Original article

A historical overview of traditional medicine practices and

policy in Ethiopia
1
Kebede Deribe Kassaye, 1Alemayehu Amberbir, 1Binyam Getachew, 1Yunis Mussema

Abstract
Background: Although traditional medicine plays an important role in Ethiopian society, knowledge about the extent
and characteristics of traditional healing practices and practitioners is limited and has frequently been ignored in the
national health system.
Objective: To review history of practices and policies on traditional medicine in Ethiopia.
Methods: A systematic review of available literature on Ethiopian traditional medicine and policy documents was
carried out. Google, Pub Med and Medline online internet searches were done to access relevant material. In addition,
materials from Jimma University Library and the Ethiopian Federal Ministry of Health Library were used. Several
authorities were also contacted to supplement the literature.
Result: There are a number of traditional medicinal practices that reflect the diversity of Ethiopian cultures. Ethiopian
traditional medicine is concerned not only with the curing of diseases but also with the protection and promotion of
human physical, spiritual, social, mental and material wellbeing. The many categories of traditional medicinal practices
dealing with these different aspects of health include: spiritual healing, prevention, as well as curative and surgical
practices. The health and drug policies of the Ethiopian Ministry of Health recognize the important role traditional
health systems play in health care. Unfortunately, little has been done in recent decades to enhance and develop the
beneficial aspects of traditional medicine including relevant research to explore possibilities for its gradual integration
into modern medicine.
Conclusion: The Ethiopian government firmly supports and encourages traditional medicine through its policies as part
of the national heritage. Despite these commitments on the policies, the government's ability to implement and provide
increased resources for the study, as well as sustainable use of traditional medicine and their integration with modern
medical practice has been limited. [Ethiop.J.Health Dev. 2006;20(2):127-134]

1
Jimma University, Faculty of Public Health, P.O. Box 5035, E-mail [email protected], Jimma, Ethiopia
128 Ethiop.J.Health Dev.
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Introduction and effective TM/CAM therapies could, thus, become a

The World Health Organization (WHO) defines traditional critical tool to increase access to health care (2).
medicine as health practices, approaches, knowledge and
beliefs incorporating plant, animal and mineral based Despite its existence and continued use over many
medicines, spiritual therapies, manual techniques and countries, and its popularity and extensive use during the
exercises, applied singularly or in combination to treat, last decade, traditional medicine has not been officially
diagnose and prevent illnesses and maintain well-being (1). recognized in most countries. Consequently, education,
training and research in this area have not been accorded
It is known that many countries in African, Asia and Latin due attention and support. The quantity and quality as well
America use traditional medicine (TM) to meet some of as the safety and efficacy of data on traditional medicine
their primary health care needs. In Africa, up to 80% of are far from sufficient to meet the criteria needed to support
the population uses traditional medicine for primary health its use worldwide. One of the reasons for the lack of
care (2). research data is due to health care policies (4).

Traditional medicine has maintained its popularity in all In Ethiopia up to 80% of the population uses traditional
regions of the developing world and its use is rapidly medicine due to the cultural acceptability of healers and
spreading in the industrialized countries. In China, for local pharmacopeias, the relatively low cost of traditional
example, traditional herbal preparations account for medicine and difficult access to modern health facilities. In
30%50% of the total medicinal consumption. In Ghana, 2000 only 9.45% of all deliveries in Ethiopia were attended
Mali, Nigeria and Zambia, the first line of treatment for by trained attendants and health workers. The rest were
60% of children with high fever resulting from malaria is attended by traditional birth attendants or relatives (5,6).
the use of herbal medicines at home. WHO estimates that
in several African countries traditional birth attendants The vast majority of Ethiopia's population lives in rural
assist in a majority of births (2,3). areas where the health care coverage is low and where
existing public sector resources are being stretched to the
Over one-third of the population in developing countries lack
limits. One of the greatest challenges facing the country
access to essential medicines. The provision of safe

is determining how best to narrow the gap between the

_______________________________________________________________________________________________
existing services and the population whose access to them practice out side of the health services although they are
is very limited (7). the main health care providers for many Ethiopians (8,11).

The Ethiopian people's reliance on traditional medicine is Having recognized the significance of traditional medicine
also reflected by the fact that Ethiopian migrants in more readily, greater attention has been paid by
developed countries continue using them. For example, a governments of many developing countries in recent years
number of herbs, traditional medical devices and to promote the widespread application of the practice in
traditional practitioners are available in the UK (8). health care. This has given a new impetus to relevant
research, investment and design of programs in the area in
In 2003/04, at least 30% of populations did not have easy many countries (12). In this article, some of the major
access to formal health services. The national average characteristics and practices of traditional Ethiopian
physician to population ratio was 1:51042 over 35.1% of medicine have been summarized in an attempt to provide
the 1889 physicians working in government and private a brief overview relevant for health policy. Moreover, an
health services were found in the three big cities attempt is made to review policies regarding traditional
accommodating 4.7% of the total population. The private medicine towards a better understanding of the historical
practitioners also work exclusively in large towns. If it background and policy perspectives on traditional
were possible to calculate for rural alone the rates will be medicine in Ethiopia.
very far below the standard (9). A study of pharmaceutical
drug use showed that 35% of the patients did not obtain the Search Methods
prescribed drugs due to lack of money (10). However, Some of the existing extensive literatures on Ethiopian
most traditional medicines are delivered either free or with traditional medicine and policy documents were reviewed
a relatively low cost, which contributes to the use of rural for this study. Other main sources were books, journals,
based healers for community primary health care need. online materials, reports and other relevant published and
unpublished documents. Google, Pub Med and Medline
The current Ethiopian health care system is primary health online searches were also carried out to access other
care focused. However, traditional healers continue to relevant publications. In addition, materials from the

Ethiop.J.Health Dev. 2006;20(2)

 Historical overview of traditional medicine practices and policy in Ethiopia 129
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libraries of Jimma University and the Ethiopian Federal which are beyond the scope of this review. There are many
Ministry of Health were reviewed. Several authorities types of traditional healing practices, which are discussed
were consulted through personal communication to here in four groups.
complement the review of the literature.
In Ethiopian traditional medicine, the issue of health is
seen holistically and not separated into physical health and
The key words used to access online materials include mental health. Spiritual wellbeing is also important.
traditional medicine, tradition, and traditional healer with Health is seen as a 'gift of God' or 'the will of God' and
or with out Ethiopia. many Ethiopians generally believe that their religion helps
keep them healthy (8).
Traditional medicine practitioners and practices
Traditional practitioners include bonesetters birth These perceptions are related to the belief that supernatural
attendants, tooth extractors, (called 'Wogesha' and yelimd forces are involved in causing disease as well as in their
awalaj' respectively in amharic) herbalists, as well as treatment. For instance, while the devil is considered to be
'debtera', 'tenquay' (witch doctors), and spiritual healers the cause of a number of illnesses, God is believed to
such as 'weqaby' and 'kalicha' (8,11). provide the healing. This scenario is even more applicable
to mental illnesses, and some other conditions that are
Religious practices play a large part in the healing process more obscure and difficult to treat with well-defined
for Ethiopians such as praying and going to church. Holy means. The use of prayer as a therapy in the practice to a
water for Orthodox Christians (called 'tsebel' in Amharic) supernatural power has been around for a much longer
or 'zemzem' in the case of Moslems is also frequently used time in the practice of Ethiopian traditional medicine.
for a wide varity of illnesses. Ethiopians believe that holy Traditional spiritual healers are known by different names,
water cures when it is drunk or bathed in (8,11). depending on the communities where they practice
including debtera, tenquay (witch doctors), weqaby and
Characteristics of traditional medicine in Ethiopia kalicha (8,11,18).
Ethiopia has a long history of traditional medicine and has
developed ways to combat disease through it (11). The The more widely known spiritual healers are grouped into
ways are also as diverse as the different cultures. Healing two categories according to their religious beliefs.
in Ethiopian traditional medicine is not only concerned Members of the Orthodox Christian clergy are called the
with curing of diseases but also with the protection and debteras and members of the Muslim community are
promotion of human physical, spiritual, social, mental and known as kalichas. Debteras usually look upon mental
material wellbeing (13). disorders as possession by evil spirits, which are thus
treated mostly by praying and using holy water or
It is widely believed in Ethiopia that the skill of traditional eventually exorcising the evil spirit. The debteras are
health practitioners is 'given by God' and knowledge on renowned for their prayer which is known as degmit,
traditional medicines is passed orally from father to a which they perform on behalf of clients. Along with this,
favorite child, usually a son or is acquired by some they prepare holy water (tsebel) and kitab amulets
spiritual procedures. Traditional Healing knowledge is containing a written script. By means of the degmit, the
guarded by certain families or social groups (14). debteras claim to have the ability to perform miracles,
which are believed to be manifested by the reactions of
Healers obtain their drugs mainly from natural substances their patients. Tsebel is commonly used to ward off evil
and in descending order of frequency these constitute spirits from patients who are believed to be possessed by
plants, animals and minerals. Drugs are prepared in the devil. Kitabs are worn for the purpose of protecting
various dosage forms including liquids, ointments, oneself against the evil eye or buda, as well as snake and
powders and pills. Drugs are also prescribed in a scorpion bites.
nonformulated form and additives are usually incorporated
and more than one drug is used in a single dosage form. The kalichas is the religious leader who, through an
Drugs were administered using different routes, the main ecstatic ritual, can investigate the causes of a disorder and
ones being, topical, oral and respiratory. When sideeffects advise the patient on what to do. Mental disorders are
became severe, antidotes were claimed to be used. The generally explained as resulting from disturbances in the
healers imposed restriction when certain types of drugs relationship between people and divinity. They conduct
were taken by patients. Drugs are stored usually in special ceremonies to effectively perform their practices
containers such as bottles, papers, pieces of cloth, leaves which include the use of excessive smoke by burning
and horns, and were kept anywhere at home (15). incense such as myrrh, and frankincense (etan). Similar to
the debteras, the kalichas also prepare kitabs of their own
In addition to traditional medicinal practices by kind to be worn by their clients (18).
professional healers, there is also an old tradition of self
care in the home and another, more recently evolved Besides its role in healing, traditional Ethiopian medicine
subsystem of lay care of transitional medicine (16,17), is also associated with a number of other beliefs. These
practices are helpful in prevent the evil eye, overcoming
Ethiop.J.Health Dev. 2006;20(2)
130 Ethiop.J.Health Dev.
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demons, defeating human enemies, obtaining long life, Surgical practice

clear eye sight, a good memory, as well as a large family Traditional practices considered to be related to surgery
and a faithful wife (11). include bone-setting, uvulectomy, circumcisions, bleeding
and cupping, cautery, scarification and tooth extraction
Preventative practice (22,23). The setting of bones is regarded as an important
Traditional Ethiopian medicine includes several elements surgical procedure which requires a certain degree of skill
or disease prevention. In the past, the spread of highly and experience on the part of the healer. In most places,
infectious diseases such as smallpox was prevented by the healer involved in bone-setting is the local wogesha.
deserting places where the epidemics occurred. Moreover, In many situations, the wogesha practices his/her skills
people were inoculated by taking pus from a sick person without aseptic conditions, with or without the application
during special rituals (19). Sweeping or covering floors of medicines. Other procedures are indicated for more
with particular plants is another traditionally practiced specific conditions such as rheumatism, bleedings,
disease preventive measure. Other methods of disease swelling, wounds, headache, localized infections, and
prevention include isolating people with contagious snake and scorpion bites (11).
diseases, prohibition or controlling movement and taking
children away from the affected areas (11,19,20). Midwifery is one of the most common practices of
traditional Ethiopian medicine. It is performed by
As noted above, kitabs are also used for the purpose of traditional midwives commonly known in Amharic as
protecting an individual against evil eye, as well as snake yelmid awalajs, (traditional birth attendants) and most
and scorpion bites. Amulets, arm rings, hair style and eye yelmid awalajs are women. Depending on the need, they
make-up (antimony or kool) are also supposed to protect carry out their practice with or without the administration
from the evil eye. Still other medicines are available for of medicines. During the Derg regime, some 11,500
use as charms against an enemy. In addition, cultural Yelmid awalajs were trained for better utilization of their
rituals and scarification are commonly employed in knowledge in midwifery (14).
diseases prevention (21).
Traditional medicines are sold in every open market in
Curative practices Ethiopia and households, especially in the rural areas.
Traditional Ethiopian medicine is commonly used to treat Market vendors selling these materials are women. These
a variety of diseases employing substances as medicines are usually sold to the public together with other
recommended by professional traditional medical materials such as spices, salt and other food items (24).
practitioners. The conditions that claim to be treated
include gastrointestinal disturbances, respiratory Traditional medical treatments are also commonly given at
disorders, sexually transmitted infections, tuberculosis, the household level. There is significant knowledge of
impotency, hemorrhoids, rabies, intestinal parasites, skin medicinal plants in the non professional public domain
problems, liver diseases, mental disorders, hypertension, where most ailments are diagnosed and treated at the
diabetes, gynecological conditions rheumatism, malaria household level. Where traditional professionals are
and others (11). Professional traditional healers known by consulted, it is often for their specialized traditional
different names in different parts of the country are the knowledge and skills pertaining to a relatively limited
primary players in the curative aspect of traditional range of health. Most of the families grow or gather these
medicine practice. One of the well recognized groups of plants in their vicinities of homes (17).
these healers are the secular medhanit awakis (kitel
betashs) herbalists using plants as their primary means of Problems associated with traditional medicine
providing treatment. A large number of plant medicines Some plants used in traditional medicines, such as
are used, and for the purpose of references, most medhanit taenicides, are widely known to be toxic. For example,
awakis possess pharmacopoeias. Minerals and animal- blindness and changes in central nervous system function
derived substances are additional items in the have repeatedly been found in people who took over
pharmacopoeia of medhanit awakis (22). dosage of Hagenia abyssinica (25). Traditional healers
may cause create delays in the treatment of communicable
The medhanit awakis diagnose disease conditions mostly diseases such as TB if they fail to refer patients to modern
by physical examination and questioning patients. health services (26). Moreover, a number of harmful
Sometimes they prescribe medicines based on descriptions practices have been traced to healers, including female
from informants. They prepare their medicines in various genital mutilation, uvulectomy, and milk tooth extraction
dosages and forms and administer medicines via different (27).
routes. After preparations, many of the medicines are
stored in containers anywhere at home without special Review of Policies
requirements. Although the medhanit awakis make efforts Formal recognition to TM in Ethiopia was given in 1942
to modernize their practices, they do not normally employ (Proc. 27) where the legality of the practice is
any of the equipment and techniques used in conventional acknowledged as long as it does not have negative impact
medical or pharmaceutical practices (22). on health. This was reaffirmed in the 1943 and 1948 (Proc.

Ethiop.J.Health Dev. 2006;20(2)

 Historical overview of traditional medicine practices and policy in Ethiopia 131
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100) Medical Registration Proclamations. Articles in the Department of the Ethiopian Health and Nutrition
Ethiopian Penal Code (512/1957) and the Civil Code Research Institute (EHNRI) (12).
(8/1967) provide guidelines for the practice of traditional
medicine. But they did not stipulate any requirement for Currently there is no registered traditional practitioner and
registration. Registration and licensing was introduced in way of registration in the Federal Ministry of Health (33)
1950 (13,28). During the Derg period of the 1970s and though herbal medicines are sold on the streets with
1980s the country's health policy emphasized disease medical claims. No regulatory requirements exist for the
prevention and health service development in the rural manufacturing or safety assessment of traditional
areas. It was followed by official attention to the medicines and herbal medicines are not included in the
promotion and development of traditional medicine, essential medicines list. There is neither a post market
particularly after the adoption of the Primary Health Care surveillance system, a restriction on the sale of herbal
Strategy in 1978. In November 1979, the Office for the medicines nor a guideline for clinical trials using
Coordination of Traditional Medicine was established. It traditional medicines (12).
conducted chemical assays and biomedical studies of some
herbal medicines and a total of 6,000 traditional An initiative was made to establish guidelines for licensing
practitioners were registered and a monograph describing and minimum standards for traditional practice and
260 medicinal plants was prepared. Meetings and practitioners. A committee from FMOH, DACA and
workshops were organized that brought together EHNRI is preparing standards of safety, efficacy and the
traditional and modern medical practitioners. In different quality of traditional medicine (33). Different researches
areas of the country healers also formed their own were also conducted on the toxicology and efficacy of
professional associations. However, these lacked drugs in the Drug Research Department of the EHNRI
guidance, funds and personnel to help them move forward (34).
(14, 28, and 29).
By early 2006 DACA had not yet carried out any activity
The National Policy of Traditional Medicine under the on traditional medicines and no traditional drug was
current Federal Democratic Republic of Ethiopia was registered and licensed although guidelines are being
issued as part of the Health, Drug, and Science and prepared (35).
Technology Policy issued in 1993 (30,31,32). Traditional
medicine is placed as one of the eight priorities of the Similarly, there is no training program exists on traditional
current Health Policy. It was reported that due attention medicine and there is no guideline for training traditional
shall be given to the development of the beneficial aspects healers.
of traditional medicine including related research and its
gradual integration into Modern Medicine. The general The Ethiopian Intellectual Property (IP) office with funds
strategies adopted include identifying and encouraging the provided by the World Bank is preparing an intellectual
utilization of its beneficial components, coordinating and property protection policy for traditional medicine (36).
encouraging research including its linkage with modern
medicine and developing appropriate regulation and
Discussion
registration of practitioners (30).
Due to poor access to health services, especially in the rural
areas, the majority of the Ethiopia people rely mainly on
The 10 targets of the drug policy include conducting traditional medicine for their primary health care needs (5).
coordinated research on traditional medicines and striving Nevertheless, the system has been neglected and its
for development into pharmaceutical drugs. The same therapeutic potentials as well as adverse effects have not
document outlines general strategies for strengthening the been thoroughly studied scientifically. Moreover, the
health sector through research and development, creating integration of the practice of traditional medicine into the
favorable conditions for the development of safe and formal health system has not been seriously considered.
effective drugs and involving private providers (31). Progress made so far in this direction in other countries has
allowed for a wide utilization of traditional medicine and
Laws and regulations on traditional medicine were issued better recognition of its practitioners as heritage benefiting
under the Drug Administration and Control Proclamation the majority of their people (37).
No. 176/99. The national drug program is one of the
responsibilities of the Drug Administration and Control The interest in and intrinsic value of traditional Ethiopian
Authority (DACA) which was established by Proclamation medicine should not be only be attributed to the lack of
No. 176.DACA. An Expert Committee is also a part of access to modern medicinal services. Even in cites where
DACA. DACA is responsible for preparing standards of modern health services are more accessible and
safety, efficacy and quality of traditional medicine, and specialized, many people continue to go to traditional
shall evaluate laboratory and clinical studies. It also gives healers (6,14). This may be due to the cultural
license for the use of traditional medicine in the official acceptability of healers, the respect they have and their
health services. The national research institute covering easy accessibility to clients. The healing process is often
both traditional and herbal medicine is the Drug Research carried out in an atmosphere of mutual confidence and

Ethiop.J.Health Dev. 2006;20(2)

132 Ethiop.J.Health Dev.
______________________________________________________________________________________

shared expectations. Compensation in traditional continuation of polarization and separate development of

medicine is different from the payment system of official the two systems with out creating a basis for integration.
health services. Healers typically receive an initial
payment in money (or in goods in rural areas) and then Policies conductive to TM exist in Ethiopia and compared
negotiate subsequent payments with the patient. In cases, to the former regimes, the current policy is comprehensive
where treatment is ineffective, the patient does not have to and gives TM an important place.
pay beyond the initial payment (38).
In spite of the promulgation of the necessary policies, little
As mentioned above, in spite of its potentials for the has been done in recent decades to enhance and develop
development and greater contribution, traditional medicine the beneficial aspects of traditional medicine including
in Ethiopia has not received significant inputs from the related research and its gradual integration into modern
administration. This is more revealing when compared medicine (5). There are many gaps between policy and
with what has been achieved in many other developing actual practices. There are clearly deficits in the organized
countries. The system is deteriorating primarily due to the approach towards ensuring an optimal contribution of TM
lack of concern and, at times, due to apparent ignorance on to the national health system. For example, there were no
the part of the authorities in responsible positions (14). regulations to the safety and efficacy, licensing, as well as
Lack of concern goes far beyond the areas of natural the registration and guidelines for clinical trails involving
resources conservation. traditional medicines (33-35).

Environmental degradation, deforestation, agricultural Moreover, there is no training institute exist on traditional
expansion, over grazing and high population growth are medicine. It is well known that trained healers learn new
potential treats to the survival of many potential valuable knowledge quickly and integrate it in to their practices.
medicinal plants (5). This trend is increasingly Training of adequate modern health professionals can also
jeopardizing the ethno botanical and other natural provide better understanding of the traditional system.
resources of the country, especially in the highlands, This acquired knowledge by the professionals in the two
largely due to over population, inadequate environmental systems of medicine may lead to mutual respect, mutual
policies and failure to fully implement them (39,10). understanding, productive collaboration (42) and delivery
of effective health services.
All healing practices involving traditional medicines in
Ethiopia continue to be limited to the non-official sectors. There is evidence suggesting a declining trend in the
This fact alone contributes to isolation and subsequent number of traditional resources of medicinal plants (5).
non-utilization of this TM in the national health system. This calls for an urgent action to document and preserve
The official Ethiopian health care system is almost the traditional medical knowledge before it disappears
exclusively based on the concept of modern medicine and from the country.
the man power employed generally does not have adequate
knowledge of the traditional healing systems. However, Conclusion
efforts were recently made by the Medical Faculty of The Ethiopian government firmly supports and encourages
Addis Ababa University to expand its curriculum and traditional medicine as part of the national heritage.
encourage research on TM. Hopefully, these and similar Policies and mandates are clearly given to different
efforts by international organizations such as WHO (41), government ministries and authorities. However, there are
will help to change prevailing attitudes. There is also a several gaps at the policy level, and only a very limited
need to change the widely held notion by the national and number of efforts have been made in recent years in
international medical community that biomedical research implementing them at the community level.
is generally more significant and prestigious than that
devoted to local health systems. The relatively small Thus, any organizational effort must be directed to an
amount of research devoted to indigenous medicine and integrative plan that includes manpower planning, the
health care systems is striking in view of its importance in development of training programs the issuance of
meeting the health care needs of large populations who regulations on safety and efficacy, the licensing, and
tend to be afflicted with most acute health problems. guidelines for clinical trail of traditional medicines. This
should include the determination of the legal status of
In the absence of a clear indication on the legal status and traditional practitioners, including clearly stated benefits
benefits emanating from their healing practices, traditional they could obtain from closer collaboration as well as their
health practitioners would find it very difficult to part their responsibilities. Moreover there is a need to involve
knowledge to researchers whom they do not trust. From traditional healers on all the aspects of traditional
the side of modern practitioners, very little effort has been medicine, including the preparation of pharmacopoeia for
made to understand traditional healing practitioners. Most evaluating all medical plants and other substances used in
modern health professionals in Ethiopia seem to think that drugs, giving therapeutic indicators, and methods of
there is no logic to what ever traditional healing preparations and dosages, as well as awards of grants for
practitioners do. This attitude contributes to the research on traditional medicine in collaboration with

Ethiop.J.Health Dev. 2006;20(2)

 Historical overview of traditional medicine practices and policy in Ethiopia 133
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