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Regulating traditional healers

14 September 2004 Angelo Coppola

Kanya Ndaki, reporting for the Heatlhe News Service, discusses traditional healers and legislation.

About 200 000 traditional healers serve at least 70 percent of South Africans who consult them regularly. Health-e News Service looks at new legislation that will soon regulate this industry.

For the past 35 years, Philip Kubukeli has been a traditional healer. He is so respected by his peers and colleagues that he has been awarded the honorary title of “Professor”.

But unlike other “alternative” health practitioners, Kubukeli’s line of work has been sidelined and has received little official recognition.

Not for much longer. Efforts are currently underway to integrate traditional medicine into the health-care system through legislation, albeit gradually.

Kubukeli is one of several experts who have been involved in the consultation and drafting of the Traditional Health Practitioner’s Bill that will come before Parliament this session.

Considering that prior to 1994 there was little interest in structuring this industry, it is not surprising that it has taken almost ten years to regulate the sector. That, and the size of this profession have combined to make the drafting of this legislation a drawn out process.

The department of health has estimated that at least 70 percent of all South Africans consult one of the more than 200 000 traditional healers in the country. To date, there is no single statutory body that controls these practitioners.

Essentially, the Traditional Health Practitioner’s Bill concentrates on the creation of a statutory council for traditional healers and the registration of traditional healers, birth attendants and surgeons.

Apart from registering people as traditional health practitioners, the council will act as “watchdog” – ensuring that there is a standard ethical conduct for traditional health practice.

The Council will have a maximum of 22 members consisting of registered traditional healers, a department of health representative, community representatives as well as a registered medical practitioner and a pharmacist.

But the proposed legislation fails to set out what the minimum requirements are or what training or practice standards have to be met in order to be viewed as a traditional health practitioner. The Minister will determine this “after consultation with Council”.

What is made clear, however, is that people who are not registered with the council will not be able to practice as traditional healers.

Any traditional healer who “diagnoses, treats or offers to treat, or prescribes treatment or any cure for, cancer, HIV/AIDS or any other prescribed terminal disease”, will be found guilty of an offence.

According to the Bill, anyone found guilty will be liable to a fine or to imprisonment of up to 12 months.

Perhaps the most controversial and talked about impact of this piece of legislation is the issuing of medical certificates and the recognition of traditional healers by medical aid schemes.

How this will work is not yet clear, however, as one of the traditional healers who actively participated in the drafting of the legislation, Kubukeli is determined it will work.

He says that once the bill is passed, a medical certificate issued by a registered healer will possess the same validity as that issued by a “Western-trained” doctor.

Certified healers will be issued with registration numbers so that employers can check whether a traditional healer is registered with the traditional healer’s council before accepting that medical certificate.

Because of the delays in official recognition of traditional health care, several private sector companies have recognised the need for involving the traditional sector.

For instance, medical aid administrator Medscheme has introduced limited alternative health-care benefits, while Eskom has since 1994 allowed employees to claim a limited number of visits to traditional healers on the company’s medical plan.

The Chamber of Mines and the National Union of Mineworkers have also allowed a panel of traditional healers at mines and have granted their employees three days’ leave to consult them.

Kubukeli already has several agreements with local Cape Town employers who endorse the medical certificates he issues to their employees. But he anticipates strong resistance from other employers and admits that misconceptions and negative attitudes surrounding the profession will make it difficult for people to accept.

But Gogo Kaizer Gumede-Maebele, chairperson of the Mpumalanga task team on traditional healers, is more direct about the possible reaction from employers.

“They are going to complain and say we are illiterate and don’t know anything, this is what they have been saying all along. But they will have to accept our letters,” she warns.

Traditional healers will now also be recognised by medical aid schemes, despite a wary reaction from medical aids who predict that this could push up premiums and costs.

But what this means for patients is that they will now finally have a choice of whom to consult and will be protected by law should the traditional health practitioner prove to be a charlatan.

Currently traditional healers are organised and "licensed" by up to 100 organisations that are officially registered under the Companies Act and not as health providers.

Although their members subscribe to a certain code of ethics, these associations cannot enforce this code, and this has made it easier for quacks and charlatans to go unpunished.

In 1999, the South African Health Review found that of the 80 000 persons practising traditional healing in Gauteng, only about 10 percent were bona fide healers, i.e. healers who abided by the strict ethical code of this profession.

Apart from weeding out fake traditional healers, another positive spin-off from the legislation could be a more effective referral system between Western and traditional medicine, which has until now, been largely one-sided – from traditional to Western.

Once the bill is passed, health care facilities and professionals will have to be educated to overcome their distrust and suspicion of this industry.

This will be even harder to do if the use of medicinal plants by traditional healers is not more strictly enforced.

Since 1997, the Medical Research Council, the department of Pharmacology at the University of Cape Town, the school of Pharmacy at the University of the Western Cape and several traditional healers, entered into a collaboration agreement to form the Traditional Medicines Database (TRAMED).

TRAMED is a collaboration between traditional healers, companies and researchers to obtain medical and botanical information on plants with healing properties, with a view to setting safety standards for herbal remedies. It has also compiled a comprehensive manual on primary health care.

Nevertheless, the World Health Organisation has noted with concern that “the quantity and quality of the safety and efficacy data on traditional medicine are far from sufficient to meet the criteria needed to support its use worldwide.”

In response to this, government has launched a focal point on African traditional medicines – the National Reference Centre for African Traditional Medicines.

The centre will be “an independent entity” coordinated by the CSIR, MRC and the health department and will have their work cut out for them. It has been estimated that one third of the 700 plant species traded in the country have medicinal effects.

Despite these breakthroughs in the regulation of traditional medicine, the real test will be whether any changes take place on the ground. 

It will take some time before this legislation comes into effect and regulating an entire industry will require more than a piece of paper.

It will take changes in budgetary, personnel, and time allocations at the central and regional levels, before anything happens at ground level.

Quick Polls

QUESTION

The second draft amendments to Regulation 28 will allow retirement funds to allocate up to 45% of their assets to SA infrastructure, with a further 10% for rest of Africa; but the equity & offshore caps remain unchanged. What are your thoughts on the proposal?

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Infrastructure? You mean cash returns with higher risk!?!
Infrastructure cap is way too high
Offshore limit still needs to be raised
Who cares… Reg 28 does not apply to discretionary savings
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