The integration of traditional and biomedical healthcare systems is a significant public health consideration across Africa. In Eritrea, this coexistence is particularly evident, yet a dedicated theoretical framework to analyse this interaction within the specific socio-cultural and historical context is absent. Existing models often originate from non-African perspectives, limiting their local relevance. This article aims to construct a theoretical framework for comparative medicine studies in Eritrea. Its objectives are to delineate the core components of Eritrea's medical pluralism, propose a structure for analysing relationships between different medical systems, and establish a foundation for future empirical research and policy development. The framework is developed through a critical synthesis of conceptual literature on medical pluralism and comparative health systems, contextualised within Eritrean and broader African realities. It employs a constructivist approach to theory-building, drawing on documented practices and socio-cultural principles relevant to the region. Key insights: The proposed framework centres on the concept of 'negotiated coexistence' rather than integration or hierarchy. A key insight is that the relationship between systems is often characterised by patient-centred pragmatism, with individuals utilising multiple systems sequentially or concurrently based on perceived efficacy, cost, and accessibility for specific ailments. The framework provides a conceptual tool for understanding the complex dynamics of healthcare in Eritrea. It moves beyond simplistic binaries and offers a context-sensitive model that acknowledges agency and pragmatism in health-seeking behaviour, addressing a gap in the theoretical literature on African health systems. Researchers should apply this framework to conduct detailed ethnographic and health services studies in different Eritrean regions. Policymakers are urged to use it to inform strategies that recognise and respectfully engage with all healthcare providers to improve overall health outcomes. Comparative medicine, theoretical framework, medical pluralism, Eritrea, healthcare systems, traditional medicine. This article provides an original theoretical framework for analysing medical pluralism in Eritrea, developed from an African perspective to enhance local relevance and application.
Meron Habte (Mon,) studied this question.