Traditional healers and doctors
- Wits University
Nearly 10 years of collaboration informing rural health.
It’s been close to a decade since researchers in rural Bushbuckridge, 500km from Johannesburg, and bordering Mozambique, wanted to understand how traditional healers were treating people living with HIV (PLHIV) and how this could be integrated meaningfully in primary healthcare at clinics.
There are about 200 000 traditional healers in South Africa, a number far greater than the number of trained doctors and nurses. Many people move between the two health modalities, but in 2017, little was known about how people actually sought care in rural South Africa and how traditional healers engaged with PLHIV.
The Ntirhisano programme (meaning “working together”) at the SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) sought to fill this fundamental knowledge gap.
“When we started the research, we knew that people were seeking care from traditional healers,” says Dr Carolyn Audet, co-project investigator for Ntirhisano and Professor at the Vanderbilt Institute for Global Health. “But we didn’t know how healers themselves understood HIV: who they chose to treat, what treatments they offered, what outcomes they expected, or what patients were paying.”
As the project’s scope grew, however, a question was asked about whether traditional healers can deliver a range of primary healthcare services. This includes HIV testing, chronic disease support, and notably, providing services to people who don’t routinely access clinics, such as men.
Indeed, as one of the traditional healers, Thembisile Makhubela, said, “As a traditional healer involved in this HIV testing and pre-counselling study, I had a positive experience. We can integrate our practices with modern testing which breaks down barriers for our community. May clients who’d otherwise avoid testing due to cultural preferences or mistrust of Western medicine can open up to us. We offer testing in a comfortable setting and test patients who would have slipped through the cracks. It's empowering to play the role in increasing access to crucial healthcare while respecting our heritage. The collaboration has also enriched my practice, allowing me to offer more holistic care to my clients.”
Medical pluralism
Underpinning the project’s logic is the broader reality of medical pluralism, in which two or more systems of care coexist and are often used in parallel.
“When people are ill, they don’t choose one system over the other, but move between them,” explains Dr Ryan Wagner, co-project lead for Ntirhisano and Associate Professor in the Wits School of Public Health.
Traditional healers are frequently consulted not only for physical illness but also for conditions understood to arise from social or spiritual causes, such as conflict, misfortune, or perceived transgressions. They are typically perceived to be more accessible than clinics, speak the same language as their patients, and can spend more time explaining illnesses and treatments.
For many patients, this makes traditional healers a first point of contact. Traditional healers often provide care that extends beyond the individual, supporting the whole family. “What patients want is time and someone who really understands what is going on in their lives,” says Audet.
“Medical pluralism is not without risk, though,” says Wagner. Medical conditions are best treated quickly, but there are delays in accessing biomedical treatment, interruptions in care, and harmful interactions between traditional remedies and prescribed medication.“ But our research also revealed that healers were referring patients for HIV testing and recognised the value of the biomedical model.”
Researchers therefore saw this support and alignment as the launchpad for Ntirhisano and for these particular traditional healers as potential partners. For Audet, long-term success depends on community ownership.
“We are not shoving this down people’s throats,” she says. “We are asking: do you want this?”
'Know Your Status'
Evodia Zandile Mnisi, a nurse working on the programme says that Ntirhisano is a game changer in HIV prevention and treatment. “Our goal is for zero HIV transmission by 2030, and that those who have the illness remain in care and are virally suppressed.” She says that patients are often treated for TB at the same time, which is beneficial for everyone.
The key research trial, “Know your Status”, was run in partnership with the South 第一吃瓜网 Department of Health and Kukula, a local organisation representing traditional healers, mobilised healers, facilitated training and ensured that the work was grounded in local realities.
“Know your Status” aimed to evaluate whether traditional healers could effectively deliver HIV counselling, testing and linkage to care, particularly among those who did not always access clinics. The goal was to generate clinical and economic evidence needed for the longer-term adoption within the public health system.
“Our next goal is to understand what else healers can do, what the health system does, but what it cannot do as efficiently,” says Audet. This holistic, relational model may be suited to community-based care in overstretched health systems. Ultimately, rather than positioning traditional and biomedical systems in opposition, the Ntirhisano programme is building a model that allows them to work in tandem.
The research has also revealed significant variation in impact across healers. This led researchers to explore whether characteristics such as age, community standing, or openness to collaboration could be better predictors of impact.
The project’s progress has not been linear. Changes in the global health funding landscape in 2025 introduced a period of uncertainty, prompting the team to pause and re-engage with communities.
“Any disruption in continuity affects relationships,” says Audet. “We’ve had to rebuild trust and re-establish momentum.” This reinforced a key lesson: trust is foundational but fragile in community-based research.
Helping heal the healers
An important component of the work has been supporting the health of the healers themselves.
This has included promoting safer practices — such as avoiding shared razor blades — and supporting access to care. “Many healers themselves are living with HIV,” Wagner notes.
Addressing healer wellbeing has strengthened both safety and trust within the programme.
The Ntirhisano programme has always been intended to disrupt traditional systems of care-seeking in public health settings. The implications extend beyond rural Mpumalanga. Audet reflects, “If traditional healers can be trained to conduct testing, then trusted community leaders elsewhere, such as barbers, salon workers, religious leaders and teachers, could play a similar role in reaching those most at risk in multiple ways.”