Conventional and complementary healthcare professionals need to work together

Mail & Guardian

2 days ago

Earlier this year, the US government took the drastic decision to terminate about 40 USAid-funded health projects in South Africa, a move that threatens the sustainability of these projects. The halting of funding has led to the closure of many clinics and a decrease in services rendered, such as HIV testing and treatment.
To mitigate the problem, the health department, together with the South African National Aids Council, the Joint UN programme on HIV/Aids and World Health Organisation, has launched the Close the Gap campaign,
which aims
But this intervention leaves a gap of more than 2 million people who are lost to treatment for different reasons. According to the health department, nearly 8 million people are living with HIV in South Africa, with 5.7 million people stable on antiretroviral drugs (ARVs).
Among the reasons for the lost numbers could be the use of complementary medicine, instead of the conventional medicine offered in the mainstream healthcare system. Despite South Africa having diverse communities with multifaceted healthcare needs, who seek assistance from both conventional and complementary medicine practitioners, research shows that access to complementary medicine remains largely unsupported. According to the WHO, 80% of the world's population uses it.
Complementary medicine includes treatments such as homeopathy, Unani-Tibb, ayurveda, traditional Chinese medicine, aromatherapy and Western herbal medicine. South African studies have highlighted the high use of complementary medicine, especially Western and traditional herbal medicine, among people living with HIV.
Additionally, these studies have shown that people living with HIV use complementary and ARVs concurrently without the knowledge of their healthcare providers. This is a huge risk as it can compromise the safety and effectiveness of ARVs and cause herb-drug interactions. This is exacerbated by the lack of inter-professional communication between conventional and complementary healthcare practitioners.
Professional inter-referral is a practice of healthcare practitioners referring patients to other practitioners to ensure complete, safe and high-quality patient-centred care. This practice is a requisite to improve patient outcomes and enhance the efficiency of healthcare delivery.
Despite the increasing evidence and popularity of complementary medicine use in South Africa, there is no formal inter-referral system between conventional and complementary healthcare professionals. Studies show that conventional healthcare practitioners do not refer patients to complementary practitioners, even though they receive referrals from them. For instance, complementary medicine practitioners refer patients to hospitals for laboratory blood tests and X-rays, as well as to various specialists.
This finding is concerning and needs to be highlighted to improve the management of multidisciplinary care and continuity of patient care.
Furthermore, evidence shows that the lack of an inter-referral system between conventional and complementary practitioners can lead to the fragmentation and compromise of the delivery of quality healthcare. This suggests that inter-referral relationship is a significant practice needed for comprehensive patient care, especially in South Africa, where diverse people use different modalities for healthcare.
It demands that healthcare practitioners realise that their area of expertise is important — but not sufficient alone. This is not easy for some to accept and warrants highlighting. Inter-referral relationships require practitioners to step outside their professional pride to appreciate others.
A 2025 South African study showed that conventional healthcare practitioners were willing to suggest that patients seek advice from complementary practitioners, yet they were unable to make a formal referral themselves.
One can assume that conventional practitioners might have a perception that practising complementary medicine is not a legitimate profession. Their insufficient knowledge of complementary medicine could also be a reason for not referring patients.
In South Africa, complementary medicine is regulated by the Allied Health Professions Council of South Africa. The licensing and registration requirements are regulated by the South African Health Products Regulatory Authority. These bodies prioritise the quality and efficacy of medicines and patient safety.
Complementary healthcare practitioners are clinically trained as diagnosticians in higher institutions across South Africa. For instance, the Department of Complementary Medicine at the University of Johannesburg offers a postgraduate diploma in phytotherapy (medicinal plant-based therapy) to medical doctors to increase their scope of practice, enhance the cross-disciplinary approach and help them provide a holistic treatment for patients.
The dominance of evidence-based medicine is identified as the main barrier to the inter-referral system. There is increasing documented scientific and clinical evidence on complementary medicines and safety data on the toxicology and possible herb-drug interactions.
This evidence is sufficient to convince conventional healthcare practitioners to refer patients to complementary practitioners. A formalised referral system is significant to strengthening the healthcare system, especially within the integrated National Health Insurance that is to be implemented in South Africa. The lack of a formalised inter-referral system has implications for patient safety in the delivery of healthcare.
The delivery of healthcare in South Africa needs to be considered alongside the broader cultural and social contexts, which necessitate a collaborative approach. South African healthcare must offer a holistic patient-centered approach that considers patients' preferences and includes them in the treatment plan. This will ensure that patients receive appropriate service according to their needs.
Dr Tebogo Tsele-Tebakang is head of the Department of Complementary Medicine, in the Faculty of Health Sciences, at the University of Johannesburg. She writes in her personal capacity.