Understanding the role of traditional healers in the Malawian healthcare system: a qualitative study

Introduction Malawi is a pluralistic health system, where people seek care from both formal (e.g. biomedical) and informal (e.g. traditional medicine) sources. An estimated 80% of the population utilizes traditional healers (TH) for care, particularly in rural areas. Given their strong community presence, TH may be able to bridge gaps in the healthcare system, however, data on barriers and facilitators to this relationship are limited. Understanding TH perspectives on disease processes and their role in the community is critical to integrating TH into the biomedical system. Methods We conducted a qualitative study using semi-structured interviews of TH in Thyolo District, Malawi in May 2024. Participants were identified and recruited using purposive sampling. Interviews were conducted in Chichewa, translated into English, and coded for themes. Results We interviewed a total of 25 TH: 17 male and 8 female, age 25 to 84 years. Time in practice ranged from 8 months to 60 years. Major themes identified included: 1. Relationship-building for diagnosis and treatment; 2. Trust and willingness to collaborate with biomedicine; 3. Compensation for gaps in the biomedical system; 4. Recognition of causes and risk factors for infection; and 5. Leadership role in the community. Conclusions In Malawi, TH demonstrate a strong desire for recognition, training, and integration into the biomedical system. Understanding of disease processes outside of traditional vs. biomedical illnesses is variable, but most TH trust biomedicine and feel comfortable referring clients. Given their respected role in society, TH may provide a useful adjunct to biomedical care in rural Malawi.