Traditional Medicine Usage in African Nations

Overview of Africa’s Post-Conflict History
Historical Formal Institutions
Colonial legacies persist in Africa in spite of a post-colonial era (Austin, 2010). These legacies have continued in post-conflict Africa’s history. In Africa, there has been no real unifying factor bringing individuals together, primarily because of the communal aspect of society throughout the continent. Community exists and can be found everywhere in Africa. Structural, dramaturgic and institutional factors in formal institutionalization in Africa of health care has come about as a result of investment, development, and political stability (Ratcliffe, 2013). The relationship among cultural traditions, laws of society, and the symbolic boundaries have served to create the structural meanings behind formal institutions; the expressive dimension, communicative properties and interaction of these elements have made up the dramaturgic, and the actors and organizations themselves have manifested the institutional. An example of this can be seen in Nigeria.
Structurally, dramaturgically and institutionally, Africa has undoubtedly been impacted by the West over the past few centuries. It has not been untouched by the modern era, and in nations like South Africa one can see just how much the West has influenced African society (Bratton & Van de Walle, 1997). Yet other parts of Africa, like Eritrea, in spite of the system of government, is of a higher quality for the people there than it is for the people of South Africa in their nation (Morrison & Stevenson, 1972; Ratcliffe, 2013). This may be because of a closer reliance to native dramaturgical and structural meanings. To make such an argument, however, one must define what is meant by these meanings (Southall, 2003). To do that one must examine the lives of the people in question to see what they themselves value and how well they succeed at attaining those values rather than applying external values shaped and fashioned by hundreds of years of experience in some other continent and imagining that they will have any significance for the people in question (Southall, 2003). To have a sense of the rules of the community, one must have a sense of the people (Afro-centric Alliance, 2001). There is a community basis for development that goes entirely missed by the progressive reformers who seek to update Africa in accordance with Westernized models of development.
As such, Africa has its mythological leaders and figures, as Prempeh (2007) points out, noting that “the assault on constitutionalism was spearheaded by Africa's larger-than-life founding fathers, leaders like Osagyefo (Victorious Warrior) Kwame Nkrumah (Ghana), Mwalimu (The Teacher) Julius Nyerere (Tanzania), le Grand Silly (Elephant) Sékou Touré (Guinea), Ngwazi (Great Lion) Kamuzu Banda (Malawi), and Mzee (Esteemed Elder) Jomo Kenyatta (Kenya)” (p. 472). These leaders’ mythologies were established, moreover, by nationalist movements—not necessarily by a yearning growing out of customary and traditional groups, who believed their traditional way of life could be facilitated by such figures’ success in the political realm. Rather, their stories were promulgated and exalted by other members of the burgeoning political class—the African activists and politicians emerging to fill a void in leadership at the governmental level as the era of colonization crashed into rubble. Prempeh (2007) argues that “Nationalist mythology and historiography had invested these leaders with messianic attributes for their role in wrestling sovereign statehood from the jaws of European colonialism” (p. 472). The result is an Africa whose post-colonial and post-conflict narrative has been written by individuals who have succeeded in rising to the top: the narrative is a type of political propaganda.
Nigeria is one nation in Africa that has benefited extensively from investment and development, and that has thus seen its structural, dramaturgical and institutional formal health care approach change and reflect modern universal trends (Shuaib et al., 2014). It has also demonstrated a formal ability to stop the spread of pandemics—as recently as the Ebola pandemic of 2014. Ebola first appeared in Nigeria following the 2014 outbreak that began in West Africa and spread throughout the neighboring state of Guinea. From Guinea, Ebola spread to Liberia and when a traveler from Liberia commuted into Lagos Airport, the pandemic reached the state of Nigeria. The patient was immediately identified as sick and death was recorded within five days of arrival. This case of Ebola was quickly marked as patient zero by Nigerian authorities. He was the “index patient” and through contact tracing Nigerian health authorities were able to show that he had “potentially exposed 72 persons at the airport and the hospital” (Shuaib et al., 2014, p. 867). The pandemic was swiftly monitored and contained primarily because of close monitoring and action by the Federal Ministry of Health, which was overseen by the Nigeria Centre for Disease Control, a formal institution that has been modeled on the American CDC. An Ebola emergency was declared in Nigeria immediately and no time was lost in politicizing the matter or wondering what to do. A protocol had been established by health authorities and was followed. 19 lab-confirmed cases confirmed that the virus was spreading from patient zero and 1000 contacts were identified by authorities. Before long the situation was under control and there was no sign that the outbreak would cripple the country (Shuaib et al., 2014).
Because Nigeria had experience dealing with outbreaks in the past, its national public institution was ready to respond to the Ebola outbreak: “six response teams were developed within the Emergency Operations Center (EOC). The EOC specific to an Ebola response, including: 1) Epidemiology Surveillance, 2) Case Management/Infection Control, 3) Social Mobilization, 4) Laboratory Services, 5) Point of Entry, and 6) Management/Coordination” (Shuaib et al., 2014, p. 868). This is but one example of how a formal health institution in Africa has emerged to battle health problems. However, there are many informal health institutions in Africa that have developed as a result of economic disparities that prevent poorer and impoverished populations from seeking care at formal institutions like this one in Nigeria (Nelissen et al., 2020).
Evolution of Informal Institutions
Informal Institutions on a community level
Community participation is expected in times of pandemics, as the 2014 Ebola crisis in Nigeria showed. Community care provision is also expected and anticipated (Shuaib et al., 2014). Community cost-sharing is a different story. Cost-sharing initiatives have been implemented in the past—particularly by the World Health Organization in sub-Saharan Africa—but they have not been particularly successful and many are not longer continued practices (Burnham et al., 2004; Shaw & Griffin, 1996). The reasons for discontinuation stem from political instability to economic instability (Burnham et al., 2004). Community food security in Africa is also another matter and varies widely from state to state. Even before the outbreak of COVID 19, food insecurity was a major problem throughout sub-Saharan Africa (Ehui, 2020). One can see examples of community participation in nearly any African state and use this state as a way to represent the whole of the continent—for though as diverse as the continent is, there is a universality in the diversity.
The Zulu word that refers to the ability of Africans to demonstrate cooperation, humanity, dignity, reciprocity, and compassion without any formal system of government obliging them to do so is Ubuntu (Khoza, 2006). Prior to the colonization of South Africa in the 17th century by Western Protestants, it had come into contact with the Catholic Portuguese. It consisted of diverse tribal communities, where a dozen languages could be found. To this day its diversity is pronounced, but its social identity has largely been shaped by issues of the Modern West, including equality and democracy. African customary practices are thus based on age-old theories of collectivism, Claridge (2004) highlights the issue of the Western world, claiming theoretical accolades for these practices they have coined as “Community Participation.” Community Participation is nothing but a new buzzword based on old concepts of community self-sustainment (Buchy et al. 2000). As Ubuntu is a Zulu word that roughly translates to a person being who he or she is because of others but that has nonetheless become a universal concept in discussing Africa it shows the extent to which a universal sense of community prevails in Africa (Fraser-Moleketi, 2009, 243). The word is now widely regarded in the literature as referring to the ability of the African culture to demonstrate cooperation, humanity, dignity, reciprocity, and compassion (Khoza, 2006, 6). The Ubuntu spirit is widely applied by many societies across Africa, and hence one can easily find its elements in many aspects of daily life across the continent, particularly by East, West, Central and South African tribes (Louw, 2006). The application of Ubuntu in the modern day world would unlock the capacity especially of African peoples to express mutuality, humanity, dignity, reciprocity, and compassion in their communities and nations (Poovan, Du Toit & Engelbrecht, 2006, p. 23-25). In many African countries, love and respect are important ideals. These two ideals are part and parcel of Ubuntu as they are thought to support community life. Thus, individual care through informal channels is an accepted practice as empathy and love inform many communities across the African continent.
Participation in communal life is thus regarded as an important part of Ubuntu. According to Brager et al. (1987), one of the many definitions of participation is a way to empower and increase the competence of citizens. By participating in the governing of their societies, citizens can get political power and strongly influence how their societies are run. Citizen participation is a process. A process in which citizens become responsible for their communities, voice their opinions on issues affecting them and act for the public good (Poovan et al., 2006). What must be noted here is that for citizen participation to work, citizens must act collectively. It is only collective efforts that can give citizens the power to influence decisions and political outcomes (Brager et al., 1987).
Ghana is a typical example of African community. The history of Ghana is linked to the slave trade of the West, when Western traders would trade with coastal African region for slaves (Dillard, Duncan & Johnson, 2017). Ghana was not an independent country at the time and so in the 15th century the Portuguese established residence there, only to lose their position to the Dutch (Ofosu-Mensah, 2017). Eventually the British took control of the area, but by the 19th and 20th centuries African nations were pushing hard for independence from the colonizers. Ghana was formed as a nation in the mid-20th century. Ghana is diverse tribally speaking but the majority of the population is Akans, followed by Mole-Dagbon, Ewe, Ga-Adangbe, Konkomba and various other smaller tribal populations (Nathan, 2016). Though English is the official language of Ghana (because of the British rule in the past), there are dozens of accepted languages in Ghana, from Bono to Wasa. It is a very diverse nation, linguistically speaking, because of the many different tribes and kingdoms that existed there. Many African states are like this and it shows the complexity of generalizing about community life in any one African nation. Families are patriarchal and traditional rather than liberal in Ghana, as in much of Africa. Families are intimately connected to communities and ethnic groups are important within the diverse population of the state. Behaviors are learned by adolescents from watching their parents, who are tasked with passing down customs (Asiseh, Owusu & Quaicoe, 2017). Family values are traditional. Homosexuality for example is not approved and the vast majority of the population views it as immoral. Women are expected to know their place and men are traditionally viewed as the heads of households. However, the fertility rate does appear to be declining over the past few decades from 7 in 1970 to just under 4 live births per woman in 2017, according to the UN (2017). This indicates that modern attitudes towards sex and sexuality are spreading through African communities and that this in turn has an impact on how communities share the health burden.
Informal Institutions on an individual level
Feeding other members of a community in need in times of health crises is not unheard of, and community members will see one another as members of one’s own family or tribe. There is a close-knit nature among community members the more similar the members are—but in a more diverse society like an urban city in Nigeria, the communal nature of society is lessened by various factors of social strata (Claridge, 2004). Sharing meals is a traditional custom in African society for generations (Brager et al., 1987).
Traditional medicines are readily available in Africa. As Mahomoodally (2013) notes, “in many parts of rural Africa, traditional healers prescribing medicinal plants are the most easily accessible and affordable health resource available to the local community and at times the only therapy that subsists” (p. 1). These medicines are not shown to be effective in treating issues like HIV or AIDS but they do have cultural value and health uses. For instance, the gum of A. senegal has been used in traditional medicine for hundreds of years in Africa, and the various parts of the plant have been found to be effective in treating bronchitis, gonorrhea, leprosy, typhoid, and respiratory tract infections and herbalists throughout the continent have used gum acacia to bind pills and as a stabilizer in emulsions (Gurib-Fakim et al., 2010; Gurib-Fakim & Kasilo, 2010; Okoro, Kawo & Arzai, 2012).)
As for individual care provision in communities, it depends upon culture, custom, experience, economic status, and geography. There are differing opinions as to the origins of the community participation theory in Africa and Midgley et al. (1986) suggest that the historical antecedents of community participation include the legacy of western ideology, the influence of community development and the contribution of social work and community radicalism. For health provisions, individual care is most likely to something pursued in formal health institutions so long as this service is affordable; but when it is not, faith healers, herbalists and traditional medicine providers are sought—or else self-medication often through alcohol or herb is used as a recourse (Gbagbo & Nkrumah, 2020). Lane (1995) added to this view, suggesting that participation is heavily influenced by theories of development and is therefore highly varied and complex due to different theoretical positions. The community participation theory emerged out of western top-down governance, and political model where in Africa it was a bottom-up approach based on Ubuntu principles.
Benefits
Medication is available in many informal ways in African states, but people will self-medicate because it is easier for them to do this than to go through the trouble of seeking out care from a health care facility. Thus, pain is often either dealt with or self-treated (Gbagbo & Nkrumah, 2020). However, pain medications are available. Ghana is typical of other African states in that it spends 5% of its GDP on health care services and health care is viewed as a human right in the country. Its access to care varies from region to region in the nation, but its health care facilities are deemed as high quality by neighboring states and thus health tourism is a phenomenon there (UN, 2017). Faith healers exist in African states because of the Pentecostal and Charismatic churches there as well as because of traditions among older tribes. Thus, to a small degree, the native religious tribal practices have some form of faith healing as well. It is one reason the Charismatic churches have caught on in states like Ghana: they are not dissimilar from native customs (Ngunjiri, 2011).
In societies in places such as Eritrea, one’s extended family is a crucial part of his or her life. Many people in such societies depend on their extended family for social, security, and financial support if they lose their jobs, fall sick, in case of unforeseen circumstances, and when old. It is normally regarded as the moral obligation of the family member who has a job to provide financial support to the needy, aged, and sick members of the extended family (Ghebregiorgis & Karsten, 2006: 150). This ethos is even captured in the general language of the country’s constitution. It is no surprise to hear any African person abroad mention that he/she sends money back to Africa to support their family. Another aspect of this customary practice is respecting and caring for the elderly. The aged are held in high esteem and social status. Caring for the elderly is a natural and expected part of life and also has its roots in strong religious beliefs, securing the caregiver’s future, as when the elderly pass on, they would protect and prepare the caregiver’s place in the next life. 
Challenges
In many communities across Africa, working together and cooperation was often exalted especially in times of difficulty. It is supporting one’s family before oneself has always been regarded as the right way of doing things. This kind of support is nowadays yearned for in many societies. If this knowledge of African collectivism was to be applied to organizations and adopted as the ethos, it could lead to communities supporting each other, reduced conflicts, and nations recording higher productivity (Wasilwa, 2017). The application of African collectivism can also lead to longer-term sustainability of organizations as is the case with African families and organizations that stick together. The application of the spirit of collectivism could also lead to many states also focusing on environmental protection since it will naturally become a focus when they start working like communities and caring for the environments they operate in (Eyong, 2007). The problem is that most African societies believe in communal existence and not individual existence. Adapting this attitude is the main challenge in a time of pandemic.
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