title: The role of traditional health practitioners in Rural KwaZulu-Natal, South Africa: generic or mode specific?
abstract: BACKGROUND
  Traditional health practitioners (THPs) play a vital role in the health care of the majority of the South African population and elsewhere on the African continent. However, many studies have challenged the role of THPs in health care. Concerns raised in the literature include the rationale, safety and effectiveness of traditional health practices and methods, as well as what informs them. This paper explores the processes followed in becoming a traditional healer and how these processes are related to THP roles.
  
  
  METHODS
  A qualitative research design was adopted, using four repeat group discussions with nine THPs, as part of a larger qualitative study conducted within the HIV Treatment as Prevention trial in rural South Africa. THPs were sampled through the local THP association and snowballing techniques. Data collection approaches included photo-voice and community walks. The role identity theory and content analysis were used to explore the data following transcription and translation.
  
  
  RESULTS
  In the context of rural Northern KwaZulu-Natal, three types of THPs were identified: 1) Isangoma (diviner); 2) Inyanga (one who focuses on traditional medical remedies) and 3) Umthandazi (faith healer). Findings revealed that THPs are called by ancestors to become healers and/or go through an intensive process of learning about traditional medicines including plant, animal or mineral substances to provide health care. Some THPs identified themselves primarily as one type of healer, while most occupied multiple healing categories, that is, they practiced across different healing types. Our study also demonstrates that THPs fulfil roles that are not specific to the type of healer they are, these include services that go beyond the uses of herbs for physical illnesses or divination.
  
  
  CONCLUSIONS
  THPs serve roles which include, but are not limited to, being custodians of traditional African religion and customs, educators about culture, counsellors, mediators and spiritual protectors. THPs' mode specific roles are influenced by the processes by which they become healers. However, whichever type of healer they identified as, most THPs used similar, generic methods and practices to focus on the physical, spiritual, cultural, psychological, emotional and social elements of illness.
authors.affiliation: Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa. tzuma@africacentre.ac.za.
authors.forename: Thembelihle
authors.identifier: http://orcid.org/0000-0001-5706-2657
authors.initials: T
authors.lastname: Zuma
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wight
authors.affiliation: Human Sciences Research Council/Human and Social Development (HSD), Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa.|Developmental Pathways to Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Tamsen
authors.initials: T
authors.lastname: Rochat
authors.affiliation: Africa Centre for Population Health, University of KwaZulu-Natal, Mtubatuba, South Africa.|School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Mosa
authors.initials: M
authors.lastname: Moshabela
mesh_terms: D000328:Adult; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D016488:Medicine, African Traditional; D036301:Qualitative Research; D012380:Role; D013019:South Africa
keywords: KwaZulu-Natal; South Africa; Traditional healing roles; Traditional health care; Traditional health practitioners