Indigenous training of traditional health practitioners in Kwazulu-Natal

19 January, 2020

Dear HIFA colleagues,

I was interested to see this new paper in African Health Sciences, one of many African journals that are now open-access (many thanks to the African Health Journals Partnership Project that is funded by the US National Institutes of Health). We have previously discussed at length on HIFA the role of traditional birth attendants and many HIFA members have argued for TBAs to be trained in basic allopathic skills such as hygiene, identification of complications and early referral.

This paper takes a completely different track, focusing on the development of traditional skills such as 'channel ancestral communication, which is a process of directing cosmic energies normally induced by burning incense (impepho)' and 'recognise signs of ancestral communication through oracles and nature'. The authors identify 'eleven core competencies [that] are fundamental pillars for critical health care provided by THPs and are crucial for setting standards for the accreditation of traditional training in South Africa'. But there is little if any evidence that these skills and training are associated with better health outcomes.

I have not had the chance to read the paper in detail, but there appears to be no mention of how to identify and manage complications, newborn care, hygiene or other basic skills. There seems to be a disconnect here... Am I missing something? What do you think?

CITATION: Nompumelelo M, Gomo E, Gqaleni N, Ngcobo M. Core competencies acquired in indigenous training of traditional health practitioners in Kwazulu-Natal. Afri Health Sci.2019;19(4):3100-3106.


Introduction: Despite the recognition of Traditional Medicine systems as a critical component of health care by the WHO and the African Union, its integration into the health care mainstream remains very subdued in South Africa. This is partly due to the lack of empirical data pertinent to traditional healer training that could inform the accreditation process.

Objective: To determine core competencies acquired by Traditional Health Practitioners (THP) of KwaZulu-Natal Province, South Africa during their apprenticeship.

Materials and methods: Purposeful, convenient and snowballing sampling and the sequential data collection methods of questionnaires, journaling and focus groups was used to collect data from the THP tutors and their trainees in rural, peri-urban and urban areas of eThekwini and uThungulu Districts of Kwa Zulu Natal (KZN).

Results: Eleven core competencies were identified: consultation, diagnoses, holistic patient care and treatment, integrative and holistic healing, application of healing procedures and cultural rituals, spiritual development, ethical competencies, problem solving, herbalism, ancestral knowledge and end of life care.

Conclusion: The apprenticeship of THPs in KZN is based on eleven core competencies. These competencies are fundamental pillars for critical health care provided by THPs and are crucial for setting standards for the accreditation of traditional training in South Africa if the THP Act 22 of 2007 is to achieve its purpose of providing for the management of and control over the registration, training and conduct of the practitioners. Hence, the appointed interim THP Council should include the identified competencies when articulating bases for accreditation of the training and assessments.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: