Embracing African Traditional Knowledge Health Systems in a HIV/AIDS and COVID-19 Pandemic Era

Abstract

This article engages the perpetual denigration of African Traditional Knowledge System (ATKS) by African governments in favor of western biomedical approaches during the COVID-19 pandemic. We demonstrate that the COVID-19 pandemic has once again put the spotlight on the alternative approaches to health and the need for a holistic and broader understanding of these practices in Africa. Using a literature review on health sectors across Africa and cases of traditional health medicines and use in selected countries, we show the Afro-cosmo vision and understanding of health, and we make a case for a non-western health approach that is holistic, endogenous, and community-centered. We argue that health approaches need to be anchored on proper understanding of African societies, whose approach to health encompasses the spiritual, emotional, and physical aspect of one’s existence. Our work lends support for the importance of having a multidimensional holistic health system and approach for universal health coverage (UHC) toward the achievement of sustainable development goals (SDGs) in Africa which encompasses ATKS in dealing with pandemics.

Introduction

Frantz Fanon is probably one of the best scholars to contribute toward the literature on what can be termed biomedical racism, in particular, psychiatry, the psychology of racism, and the psychological impact of colonialization of black Africans (Butts, 1979; Sikuade, 2012). Yet as Ali and Rose (2022) note, Fanon’s (1965, 1967) oeuvre to global health research has largely been ignored. Although Fanon’s (1965, 1967) work focused on political activities, his work remains relevant our work in that the management of HIV/AIDS and the COVID-19 pandemic has tended to project the Africans as the “other” in the management of the pandemics. Fanon has also been praised for exposing the socio-cultural and political conditions of patients in understanding their health state (Butts, 1979; Sikuade, 2012). Ali and Rose (2022) have applied Fanon’s work on the resistance against the use of biomedical solutions to the Ebola epidemic in West Africa by communities due to mistrust, confusion, and blame. They argue that at the core of Fanon’s work, in relation to health was to demonstrate a deeper understanding of how people react to solutions for their health.

Fanon’s work remains important because of the ongoing practice and common belief amongst policy makers, the public, and some academics is that African traditional knowledge systems (ATKS) are ineffective, unscientific, and incapable of contributing meaningfully to human health systems. This demonization of Afro-cosmo vision for health denotes the continuation of the colonized mindsets of those controlling health care in Africa, and globally. They believe that western biomedicine is more effective and scientific in treating many health conditions because it is based on empirical evidence and is modern in comparison to African traditional medicine. This kind of western and colonially induced mindset has tended to view African Indigenous ideologies, philosophies, epistemologies, and approaches to health as unscientific, inferior, and associated with witchcraft, paganism, and barbarism, while western knowledge is perceived as superior and universal (Mokhutso, 2021; Ned, 2019; Nemutandani et al., 2021; Ngunyulu et al., 2020).

The problem that we examine and discuss is the perpetual denigration of ATKS, in attitudes, perceptions, policy, and practice, by African governments in favor of western biomedical approaches during the HIV/AIDS and COVID-19 pandemics. Here, an important issue to note is that most, if not all African government health budgets and materials are supported externally by western entities, and the pharmaceutical industry is now such big business that is western-controlled, which often limits the political voice of poor countries (Gautier & Ridde, 2017). Mashego et al. (2021) noted that there has been very little attempt to explore the potential contribution of ATKS or alternative therapeutics to the development of the COVID-19 vaccine. However, there are some encouraging and positive developments that are valorizing and giving attention to non-western health knowledge systems by way of investing and exploring policy options that give status to traditional health knowledge systems and practitioners. Our attempt here is to use the biomedical approaches to the COVID-19 pandemic and the reaction by African communities to think more critically about health approaches to pandemics, and how they can be improved.

In South Africa, there has been a re-emergence of initiatives to value ATKS in development, especially by leading institutions such as the African Union, South Africa’s National Research Foundation (NRF), the Indigenous Knowledge System (IKS) for Health, at the University of Free State (UFS), Indigenous Knowledge Systems center at the University of KwaZulu Natal (UKZN), the Institute for Plant Biotechnology at Stellenbosch University, and many other institutes. For example, the Indigenous Knowledge System (IKS) for Health in the Department of Pharmacology, Faculty of Health Sciences at the University of the Free State (UFS) was awarded an annual Technology and Innovation Agency Platform grant of R17 million for a period of 5 years by the South African National Research Fund in 2021. To this effect, the research and teaching program in the School of Clinical Medicine will become the African Medicines Innovations and Technology Development Platform (AMITD) in a drive to respond to community health needs and address industry research challenges (JUTA Medical Brief, 2021).

Although we do not profess to be decolonial experts, we deploy a decolonial approach (Ali & Rose, 2022; Fanon, 1965, 1967) to decolonize global health interventions through a holistic understanding of African communities, especially in the way they reacted to the COVID-19 pandemic. Building from the works of scholars such as Powers and Pieterse (2023) on socio-cultural and political responses to the COVID-19 pandemic in South Africa and he Unites States of America, we want to contribute and get a conversation on ATKS as well as the understanding of alternative views to health by African communities going. Our aim is to draw attention to the silent battlefield of health knowledge systems through the case of COVID-19 pandemic experiences. We examine the use of traditional health knowledge and medicines, explore the perceptions, attitudes, and practices of traditional/Indigenous health knowledge and medicines use vis-a-vis higher recovery rates and low morbidity rates in selected African countries, in the context of higher infections rates and poorly funded and corruption ridden public health sectors in Africa. We argue that a broader understanding of African communities and their cosmo view of health and wellbeing will help government policy and decision makers to enact inclusive, holistic, and appropriate policy frameworks. Here, Ali and Rose (2022, p. 2) remind us that “a Fanonian-inspired orientation will help address the question of why some people were hesitant to follow the public health directives of outsiders, and why on the other hand, outsiders were sometimes quick to label the actions of locals as ‘irrational’”.

We emphasize that African communities are different from western communities where the dominant views, practice, and theories on health originate at the exclusion of traditional Afro-Asian and Latino viewpoints, understanding, and practice. We reviewed the contributions of ATKS toward health systems in Africa to illustrate how public health policy needs to embrace the lived realities of the use of an ATKS approach to health. We do this by arguing that western biomedicine and research approaches to public health practice in Africa need to be aligned to ATKS. We are therefore guided by the following two questions: How does ATKS contribute to the health care systems in Africa? What policy approaches can be developed to advance inclusive health care systems in Africa? These are not easy questions, given the multifaceted and complex issues, vested pharmaceutical and intellectual property interests, and contested knowledge systems of health in Africa.

Our position is that the public health approaches must not be polarized into western approaches viewed as better and more scientific and on the other hand, African approaches that are seen as inferior. A broader understanding of traditional African health systems will help government officials enact appropriate policy frameworks and other related decisions given the ubiquity of traditional medicine use, markets, and practitioners. In other words, despite the lack of official policy and support, traditional African health systems are an integral part of Africa, its culture and people hence policy needs to catch up, acknowledge, support with research and development and codify ATKS into medical practice. In our work we show that ATKS have contributed significantly in investigating and treating infertility, and alleviating and treating diseases such as contraception, HIV/AIDS, malaria, cancer, opioid abuse, tuberculosis (TB), obesity, birthing (including caesarian section), pregnancy symptoms, and other illnesses. We therefore need a broader and holistic understanding of local health dynamics and the multidimensional contexts of communities in Africa in the context of pandemics. This study falls within the field of Black Studies/Africana Studies, particularly as a Health/Science/Technology area of inquiry in that we examine the lived experiences of black communities in the context of the western biomedical hegemony in handling pandemics.

This article is organized as follows: we start by contextualizing the bias against ATKS in health promotion, then followed by a discussion of the tensions between western and African health approaches, followed by focusing on the contribution of AIKS to health care systems in Africa, and finally, a presentation of how we envision an Afro-cosmology in the health care systems.

Contextualizing the Bias Against ATKS in Health Solutions

By Indigenous or traditional, we loosely refer to African communities who rely on local knowledge which is embedded in people’s everyday life. Indigenous approaches to health which is also termed traditional medicine involves “health practices, approaches, knowledge, and beliefs incorporating plant, animal, and mineral-based medicines, spiritual therapies, and manual techniques and exercises, applied singularly or in combination, to treat, diagnose and prevent illnesses or maintain well-being” (Busia, 2018, p. 193). We use ATKS to refer to the kind of often unwritten knowledge that African communities possess as a way of life, and use to handle certain problems. Such knowledge is passed through oral histories, spiritual practices and training by practitioners, custodians of traditions, rituals, and specialized knowledge. We acknowledge that there are very few communities who are Indigenous in the strict sense of the word. Chambers (1991, p. 83) notes that ATKS involves rituals, beliefs, and perceptions, the ways of learning, stocks of knowledge, local technology, and the numerous ways of acquiring and transmitting this knowledge from one generation to the other in rural Africa.

The bias and denigration of African traditional health and traditional knowledge systems is as old as colonialism. Thus, health sector remains one of the on-going battlefields and domains of knowledge between the western knowledge systems and the non-western knowledge systems, including the African, Asian, and Latino systems. This is despite the multibillion-dollar African traditional health market and a huge consumer/clientele market in Africa, and the efficacy of ATKS as part of a broader and holistic Afro-cosmo vision of health. During colonial times in Africa, traditional health practitioners were erroneously assumed to be practicing witchcraft and were prohibited by laws despite the contribution of ATKS to health care (Kasilo et al., 2018; Mlisa, 2019). Historically, traditional practitioners of any kind in the then British colonies were criminalized through the Witchcraft Suppression Ordinance of 1896, which resulted in the decline in Indigenous approaches to health, and the spread of western approaches, such as the setting up of clinics, as well as public and private hospitals (Busia, 2018).

Yet again, the importance of ATKS was demonstrated during the advent and peak of the COVID-19 pandemic started (2019 and 2021). There were lot of expectations that infections and deaths in Africa were likely to be higher, and that the COVID-19 pandemic in Africa was going to be more destructive because the public health sectors are often corrupt ridden, overstretched, and underfunded. These predictions were also based on the huge numbers of deaths in Ecuador where dead bodies were lying on the streets during the COVID-19 pandemic, and some commentators even imagined that there would be dead bodies in African streets (Africa Check, 2020).

How Africa managed the COVID-19 pandemic without the doomsday and catastrophic scenarios of “Africans dying in large numbers” as was envisaged remains debatable, and there is need to examine the reliance on traditional medicine by most African societies. It bears repetition here that, what is crucial is the inherent resistance against biomedical interventions to handle pandemics in Africa. There is, therefore, a strong need to study the nature of African societies in relation to handling of pandemics. Nevertheless, the HIV/AIDS and Ebola epidemic had had a devastating impact in Africa in terms of morbidity cases because of the collapsing public health sectors on the continent. Although some speculated that low COVID-19 cases in Africa were probably a result of poor testing (Africa Check, 2020), many experts including the World Health Organization (WHO) were still unable to explain convincingly about the low incidence and morbidity rates in Africa. These anomalies raised more questions about medical racism (Noko, 2020). The conversations about the shock that Africans did not die in huge number in the COVID-19 pandemic were laced with racial undertones.

Engaging the Tensions Between Western and African Approaches to Health

The COVID-19 pandemic exposed that African governments were not ready to handle massive pandemics and showed the need for health policies to include ATKS. Within this context, it can be argued that there is a poor understanding or lack of interest, research and development investment in ATKS, and African communities’ view of and approaches to health. The COVID-19 pandemic has given new insights into the potential of alternative approaches to health, and the need for a broader examination of these practices and local communities in Africa. Unlike in other countries such as China and India where research and development on traditional medicine is highly advanced (Mashego et al., 2021), in Africa, ATKS approaches to health are not developed despite their contribution to treating numerous illnesses. A holistic picture of health and a clear understanding of views, preferences, and health practices in Africa would improve the way we understand and approach health.

What remains puzzling and intriguing is the extent to which Africa had better recovery rates during the COVID-19 pandemic despite negative predictions by scientists. Despite Africa’s notoriously poorly funded, corruption ridden, and overstretched health care systems, poor sanitation and housing, fewer people died of COVID-19 in Africa compared to Americas, Asia, and Europe (Popoola et al., 2022). For instance, by 27 June 2021, the Americas had record 73, 1 million COVID-19 cases (with 1, 9 deaths), Europe had experienced 47, 8 million cases (with more than 1 million deaths), while in Asia, there were 55, 4 million COVID-19 cases (with 784, 965 deaths). During the same time, Africa had only recorded 3, 9 million cases (with 94, 217 deaths) (Adams et al., 2021). A team of COVID-19 academics at the African Academy of Sciences noted that the reasons for the low death rates in Africa could range from genetic factors, pre-existing protective immunity, younger populations, climatic differences, and variations in behaviors (Marsh & Alobo, 2020).

In a related matter, in Haiti, a Caribbean country largely inhabited by black communities with strong beliefs in ATKS, a related scenario unfolded. Scientists had considered Haiti a recipe for disaster because of the lower vaccination rates, vaccine hesitancy, and other factors such as chronic poverty, poor adherence to lockdown regulations, overcrowded slums controlled by gangs, lack of clean water and sanitation, as well as limited access to hospital beds. Stunningly, the country had the lowest COVID-19 cases and deaths in the world, which baffled scientists. Even much more baffling is that Haiti’s neighbor, the Dominican Republic, with roughly the same population, had high COVID-19 cases and deaths (Price et al., 2022). Reasons for this anomaly in Haiti ranged from the presence of a huge population of young people, leading to more exposure to sunlight for vitamin D, as well as sufficient exposure to ventilation and open-air environments, lower consumption of meat in favor of a plant-based diet, and other reasons (Ariste, 2022; Price et al., 2022). In a conversation on the Al Jazeera TV program, with scientists who have been studying Haiti for decades, some scientists claimed that many people in Haiti treated some illnesses with herbal teas and concoctions during the COVID-19 pandemic (Al Jazeera English, 2021). How countries such as Haiti, and African countries dodged the mass COVID-19 comorbidities as was expected by scientists requires further examination in relation to handling pandemics.

African countries relied on experimental vaccines (not cures) from the west, but the same countries were unwilling to acknowledge and invest in the research and the development of African traditional medicines and support such approaches to health (Mokhutso, 2021). While we acknowledge the shortcomings of traditional knowledge in health systems, we must also equally appreciate the shortcomings of western medical approaches (trial and error vaccines) in curing numerous illnesses in African and other contexts. Arukwe (2022) questions this biomedical hegemony of “cure” by noting the “copy and paste” approach by Africans governments who completely adopted European and American traditional approaches to managing pandemics, which denied a nuanced and effective response to the pandemic. This one-size-fits-all approach ignored that Africa faces different social, cultural, political, and economic challenges.

A case in point is that while African governments were largely eager to implement western vaccines, many in Africa were skeptical about the safety and efficacy of the vaccines. Despite the incentives offered by numerous governments for people to get vaccinated, many opted for traditional treatments and management of COVID-19 and related conditions. In fact, a study by Afrobarometer in Benin, Niger, Liberia, Togo, and Senegal found that only 4 in 10 people wanted to get vaccinated, citing skepticism around safety and efficacy of vaccines, as well as misinformation and conspiracy theories about COVID-19 (Seydou, 2021). Much of this hesitancy was based on the wider belief that the COVID-19 pandemic was planned by pharmaceutical companies and global elites to control humanity, and to reduce population on the planet (Powers & Pieterse, 2023).

The suspicions against biomedical solutions to health in Africa is old. Earlier, Fanon (1965, pp. 123–124) had noted that the Algerians had interpreted the deaths in hospitals as part of a conspiracy by European doctors to eliminate them, and hence Algerians had grown suspicious of hospitals. Washington (2006), a respected American medical researcher has long argued that medical research is fundamentally based on ethically flawed and dubious practices. The hesitancy against COVID-19 vaccines mirrors the social resistance against the medical solutions to the Ebola epidemic in West Africa which was characterized by mistrust, corruption of political elites, confusion, and blame, which Ali and Rose (2021, p. 3) argue “reflected enduring effects of colonial rule” on the part of local communities. Interestingly, Fanon (1965, p. 121) once argued that “western medical science, being part of the oppressive system, has always provoked in the native an ambivalent attitude.” Here, Fanon correctly notes that “the colonized and formerly colonized tend to perceive Western medicine as an extension of colonial rule – that is, as yet another form of apathy, conquest, trickery, and dehumization” (Wyrick, 1998, p. 91, cited in Ali and Rose, 2022, p. 5). Viewed from a Fanonian perspective, a wrong diagnosis, which is not anchored on an understanding of the socio-cultural and political factors, leads to a faulty medical solution (Fanon, 1965, 1967; Sikuade, 2012). Thus, there is a need for holistic and culturally relevant nursing curricula based on local values, beliefs worldviews and philosophies to be taught at training institutions (Moeta et al., 2019; Ngunyulu et al., 2020).

The continuing subjugation of African health solutions remains intriguing. There is some anecdotal evidence in Africa which suggests that some communities were relying on Indigenous practices and herbal remedies to treat COVID-19 symptoms such as local herbal concoctions (Mashego et al., 2021; Nemutandani et al., 2021; Popoola et al., 2022). For example, in West Africa, researchers found 124 plant species (some of whom have been medically tested) which were potent in treating HIV symptoms, Echoviruses, hepatitis, Sexually Transmitted Infections, jaundice, yellow fever, common cold, fevers, measles, and other illness. Many people in West Africa are reported to have used some of these plants to treat COVID-19 symptoms, even though the effectiveness of such plants against COVID-19 symptoms have not been clinically tested. Most importantly, the resurgence of the COVID-19 variants shows that vaccines will have to keep getting improved to increase effectiveness (Popoola et al., 2022).

ATKS remains important in the African health sector because despite the hegemonic western approaches of treating illnesses, many Africans rely on, afford, and trust traditional medical practitioners or other Indigenous ways of treatment. The African cosmology of health, like many others elsewhere, is linked to culture and spiritual aspects. The continued reliance on traditional medicine in Africa, despite the demonization of ATKS, mirrors the perpetual use of traditional health approaches during the COVID-19 pandemic despite the compulsion and incentives for people to get vaccinated. For instance, about 80% of people in Africa prefer using traditional medicine for their health (Kasilo et al., 2018). Shewamene et al. (2017) and Popoola et al. (2022) assert that the tendency of poor communities to rely on traditional African herbs for illnesses is caused by the inadequate access to medication in poorly resourced public health facilities, and the perceived safety of traditional herbs in Africa generally. Mokgobi (2013) notes that many Africans prefer traditional medicine, even where they can afford western medication. In some cases, they use both western and traditional medicines which can cause dangerous health complications if the dispensing authorities do not communicate regarding the matter.

Most importantly, there has been a sustained suspicion of western medical solutions in Africa since the unethical medical and reproductive experiments from the enslavement era, biological warfare technologies aimed at eliminating black people, infertility treatments on black women infected by HIV/AIDS, and it was not surprising that the COVID-19 pandemic also revived the suspicions from a history of medical experimentation in Africa. In her ground breaking book titled Medical Apartheid, Washington (2006) details how modern western science emerged from the abuse of black bodies, including enslaved women who were operated unanesthetized to the extent that some white doctors could not stand the agony and pain of black women when they were operated. Her argument is that even in contemporary America, health care is still racialized and that black Americans are still abused in the health system as evidenced for instance by the high mortality rates of black babies, which is twice than that of whites. Further, black Americans suffer more health complications more than whites such as diabetes, easily curably disease, limb loss, terminal heart disease, kidney failures, blindness, cancer, HIV/AIDS, mental illness, and other ailments, which is proof that the health system, including pharmaceutical companies probably have a conspiracy to eliminate black communities.

During colonial times, Africa was used by western medical experts as a testing lab for the greater good of health in the West. Even after independence, African leaders have historically colluded with western pharmaceutical companies to test drugs on poor African communities (Lichtenstein, 2020). These clinical trials are often funded by WHO, the America Centers for Disease Control (CDC), and the National Institute of Health (NIH). For example, in Zimbabwe, about 17,000 HIV positive women were experimented with the anti-retroviral drug AZT in a clinical trial that was funded by CDC, WHO, and the NIH without informed consent in the 1990s (Lichtenstein, 2020). Pfizer, an American pharmaceutical company also tested its meningitis drug, Trovan, on 200 children in Nigeria without any informed consent in the 1990s (Lichtenstein, 2020). These acts of unethical medical practice and racism have inflicted trauma on Africans, eroding any trust on vaccines from pharmaceutical companies in Africa, as well as sowing seeds of conspiracy theorists (Lichtenstein, 2020).

Therefore, the suspicions against western medicine and vaccines in Africa appear to be grounded in the subjugation and historical medical abuse of black bodies. The belief is based on the experience of poor black bodies that have been used by western medical experts for experimentation, exhibition, fetish expeditions, and a variety of dehumanizing acts, often with no informed consent, leading to medical injuries and deaths (Noko, 2020). Noko (2020) further indicated that one patient remarked that western pharmaceutical companies “are using it to make research, make billions of dollars. . .that medicine they will produce will not be free. It will be something that you will sell.” One French medical doctor, Jean-Paul Mira, was qouted on TV saying: “wouldn’t we be doing this study in Africa where there are no masks, no treatment, no intensive care, a little bit like we did in certain AIDS studies or with prostitutes?” (Wong, 2020). Although he later apologized, these comments indicate that some western medical experts continue to see Africa as a dark continent, inhabited by sub-humans who can be experimented with, for the greater good of Europe.

Historically, health approaches in Africa by colonial authorities were steeped in cultural racism wherein white settlers presented themselves as innately superior, and hence having the responsibility to save peoples in former Third World countries from their backward health approaches (Arukwe, 2022). Here, the core of cultural racism was that former Third World countries were inferior, cultural, politically, economically, and otherwise, and that white settlers were saviors who were there to assist black peoples to progress in any means (Arukwe, 2022). Therefore, colonization was the beginning of the denigration of African approaches to health, belief systems, and ways of life (Ngunyulu et al., 2020). The prejudice against Indigenous approaches to health as was the case during the COVID-19 pandemic is arguably a continuation of the colonial legacy, invalorization, and subjugation. The major aim of colonization was to force Africans to disparage their forms of knowledge, cultures, languages, clothing, food, and anything that was African, and to accommodate westernization (and Christianity) as a way of “enlightment,” as well as western modernity, education, and development (Adebajo, 2021; Mji et al., 2017; Mlisa, 2019).

According to western culture, belief systems and medical approaches, illness, and health are biological matters (van der Watt et al., 2021), whereas, for the African cosmology view health explanatory models of illness encompass the physical, the mind/psychological, and the spiritual sides of an individual (Busia, 2018; Mashego et al., 2021; Mji, 2019; Mlisa, 2019). Therefore, Fanon (1965, p. 123) persuasively argued that “in a non-colonial society, the attitude of a sick man in the presence of a medical practitioner is one of confidence. The patient trusts the doctor; he puts himself in his hands. . .at no time, in a non-colonial society, does the patient mistrust his doctor.” Ancient Egyptians who were advanced medical practitioners believed that good health was linked to a healthy diet and good lifestyle, as well as having harmonious relations with gods, ancestors, and spirits. In this sense, misfortune and bad health were linked to an imbalance of the physical, the mind, and the spiritual (Busia, 2018). Based on his fieldwork in Nigeria, Omonzejele (2008, p. 120) also noted that:

for a traditional African man, health is not just about the proper functioning of the bodily organs. Good health for the African consists of mental, physical, spiritual, and emotional stability for oneself, family members, and community; this integrated view of health is based on the African unitary view of reality.

Thus, the health discourse in Africa is holistic in that it includes the belief and reality that when one is physically ill, it is not just because of a set of medical issues, but there are numerous spiritual, psychological, physical, and emotional imbalances and afflictions affecting an individual. Much as these beliefs, myths, and spiritual aspects in African cosmology cannot be tested in western scientific standards, the fact is that this is a lived reality. Hence, any health approach must recognize African cosmology, not solely using western approaches to health as it happened during the COVID-19 pandemic. A classic case is that of Mlisa (2019), a South African psychologist, who also practices as a sangoma (traditional doctor), and pastor at the same time because human beings require a holistic and flexible approach to health. Here, the emphasis is that medicine, or a sole biomedical approach to health matters is inconsistent with the lived realities of African health matters. This explains why some in South Africa use traditional medicine concurrently with western biomedical solutions (Moeta et al., 2019; Ngunyulu et al., 2020). Therefore, Mokhutso (2021) decries that African leaders are not only capitulating to the subjugation of AIKS, but they also contribute to its demonization as the COVID-19 pandemic has shown, despite the efficacy evidence of traditional medicine in treating and managing certain illnesses. Here, Fanon’s work becomes important in that he showed that western science can be guilty of misdiagnosing the health of a patients through the failure of recognizing the socio-cultural and political factors which may shape the health condition of a patient, leading to wrong solutions (Fanon, 1965, 1967; Sikuade, 2012). For us, Fanon’s ideas resonate with the way health pandemics have often ignored the need for a holistic understanding of the nature of African societies.

The Contribution of AIKS in the African Health Care Systems

When the COVID-19 pandemic started toward the end of 2019, there were numerous debates about alternative therapeutics that could treat the symptoms of the disease, but the suggestions were quickly rebuffed by mainstream institutions such as the WHO. For instance, Dr Stella Immanuel, a US based Cameroonian born medical doctor who also practices as a pastor controversially claimed she had been treating her COVID-19 patients with an anti-malaria drug, hydroxychloroquine, with impressive success. Together with America’s Frontline Doctors, her team of doctors who were critical of the mainstream scientific consensus on the COVID-19 pandemic, received support from the then American President, Donald Trump, and his sons, even though their attempts were rejected by WHO and the US Food and Drug Administration (FDA; Olewe, 2020). Eventually, Dr Stella Immanuel and her colleagues’ claims were not taken seriously.

In Africa, there were several claims that homemade traditional concoctions could treat COVID-19 symptoms, even though there was skepticism about such claims (Mashego et al., 2021; Nemutandani et al., 2021). In South Africa, umhlonyane or lengana (Artemisia afra) became quite popular as a possible herb to treat COVID-19 symptoms, even though the South African government pushed for scientific proof of such claims. Although nothing conclusive came of the claims about possible Indigenous health treatment of COVID-19, the African countries pushed for mass vaccinations in collaboration with western countries. The Madagascan president, Andry Rajoelina was also largely denigrated for claiming that their Covid-Organics (CVO), a concoction made from Indigenous herbs (including artemesia, a plant known to have proved effectiveness in treating malaria) would treat COVID-19 in 7 days. At the time, the Africa Centre for Diseases Control and Prevention (CDC) had showed that Madagascar had the highest COVID-19 recovery rates in Africa without fatalities (Nhongo, 2020).

When the Madagascan president offered their CVO as a solution to the pandemic, African countries such as Tanzania, Niger, Liberia, Guinea Bissau, Democratic Republic of Congo (DRC), Equatorial Guinea, Comoros, and Central African Republic (CAR) received the CVO from Madagascar, while South Africa, Nigeria, Senegal, and the AU’s Centre for Disease Control had promised to test the CVO remedy (Richey et al., 2021). The WHO and the African Union (AU) were skeptical, and they asked for a scientific-based proof (Makgatho, 2020). WHO, which is influenced and largely financially backed by pharmaceutical corporations who are strategically placed in many government and influential organizations was initially optimistic about clinically observing, researching, and developing the Madagascan CVO, but quickly backtracked. Interestingly, while WHO rejected the CVO, the global health organization had offered unconditional support to pharmaceutical companies which were at different stages in developing vaccines, even though theses vaccines had not yet been tested on humans. In a sense, the vaccines production, especially the “warp speed” had not been done according to strict WHO guidelines of vaccine development. Vaccines development had previously taken decades to be approved (Arukwe, 2022). Nevertheless, a study on CVO by Professor Chidi Osuagwi, a medicinal chemist and medical biochemist from the African Center for Biomedical Engineering Research proved the efficacy of Madagscan CVO is treating Covid-19. His study showed that CVO contained artemisinin, an extract of Atermisia annua plant which killed malaria parasites, coronavirus, or other microbes, which made CVO a potent solution for COVID-19 (Osuagwi, 2020, cited in Arukwe, 2022).

Therefore, despite the presence of traditional approaches to health, African leaders relied on western pharmaceutical companies for vaccines through the COVID-19 Vaccine Global Access (COVAX) initiative (Seydou, 2021). Although the WHO had been open to using AIKS, there was a sense that AIKS had to be tested according to western scientific standards. For example, the United Nations (UN) also stated that clinical trials were needed to test the efficacy of such herbal concoctions (Nhongo, 2020). Professor Motlalepula Matsabisa was quoted saying that scientists are often not keen to take the materials to the lab and test the properties and their efficacy because of lack of funding for research, unfavorable regulatory frameworks, the hegemonic power of pharmaceutical companies, and that western biomedical solutions have long been tolerated as the only solution (eNCA, 2022). Here, the challenge is that the African approach to health is based on metaphysics, ethics, and cosmology, and cannot be examined by a western medical paradigm. Thus, the “use of a western paradigm for this purpose will inevitably result in ideological, epistemic, and perhaps ethical conflicts” (Omonzejele, 2008, p. 123).

Nevertheless, it is asserted that Africa has always had unique Indigenous knowledge which was undermined, sometimes stolen, and replaced by western knowledge, ideologies, and epistemologies (Khan & Mantzaris, 2006). Despite the suppression of AIKS as early as 1884, there was an acknowledgement by researchers and missionaries that western science had a lot to learn from AIKS, even though the demonization of Indigenous practices has continued (Nemutandani et al., 2021; Omonzejele, 2008). For instance, in Malawi despite the banning of traditional birth assistants (TBAs) in 2007, the complimentary role of TBAs toward the modern maternity health services is well documented. This primarily because many pregnant women struggle to access modern health facilities, and that TBAs are often the preferred (trusted/loved) approach of giving birth to the extent that some women use them in secret (Uny et al., 2019).

There is evidence that 25% to 30% of modern medicine is directly or directly derived from medicinal plants through the application of modern technology to AIKS. For instance, modern medicines such as antihypertensive agents (reserpine), decongestants (ephedrine), antimalarials (quinine and artemisinin), and anticancer medicine (vincristine and vinblastine) were derived from medicinal plants (Kasilo et al., 2018).

Most fascinatingly, Felkin (1884) wrote in his 1879 journal titled “Notes on labour in Central Africa” that Indigenous healers in various tribes of Uganda were capable of performing sophisticated operations such as birth by cesarean section successfully. Felkin (1884) went further to detail that at the time when women would know they were nearing their birth date, they would restrict themselves to a specific diet to prepare for birth. Hence, most women had mastered the art of assisting in delivery, and when the natural delivery failed, the pregnant women would be handed to specialist male traditional doctors who would perform cesarean section, using numerous herbal concoctions to numb the pain during the operation.

By 1978, the role of traditional leaders in the provision of health care services was recognized by the WHO through its Alma Ata Declaration. ¹ Member states were encouraged to develop proper legislative frameworks and policies to regulate and guide the development of traditional medicine (World Health Organization [WHO], 1978). Since then, African leaders have signed numerous agreements to support the development, research, and use of traditional medicine through enacting policies, regulations, research programs, and institutions, although the progress has been slow (Kasilo et al., 2018).

In Africa, traditional practitioners who are highly respected in their communities usually involve specialties such as spiritualists, traditional surgeons, herbalists, bone setters, birth attendants, and diviners (Busia, 2018). Mekoa (2021) adds that traditional medicine has proved to be effective in mental health, non-communicable diseases, preventing illnesses, and contributing to the improved quality of life among the elderly, and people living with chronic illnesses. As such, ATKS has contributed to the healing of illnesses such as malaria, hypertensions, diabetes, obesity, and other diseases (Mekoa, 2021).

There are examples of plants and herbs that can cure many illnesses in Africa. A classic example is that of hoodia, an organic plant found in South Africa and Namibia, and iboga found in Senegal and Cameroon which has proved to be effective in treating various illnesses such as cancer, obesity, and opioid abuse outside Africa (Mashego et al., 2021). Also dubbed the miracle plant because of its multiple purposes, the Moringa tree (which is originally from India) is grown in countries such as Egypt, Nigeria, Sudan, Ethiopia, Kenya, Ghana, Zambia, Rwanda, Senegal, Zimbabwe, India, and other countries. The health uses of Moringa include for example treating ear and eye infection, fever, toothaches, snake bites, malaria, typhoid, skin disorders, diabetes, hypertension stomach pains, asthma, and cancer. Other health uses of Moringa tree include treating kidney infection, milk production in mothers, worm infestation, fertility disorders, boosting immune system especially for people living with HIV/AIDS, male impotency, and supplementing a diet due to its multi-nutrients (Wambebe, 2018).

In addition, anecdotal evidence from our lived experience as researchers in Africa, shows that Indigenous knowledge has been central to the lives of rural communities, and increasingly urbanites as well. In Zimbabwe, herbs have been used to treat sexually transmitted diseases, infertility, venereal disease, back aches, and treating snake bites. Zimbabwean traditional doctors have been shown to be able to investigate male infertility among young boys to provide early solutions such as complicated herbal concoctions administered in the form of powder, inhalations, decoctions, infusions fumigation, and scarification, even though the system was not always perfect (Moyo, 2013).

African traditional health practitioners have contributed significantly to the fight against diseases such as HIV/AIDS, TB, and malaria (Mashego et al., 2021). In South Africa, the government has made significant attempts to modernize and commercialize research on bio prospecting and product development on African medicine linked to the management of cosmetics for skin cancer, HIV/AIDS, diabetes, nutraceuticals, TB, as well as food products such as energy supplements, moringa-based products, vegetables and soups, and health teas (Mekoa & Mapadimeng, 2021, p. 10).

Maroole et al. (2019) identified about 25 plants that were used by African Indigenous groups that have long been using herbs for contraception, although such herbs can be toxic to human beings and animals. Other countries that are known to be using Indigenous knowledge for contraception are Tanzania, Malawi, Gambia, Zimbabwe, Mozambique, Nigeria, Uganda, and others (Maroole et al., 2019). The plants are easily accessible to Indigenous people and modern contraception is believed to be linked to side effects such as genital infections, menstrual bleeding, abdominal pain, cardiovascular diseases, nausea, weight gain, hypertension, increased risk of cancer, hormonal imbalance, depression, headache, and others (Maroole et al., 2019). Further, a study by Shewamene et al. (2017) which focused on the period from 1985 to 2016, findings showed that ATKS was important in treating pregnancy-related symptoms in Nigeria, South Africa, Ethiopia, Uganda, Tanzania, Zimbabwe, Zambia, Mali, Lesotho, Kenya, Morocco, and Egypt.

What is concerning is the extent to which ATKS is appropriated for profits, with little benefit to local communities. There is a downside of poor communal participacition and beneficiation, as well as overharvesting due to commercialization when Indigenous fruits are commercialized—this is the case of Makoni tea and masawu, mazhanje, and other wild fruits in Zimbabwe—it becomes unsustainable (Shava, 2005). For instance, the South African Aloe forex (or Cape aloes) can be traced to its commercialization and appropriation from Indigenous communities and exported to countries such as the United States (US) and Britain in the 1700s. Aloe forex has been linked to medicinal uses such as laxatives, beverage purposes, health supplements, cosmetics products, wound healing, and other uses (Katerere, 2018, pp. 145–147). In 1971, western scientists appropriated Artemisia annua ² which revolutionized the treatment of malaria, albeit without any recognition or benefits for local African communities (Kasilo et al., 2018). Other studies have shown that biopiracy in Africa has led to appropriation of medicinal plants in Libya, Egypt, and countries such as Ethiopia, Angola, Botswana, Namibia, and Bostwana (Kasilo et al., 2018).

By any standards, there is a huge market for traditional medicine in Africa. For instance, research shows that many people in South Africa do not consider traditional medicine to be inferior to biomedical approaches because traditional medicine is trusted in that it can treat some illnesses which western approaches do not treat adequately. Here, traditional medicine, which is expensive, is preferred over western medication, because traditional medicine is seen as holistic. About 72% of black South Africans (26.6 million) from various backgrounds (religions, age, occupational levels), use traditional medicine. The trade in traditional medicine is widespread and normalized, including in urban areas. There are at least 133,000 people employed in the trade, with a large percentage of them being rural women. The value of traditional medicine in South Africa has been estimated to be worth around R2.9 billion per year, representing 5.6% of the National Health budget (Mander et al., 2007).

Conclusion

The experiences with HIV/AIDS and COVID-19 pandemics, among other ailments, have reignited the need for examination of the effectiveness of ATKS approaches for health management through a multi-dimensional understanding of African societies. The COVID-19 experience has demonstrated that the western approaches to illness are not always trusted and convincing for many in Africa. If Africa is to make progress toward universal health coverage (UHC) and SDGs 3 and 10, there is need for an endogenous, community centered, bottom up, holistic, and multi-faceted understanding of and approach to health management in Africa.

In this paper, we have argued that a broader understanding of traditional health systems and approaches in Africa will help the continent’s citizens to lobby governments to enact appropriate policy frameworks and deploy the natural capital and resources for development. Our aim was to discuss and contribute to the discourse on alternative views on African Indigenous health knowledge systems for increased understanding of the approaches used in Africa, which are different from western communities where most theories on health originate.

We have also highlighted the extent and value of the economics of the traditional medicines market, its vibrant trade, and contribution to the national health budgets, and consumers, thus arguing that African Indigenous health knowledge is here to stay and needs research and development support from Africa if it is to realize its full value, potential, and contribution in the face of other health knowledge systems. A holistic picture and a clear understanding of views, preferences, and health practices in Africa helps us to think about improved approaches to health.