Understanding the perspective of traditional healers on their role within the Malawian healthcare system: a qualitative study in Thyolo District

Malawi has 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 from the TH perspective are limited. Understanding TH perspectives on their role within the community is critical to integrating TH into the biomedical system. We conducted a qualitative study using semi-structured interviews of TH in Thyolo District, Malawi, in May 2024. A cross-sectional survey of community members in the area was used to inform participant recruitment for the interview study. Interview participants were identified and recruited purposively using these survey data and information gathered by the local study team through engagement with the Traditional Healer Association of Malawi. Interviews were conducted in Chichewa, translated and transcribed in English, and coded for themes. We interviewed a total of 29 TH: 21 male and 8 female, ages 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. In Malawi, TH demonstrate a strong desire for recognition, training, and integration into the biomedical system. Understanding of disease processes beyond 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, however, additional context from healthcare providers and patients is needed.