South Africa wants to regulate traditional healers – but it's not easyRenee Street, South African Medical Research Council and Christa Rautenbach, North-West University
South African traditional healers play a significant role for people that follow African cultural beliefs. There are more than 200,000 traditional healers across the country.
Until recently, traditional healers have operated relatively freely from government interference, though many work under governing structures such as the Traditional Healers Organisation, which has more than 29,000 members.
In 2014, the Traditional Health Practitioners Act was passed to standardise and regulate the affairs of all traditional healers. Late last year additional regulations were published to give effect to the act. The government has invited public comment on the regulations.
Both the act and the proposed regulations have been criticised by some traditional healers who believe they are unrealistic and unworkable.
Protection for practitioners and users
The act has established an interim council to provide a regulatory framework. This allows for traditional healers to be registered and categorised according to their different healing specialities. These include:
a diviner (those who have a calling from ancestral spirits);
a herbalist (someone practising herbalism);
student (someone training to be a traditional healer);
traditional birth attendant (a midwife);
traditional tutor (a traditional healer trainer); and
traditional surgeon (someone performing cultural operations such as circumsion).
The proposed regulations would require all traditional healers to register before being able to practise. This means all traditional healers will have to apply to the council to be registered. They will also have to pay R200 for a practising certificate.
This will only be issued if the registrar, who is appointed by the health minister after consulting with the council, is satisfied that they meet the requirements. These include:
being a South African citizen;
providing character references from people unrelated to the applicant; and
proof of qualifications.
There are several advantages to registering traditional healers. Aside from the government being able to exercise greater control over the quality of the profession, the public will also be protected from swindlers.
Although legislation is not always the best way to address problems, it might be the only way to provide protection to both the profession and its users.
Regulations need to be realistic
The regulations place several additional responsibilities on traditional healers, which could be costly and time-consuming.
As a start, the proposed regulations will require traditional healers to undergo education or training at an accredited training institution or educational authority. This is to ensure that the profession complies with universally accepted health care norms.
But the practicalities of how, when or where this training will take place remains indeterminate. This will be particularly challenging as there are currently no accredited training institutions.
A prospective trainer will have to register at a cost of R500. They would need to provide a list of their qualifications and details of the course modules, practical skill that would be acquired and duration. But the minimum skills or qualifications are not defined in the regulations.
One of the most bizarre requests is for trainers to produce copies of their teaching or learning materials. This may have serious implications for intellectual property rights. The tutors or training institutions will also need to keep in mind that there are different categories of traditional healers that are recognised in terms of the Act. Each category has different training needs.
For students to be considered, they would need an Adult Basic Education Training certificate level 1. This amounts to basic numeracy and literacy skills. The regulations also propose an age restriction of at least 18 years for student diviners and herbalists. Traditional birth attendants and traditional surgeons would need to be 25 years old before they can be registered to practice.
Diviners, herbalists and traditional birth attendants need to train for a minimum of one year while traditional surgeons need to train for at least five years.
The onus will be on trainers to ensure that their students are registered with the council. At the end of their training, students need to submit a log book to the council, providing details of the observations and procedures they undertook during their training.
Better cover for employees
Employment laws in South Africa require employees absent for more than two consecutive days to provide a valid medical certificate. This certificate must be issued and signed by a medical practitioner, registered with a professional council. If this does not happen, the employer has the right not to pay the employee.
As none of the traditional healers associations in the past were registered with a professional council, employers were not obligated to accept medical certificates from traditional healers.
The introduction of the act means that traditional healers would be registered by a professional council and employers would no longer be able to refuse a valid medical certificate issued by the traditional healer.