Integration of phytomedicine into the main-stream health care system: perceptions from Bojanala District, South Africa.

Abstract

South Africa’s healthcare system is plagued by inequalities, especially in rural and marginalised areas, where access to healthcare facilities and quality healthcare services is limited. This is one of the reasons why the use of traditional medicine is still very prevalent in the country. In the North-West Province, there is limited research on phytomedicinal plant use. This study therefore aimed to explore phytomedicinal practices in the Bojanala District, North-West Province, and to assess healthcare professionals' perceptions of integrating traditional medicine into the mainstream healthcare system. Ethnobotanical data were collected from 37 participants selected following purposive and snowball sampling techniques through face-to-face interviews using semi-structured questionnaires. Thereafter, ethnobotanical indices, including use value (UV), fidelity level (FL), and plant part value (PPV) were calculated. The survey revealed 52 medicinal plant species across 28 families, with Asteraceae, Fabaceae, and Anacardiaceae being the most represented. A. afra (UV=1.108), D. anomala (UV=0.622), S. aethiopicus (UV=0.459), D. sanguinea (UV=0.459), and H. hemerocallidea (UV=0.405) were the most commonly cited species. Leaves and roots were the most frequently harvested plant parts, with PPVs of 0.329 and 0.237, respectively. Decoction and burning were the most commonly used preparatory methods, and the majority of herbal preparations were taken orally. Although 63% of recorded plant species were classified as Least Concern (LC) by SANBI, several of these species experienced decline in populations due to overharvesting and habitat loss. There is, therefore, a need for continuous monitoring and the implementation of sustainable harvesting practices, as well as the pharmacological validation of the most frequently used species. Additionally, further research is needed to identify bioactive compounds in medicinal plant species, to support traditional claims, and promote the development of plant-based therapeutic agents. In the second phase of the study, 40 purposively selected healthcare professionals were interviewed using a semi-structured questionnaire focusing on knowledge, attitudes, and practices (KAP). The collected data were analysed using thematic analysis. The findings revealed that most healthcare professionals acknowledged the effectiveness of traditional medicine. Only 17% of participants expressed confidence in the safety of traditional medicine, while others raised concerns about the lack of standardisation of dosage and the absence of scientific evidence on its efficacy. Even so, 65% of healthcare professionals supported the integration of traditional medicine into the mainstream healthcare system, provided concerns over its safety and effectiveness were addressed. Fifty-five percent (55%) of healthcare workers have never used traditional medicine before, while 67.5% indicated they would not recommend it to anyone. The findings revealed that successful integration is possible only if both traditional health practitioners and healthcare professionals are properly educated and trained, and if thorough research on traditional medicine is conducted to address safety concerns.