**Background:** Religion is a powerful social force in sub-Saharan Africa, where the arrival of Christianity since the late nineteenth century has produced religious syncretism and fusions of Christian and African traditional practices. In South Africa, traditional healing practitioners (THPs) work as faith healers in the Christian tradition (prophets/amaprofeti) or as diviners/herbalists (sangomas/inyangas). Previous studies estimate that 70–80% of South Africans consult THPs for illness treatment, yet few studies have examined pluralism in the beliefs and practices of THPs themselves. This study examines how spiritual worldviews among traditional healers have been revitalized to meet contemporary health challenges.
**Methods:** The study enrolled 18 THPs practicing in Soweto, Katlehong, or Vosloorus townships surrounding Johannesburg between January and May 2022. A qualitative design used semi-structured interviews guided by an interview guide developed with two THPs from the Health Economics and Epidemiology Research Office (HE²RO) at the University of the Witwatersrand. Participants were recruited via snowball sampling. Eligibility criteria included being 18 years or older, able to provide informed consent, and recognized as an official THP after completing thwasa (traditional healer training). Interviews lasted 35–60 minutes and were conducted at the healer's home or workplace. Research assistants fluent in English, isiZulu, and isiXhosa provided real-time translation. Transcripts were analyzed using directed content analysis in NVivo 12.0 with inter-coder reliability. The study received ethics approval from the University of the Witwatersrand (#M210815) and Johannesburg Health District (#GP_202111_059). Participants provided written informed consent and were compensated 100 rand (~$7).
**Key Results:** Eighteen THPs were interviewed (9 males, 9 females; ages 21–74, mean 39 years; 2–48 years experience, mean 16 years). Fifteen of 18 THPs were both sangomas and prophets, reflecting syncretic relationships between traditional African beliefs and Christianity. Of these 15, 9 were with the Apostolic church, 3 with the Zion Christian Church (ZCC), 1 with Shembe, and 2 with other independent churches. Sixteen of 18 healers reported experiencing their calling via illness that 'doctors cannot treat,' often manifesting as mental illness, seizures, fainting spells, back pain, headaches, chronic fatigue, and vision problems. All THPs reported that upon starting thwasa training, the illness immediately disappeared. THPs who were both sangomas and prophets were members of non-Pentecostal African-initiated Churches (AICs), which welcome sangomas, unlike Pentecostal churches that view them as evil. Two THPs had to leave Pentecostal churches when they became sangomas. Many THPs practiced medical pluralism, mixing Western treatments with traditional practices. One THP was simultaneously a sangoma, prophet, and practicing nurse. THPs distinguished between 'natural' illnesses (for doctors) and 'supernatural' illnesses (for traditional healers). Several THPs argued they could cure illnesses such as HIV when of supernatural origin. Almost all THPs viewed collaboration with Western medicine positively and encouraged patients to get HIV testing at clinics. Many had completed short medical training courses on HIV/AIDS, COVID-19, cancer, first aid, nursing, STIs, TB, hygiene, nutrition, family planning, and counseling through local THP associations.
**Clinical Implications:** This study demonstrates that THPs in Johannesburg operate within highly pluralistic religious and medical frameworks, simultaneously drawing on African traditional beliefs, Christianity, and biomedical approaches. The finding that 15 of 18 THPs integrate sangoma and prophet roles indicates that religious syncretism is the norm rather than the exception. The near-universal experience of illness as an ancestral calling—particularly mental health symptoms—has important implications for how mental illness is understood and treated in South African communities. The strong support for collaboration with biomedical practitioners, combined with THPs' existing engagement with biomedical training and HIV testing, suggests opportunities for integrated care models. However, the belief that supernatural illnesses (including HIV) may not respond to biomedical treatment highlights potential risks of delayed evidence-based care. The authors note that collaborative healthcare services would be highly acceptable among pluralistic communities, though challenges include lack of uniform ethics codes, reports of exorbitant fees, physical or sexual abuse, acute poisoning from herbal remedies, delays in evidence-based treatment, and lack of trust between healers and biomedical workers. The study is limited by its qualitative design and small sample (n=18), and did not include bazalwane (Pentecostal) prophets, limiting generalizability.