Background

In ancient Africa, the practice of medicine was deeply embedded in cultural and spiritual beliefs. Traditional medicine plays a vital role in the healthcare systems of many African countries, with a significant proportion of the population relying on traditional healers for their healthcare needs (Oyebode et al., Reference Oyebode, Chilton, P. and Lilford2016). Divination is a largely contested superstitious or supernatural practice that seeks to discern hidden knowledge or insight and is an integral component of traditional medicine in Africa (Tella, Reference Tella1979). In Southeast Nigeria, for example, Dibia traditional healers use divination practices such as Ifá to diagnose and treat illnesses (Anjorin et al., Reference Anjorin and Hassan Wada2022). Despite its importance, divination in traditional medicine remains poorly understood, with many modern healthcare systems dismissing it as mere superstition. However, research has shown that divination plays a crucial role in patient care, influencing patient trust, perception and response to treatment (Peeters Grietens et al., Reference Peeters Grietens, Boock, Hausmann-Muela, Peeters, Kanobana, Gryseels and Muela Ribera2012). To become a healer, one was believed to be chosen by the gods, possessing a divine understanding of medicinal herbs and treatments. This sacred calling was accompanied by rituals, incantations, sacrifices and libations, which not only appeased the gods but also had a profound psychological impact on patients (Mokgobi, Reference Mokgobi2014). The therapeutic process was a holistic experience, addressing the physical, spiritual and emotional aspects of well-being. Healers were revered for their ability to communicate with the divine, interpreting symptoms and prescribing treatments that went beyond mere physical remedies. This spiritual dimension of traditional medicine played a significant role in the perceived efficacy of treatments, as patients believed that the gods had sanctioned their healing (Gruca et al., Reference Gruca, T. and Balslev2014).

Modern medicine has come to recognize the value of this psychological dynamic, harnessing its power in various ways. The placebo effect, once dismissed as a mere trick of the mind, is now acknowledged as a legitimate therapeutic tool (Kihlstrom, Reference Kihlstrom2008). In vaccinology and clinical trials, researchers exploit the placebo effect to enhance the efficacy of treatments (Caliskan et al., Reference Caliskan and Kunkel2024). Even the symbolic authority of the white coat, once a hallmark of traditional medicine, continues to inspire trust and confidence in patients (Marques Caetano Carreira et al., Reference Marques Caetano Carreira, Correia, Pereira, Belo, Madanelo, Brito, Gomes, Monteiro, Correia, Maia, Marques, Sousa, Abreu, Matias, Constantino and Rosendo2021). Recognizing the rich historical and cultural heritage of traditional medicine allows us to gain a deeper understanding of the intricate dynamics that drive human healing. By incorporating spiritual and cultural beliefs into modern healthcare practices, we may unlock the potential for more comprehensive and effective treatments. This integration has the potential to not only improve patient outcomes but also enhance overall well-being, fostering a more inclusive and compassionate approach to healthcare that honors the diversity of human experience.

The World Health Organization (WHO) defines traditional medicine comprehensively as: The sum of knowledge, skills and practices that are rooted in the theories, beliefs and experiences of various cultures and are utilized to promote health, prevent, diagnose and treat physical and mental illnesses, as well as improve overall well-being (Abbo, Reference Abbo2011). The definition, as first outlined by the WHO in 2010, acknowledges the diversity of traditional medicine practices and recognizes their importance in healthcare systems worldwide.

Traditional African healthcare has a rich and complex history, rooted in a holistic approach that incorporates physical, emotional and spiritual dimensions. This approach is characterized by three fundamental practices: divination, herbalism and spiritualism (Josephine Ozioma and Antoinette Nwamaka Chinwe, Reference Ozioma EJ and Nwamaka Chinwe OA.2019). Divination has played a significant role in shaping the diagnosis, treatment and prevention of various health concerns, serving as a vital diagnostic and guidance tool (Thomas & Yidana, Reference Thomas and Yidana2015). For centuries, African medicine and traditional care were grounded in these three fundamental approaches (Josephine Ozioma and Antoinette Nwamaka Chinwe, Reference Ozioma EJ and Nwamaka Chinwe OA.2019). Through a nuanced examination of divination practices, we aim to uncover the ways in which this ancient practice contributes to the holistic approach of traditional African medicine.

Traditional medicine in Africa was rooted in institutional identities that relied on beliefs and spiritual connections, serving as a bridge between the afflicted and the divine (Kofi-Tsekpo, Reference Kofi-Tsekpo2004). Traditional diviners, adorned in cultural attire and symbolic accouterments like feathers, masks and effigies, facilitated communication with the spiritual realm. In Southeast Nigeria, the Dibia marked their eyes with native chalk, signifying their role as intermediaries. These intercessors were known by various names across different tribes and cultures, including Sangoma in South Africa, Akomfo in Ghana, Shaman or Laibon in Kenya, and Dibia or Babalawo in Nigeria (Abdullahi, Reference Abdullahi2011). This diversity of names reflects the rich cultural heritage and unique traditions that underpin African traditional medicine. Once revered and influential members of their societies, traditional diviners and healers have been marginalized due to the misguided association of herbal medicine with voodoo or juju (Okaiyeto and Oguntibeju, Reference Okaiyeto and Oguntibeju2021). However, some contemporary public health researchers argue that “African traditional medicine” should not be lumped together with “Alternative or Complementary medicine” (Kofi-Tsekpo, Reference Kofi-Tsekpo2004). Instead, they advocate for a more nuanced understanding that aligns with the WHO’s definition, which emphasizes the importance of indigenous practices and experiences that are unique to specific cultures.

According to the United Nations, the African continent is expected to account for over 50% of global population growth between 2015 and 2050 (United Nations, 2017). This rapid growth underscores the urgent need for a strategic plan to address emerging health needs and improve global population health. The defining characteristics of this population growth in Africa are twofold: first, the continent is urbanizing at an unprecedented rate, with an estimated 56% of the population projected to live in urban areas by 2050 (United Nations, 2014); and second, Africa will be home to 35%–40% of all adolescents and children globally by 2050 (2014). These trends pose significant challenges and opportunities for healthcare systems, infrastructure and policies on the continent.

The rapidly urbanizing population in Africa, particularly the youth, is vulnerable to the growing threat of chronic noncommunicable diseases and multimorbidity, fueled by unhealthy urbanization practices such as high sugar and salt consumption (Oni et al., Reference Oni, Matzopoulos, Adams, Pentecost, Rother, Albertyn, Behroozi, Alaba, Kaba, van der Westhuizen, King, Levitt, Parnell, Lambert, E. and members2016). To mitigate this risk, it is essential to develop and implement sustainable solutions and Sustainable Development Goals (SDGs) tailored to the continent’s needs, with a focus on rural areas. This includes expanding vaccine coverage, promoting hygiene and safe sex practices through education, and launching inclusive and participatory social development campaigns in schools and universities.

According to the WHO, approximately 80% of Africans still rely on traditional medicinal plants for their healthcare needs (World Health Organization, 2002). While herbal medicine is readily available, the goal is to educate and promote the adoption of modern medicines, particularly vaccines, to eradicate diseases such as malaria and HIV, for which vaccines are nearing completion of clinical trials. To achieve this, the implementation of Sustainable Development Goal 3 (SDG-3) – ensuring healthy lives and well-being for all at all ages – is crucial. Additionally, educating a new generation of urban health scholars at the grassroots and public policy levels is essential for driving this change.

Divination

Divination is an ancient and revered practice that endeavors to decipher the enigmatic complexities of events that surpass the realm of mundane comprehension, venturing into the mystical domain of the unknown (Peek, Reference Peek1991; Curry, Reference Curry2010). This esoteric art is deeply rooted in a tapestry of beliefs, subjective experiences and individualized practices, which diverge from the pragmatic and empirical foundations of conventional wisdom. Within the context of medicine and healing, divination is inextricably linked to a profound spiritual and religious framework, one that transcends the materialistic and reductionist paradigms of mainstream medical discourse (Egnew, Reference Egnew2005). The symbiotic integration of divination into traditional African medicine infuses the practice with a transcendent and supramundane essence, acknowledging the intricate interconnectedness of the corporeal and spiritual realms (Mokgobi, Reference Mokgobi2014). By embracing the mysteries of divination, traditional African medicine humbly recognizes the limitations of rational explanations and seeks to illuminate the profound enigmas that govern human existence (Okpako, Reference Okpako1999). This distinctive approach imbues traditional African medicine with a singular attribute, one that honors the labyrinthine complexities of human experience and the holistic interconnectedness of all phenomena (Busia, Reference Busia2005). While its forms have evolved over time, divination remains a pervasive phenomenon, manifesting in various cultures. In European culture, for instance, divination takes the form of horoscopes and astrology, which remain popular practices to this day.

In the practice of traditional medicine, divination endears the sick, whether spurious or true, producing an effect on the mind via two pathways: induction and intuitive differentiation. This psychological component, akin to the placebo effect, is a crucial aspect of traditional remedies. Divination imbues trust in the caregiver through the patient’s beliefs and submission, fostering a bond that enhances the therapeutic relationship. Studies have shown that social attachment possesses a physiological background, with the release of oxytocin, a neuropeptide that promotes bonding and social behavior (Carter, Reference Carter1998). This highlights the significance of divination in traditional medicine, as it leverages the psychological and social aspects of healing. Through selectively tapping into the patient’s beliefs and trust, divination contributes to the efficacy of traditional remedies, making it a vital component of traditional medicine. As such, divination remains an integral part of traditional medicine, shaping the dynamics of the patient–caregiver relationship and influencing health outcomes.

Critical reflection on the role of divination in traditional medicine

Integrating traditional medicine into modern healthcare: Practical steps

Integrating traditional medicine into modern healthcare can be achieved through practical steps. Offering traditional medicine therapies as complementary services, such as acupuncture or herbal consultations, can enhance patient care. Training healthcare providers in cultural competence can also help them understand and respect diverse cultural beliefs and practices. Additionally, developing integrative medicine programs that combine conventional and traditional approaches can provide comprehensive care.

Further steps can include creating referral networks between conventional healthcare providers and licensed traditional practitioners, supporting research and evidence-based practice, and incorporating traditional medicine into medical education. Addressing regulatory and licensing issues can also facilitate integration. Fostering community engagement and involving local communities in the integration process can help ensure that healthcare services meet the diverse needs and preferences of the population.

Limitations

Integration of traditional medicine into modern healthcare systems presents several challenges that warrant attention. Notably, disparities in quality and safety standards between traditional and conventional medicine may compromise patient care. Specifically, traditional medicine practices and products may not be subject to the same rigorous testing and regulatory oversight as conventional medicine, raising concerns about efficacy, safety, and potential interactions with conventional treatments.

Effective integration requires careful consideration of cultural dynamics and power relationships. The adoption of traditional medicine practices by conventional healthcare systems can potentially lead to cultural appropriation and exploitation, disempowering traditional communities and erasing their cultural heritage. Moreover, the integration process may not always involve equitable partnerships between conventional healthcare systems and traditional communities, potentially perpetuating existing health disparities and power imbalances.