TABLE OF CONTENTS CHAPTER 1. INTRODUCTION ........................................................................................................................4 1.1 STATEMENT OF THE PROBLEM ............................................................................................................4 1.2 OBJECTIVES ...................................................................................................................................................6 1.3 METHODS ...........................................................................................................................................................7 1.4 CHAPTER LAYOUT.....................................................................................................................................14 CHAPTER 2. GLOBAL PERSPECTIVES ON TRADITIONAL HEALTH CARE SYSTEMS ....17 2.1 INTRODUCTION............................................................................................................................................17 2.2 MEDICAL PLURALISM.............................................................................................................................17 2.3 SALIENT FEATURES OF TRADITIONAL AND MODERN MEDICINE...................................20 2.4 ASIAN PERSPECTIVES ..............................................................................................................................22 2.4.1 TRADITIONAL MEDICINE IN CHINA............................................................................................................. 22 2.4.2 SOUTH -EAST ASIAN PERSPECTIVES ......................................................................................................... 26 2.5 EUROPEAN PERSPECTIVES ..................................................................................................................28 2.5.1 ALTERNATIVE MEDICINE............................................................................................................................. 29 2.6 AFRICAN PERSPECTIVES ........................................................................................................................33 2.6.1 HISTORICAL BACKGROUND......................................................................................................................... 33 2.6.2 THE CONTINUED EXISTENCE OF TRADITIONAL MEDICINE.................................................................... 34 2.6.3 THE REVIVAL OF TRADITIONAL MEDICINE.............................................................................................. 36 2.7 APPROACHES TO MEDICAL PLURALISM.......................................................................................36 2.8 LEGAL ISSUES ...............................................................................................................................................41 2.8.1 INTRODUCTION................................................................................................................................................ 41 2.8.2 THE STATUS OF THE AFRICAN TRADITIONAL HEALTH CARE SYSTEM ............................................... 42 2.8.3 THE “LIBERALISATION” OF TRADITIONAL MEDICINE........................................................................... 43 2.8.3.1 Traditional medicine in Botswana............................................................................................................ 46 2.8.3.2 Traditional medicine in Ghana..................................................................................................................... 50 2.8.3.3 Traditional medicine in Nigeria .................................................................................................................. 54 2.8.3.4 Traditional medicine in Swaziland.............................................................................................................. 61 2.8.3.5 Traditional medicine in Zimbabwe .............................................................................................................. 65 2.8.4 LEGAL OPTIONS FOR TRADITIONAL MEDICINE....................................................................................... 76 2.9 CONCLUSION.................................................................................................................................................78 CHAPTER 3. AN OUTLINE OF THE SOUTH AFRICAN HEALTH CARE SYSTEM.................81 3.1 INTRODUCTION ...............................................................................................................................................81 3.2 THE OFFICIAL HEALTH CARE SYSTEM ..........................................................................................81 3.2.1 THE PUBLIC AND PRIVATE SECTORS OF THE NATIONAL HEALTH SYSTEM (NHS)......................... 87 3.2.2 LEGAL ASPECTS OF THE SOUTH AFRICAN OFFICIAL HEALTH CARE SYSTEM ................................... 93 3.3 HEALTH CARE PROVISION OUTSIDE THE OFFICIAL HEALTH CARE ......................... 103 SYSTEM ..................................................................................................................................................................... 103 3.3.1 SELF-CARE....................................................................................................................................................103 3.3.2 THE SECTOR OF THE ALLIED HEALTH PROFESSIO NS ...........................................................................106 3.3.3 THE TRADITIONAL MEDICAL SECTOR....................................................................................................110 3.3.3.1 Historical and legal development ............................................................................................................111 3.3.3.2 Political changes since 1994 ...................................................................................................................113 3.4 CONCLUSION............................................................................................................................................. 121 2 CHAPTER 4. TRADITIONAL HEALING IN SOUTH AFRICA ........................................................ 125 4.1 INTRODUCTION ........................................................................................................................................... 125 4.2 SOME BASIC AFRICAN CONCEPTS OF HEALTH AND ILLNESS....................................... 125 4.3 CAUSES OF ILLNESS AND CLASSIFICATION OF DISEASES ............................................... 127 4.4 THE HEALING PROCESS AND AIM OF HEALING .................................................................... 129 4.5 AFRICAN TRADITIONAL HEALERS ................................................................................................ 131 4.5.1 THE CATEGORISATION OF TRADITIONAL HEALERS .............................................................................131 4.5.2 THE DIVINER .................................................................................................................................................132 4.5.3 THE HERBALIST............................................................................................................................................134 4.5.4 SPIRITUAL OR FAITH HEALERS .................................................................................................................136 4.5.5 TRADITIONAL BIRTH ATTENDANTS ..........................................................................................................137 4.5.6 SPECIALISTS ..................................................................................................................................................140 4.5.7 GENERAL FEATURES COMMON TO ALL CATEGORIES ..........................................................................141 4.6 THE HEALER’S FEE.................................................................................................................................... 143 4.7 THE TRADITIONAL HEALER’S MEDICINES ............................................................................... 144 4.7.1 CATEGORIES OF MEDICINES......................................................................................................................144 4.7.2 METHODS OF TREATMENT.........................................................................................................................146 4.7.3 ROUTES OF ADMINISTRATION OF MEDICINES........................................................................................147 4.7.4 THE IMPORTANCE OF PREVENTION............................................................................................................148 4.7.5 THE TRADITIONAL PHARMACOPOEIA........................................................................................................149 4.7.5.1 General .............................................................................................................................................................149 4.7.5.2 Herbal medicines in a broader context ........................................................................................................150 4.7.6 TWO POINTS OF PARTICULAR SIGNIFICANCE........................................................................................153 4.8. THE TRADITIONAL HEALER’S CLIENT .......................................................................................... 153 4.8.1 THE CLIENT’S TREATMENT OPTIONS..........................................................................................................154