Background information

Traditional healers - in South Africa known as inyangas, sangomas, and witchdoctors - have a crucial role in providing health care to the majority of South Africans. They are deeply interwoven into the fabric of cultural and spiritual life. In 1980, the Traditional Healers' Organization was created.

The National Department of Arts, Culture, Science, and Technology funds consortium research projects into traditional medicines (58).

Statistics

Traditional healers are present in almost every community. They are the first health providers to be consulted in up to 80% of cases, especially in rural areas (59). There are over 200 000 traditional healers in South Africa and only 27 000 allopathic medical practitioners. The Traditional Healers' Organization currently represents more than 180 000 traditional healers from South Africa and a number of neighbouring countries, including Swaziland, Zambia, and Zimbabwe (60). There are approximately 200 chiropractors practising in South Africa (45).

Every year 1500 tons of traditional medicines are sold in medicine markets in Durban alone. The traditional medicine industry is worth up to 2 300 000 South African rand per year.

Regulatory situation

South Africa regulates general traditional healers, herbalists, chiropractors, homeopaths, osteopaths, and naturopaths under the Associated Health Service Professions Act of 1982, as amended (61). This Act sets up a registration and licensing scheme for various professions. Registration entitles medical providers to practise for gain and call themselves members of that profession. Practice for gain by a non- registered person is an offence punishable by a fine and/or imprisonment of up to one year.

To qualify as a traditional healer, one has to serve an apprenticeship of between one and five years and must be well known within the community one serves and amongst other traditional healers. Qualified traditional healers register with the Traditional Healers' Organization and are given a book to certify that they are qualified healers. The qualifications are valid in Africa, Asia, Latin America, Europe, and Australia (60). However, Section 41 of the Associated Health Service Professions Act of 1982 states that the provisions of the Act shall not be read to "derogate from the right which a medicine man or herbalist contemplated in the Code of Zulu Law may have to practise his profession". The South African law also imposes restrictions on the professional nomenclature that can be adopted by traditional healers. Use of the title "Medical Practitioner", or a title suggesting that its holder is qualified as an allopathic medical practitioner, is prohibited.

Applicants for registration as chiropractors must show they hold a degree, diploma, or certificate demonstrating sufficient proficiency in chiropractic. Such qualifications are not, in contrast, required for the registration of an osteopath or naturopath. The Associated Health Service Professions Board may, on an individual basis, impose restrictions on the kind of work that can be carried out by chiropractors or require applicants for registration to obtain further practical experience, on terms stipulated by the Board.

Chiropractors and osteopaths are prohibited from performing operations, administering injections (other than intramuscular or hypodermic injections), practising obstetrics, and taking or analysing blood samples. Additionally, chiropractors and osteopaths may not "treat or offer to treat cancer or prescribe a remedy for cancer or pretend that any article, apparatus, or substance will or may be of value for the alleviation of the effects or for the curing or treatment of cancer". There is also a prohibition against preventing or improperly discouraging a person from obtaining treatment by an allopathic physician or health care professional. Osteopaths are subject to further restrictions, which, among other things, bar them from performing internal examinations or reading or interpreting Roentgen plates as part of a clinical diagnostic procedure.

In August 1998, the South African Parliament decided to enlist the help of traditional healers in achieving major goals in primary health care. However, whether traditional healers should become part of the Department of Health itself or belong to their own association in affiliation with the Department of Health remains controversial (59).

The National Department of Agriculture governs traditional medicines via the National Plant Genetic Resource Committee, of which a traditional healer is a member. The National Department of Health produced the National Drug Policy. For the purpose of implementing the National Drug Policy with respect to traditional medicines, the National Department of Health established the National Reference Centre for Traditional Medicines. Traditional medicines are included in the Drug Policy section of the Government's Reconstruction and Development Programme.

The goals of the Traditional Medicines Programme of the Department of Pharmacology, University of Cape Town (62, 63), are to promote the use of safe, effective, and high-quality essential traditional medicines; to promote the documentation and scientific; validation of traditional medicines; to contribute to primary health care by providing appropriate information to traditional healers and other health professionals; to support industrial development in this sector; and to contribute to the training of traditional healers. In 1994, the Programme participated in formulating an outline proposal on the registration and control of traditional medicines.

In 1998, the Parliament passed Act 132, the South African Medicines and Medical Devices Regulatory Authority Bill (64), covering the registration and regulation of traditional medicines and changing the regulation of medicines in the country. The Bill establishes the South African Medicines and Medical Devices Regulatory Authority to replace the Medicines Control Council, which was set up in 1965. The Medicines Control Council held allopathic, traditional, and complementary/alternative medicines to the same set of standards and procedures. The South African Medicines and Medical Devices Regulatory Authority Bill, in contrast, makes provisions for different procedures to be applied when registering allopathic medicines and traditional and complementary/alternative medicines. This is done by establishing separate expert committees for the two major types of medicine. In the case of traditional medicines, issues of safety and quality take precedence over demonstrations of efficacy. The aim is to regulate and not to prevent access to what many people use in preference to allopathic medicines.

Education and training

In the 1960s, due to pressure from the South African Medical Council, non-allopathic medical colleges were closed. Those practising at the time were 'grandfathered' into a closed register. Allopathic medical doctors retained the right to practise homeopathy regardless of their level of homeopathic education. The Homeopathic Association of South Africa is currently working to gain recognition for homeopathic education as a pre-graduate and postgraduate university subject. The long-term vision is a chair of homeopathy at one of the universities. As a first step, there are overtures to the South African College of Medicine for accreditation and application for registration of a South African Faculty of Homeopathy (53). There are two institutions offering six-year chiropractic programmes leading to a Master's degree (65).