policy makers for more effective regulation of the THP sector and management of natural resources.

Conclusion

The findings suggest that significant gaps remain in the inclusion of stakeholders in current efforts of wildlife protection and addressing the loss of biodiversity. The THPs highlighted a desire and need for effective, genuine collaboration between their community and the conservation sector towards the mutually beneficial goal of environmental protection. In turn, this would significantly promote the voices of THPs in decision-making spaces regarding policy and legislation in South Africa.

The THPs identify themselves as guardians of the environment and view wildlife not as commodities, but as having an inherent value important to South African cultures. Collaboration across the THP and conservation sectors may facilitate the integration of knowledge and promote recognition of the diversity of traditional cultures in South Africa.

Cross-sector engagement between wildlife conservation and THPs is beneficial for all stakeholders and biodiversity conservation, as it serves to dispel stereotypes; improve communication and collaboration; and create opportunities to connect the two sectors with policy-makers for more inclusive policy decisions in South Africa. It is pertinent for the conservation sector to learn about THPs’ needs and challenges related to environmental matters to effectively mobilise the THP community.

Data availability statement

The anonymized raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.

Author contributions

SK: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing. WK: Conceptualization, Data curation, Formal Analysis, Investigation, Methodology, Project administration, Validation, Writing – original draft, Writing – review & editing. LW: Conceptualization, Funding acquisition, Investigation, Supervision, Writing – original draft, Writing – review & editing.

Funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. Funding was provided by the Environmental Investigation Agency USA to conduct the workshop in Johannesburg, South Africa.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Generative AI statement

The author(s) declare that no Generative AI was used in the creation of this manuscript.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fcosc.2025.1531547/full#supplementary-material

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