18/02/2026
We are moving💙🕯
Transforming Public Health in a Plural Health System
Featuring: Mr Refentse Sebothoma aka Ngaka Tladi Motaung oa Machela
Head: Public Health, Integrated Care & Community Services - THPASA i-NEC
As part of the THPASA i-NEC Leadership Series, today we deepen the conversation by engaging the systems-level thinking of Ngaka Tladi Motaung oa Machela, whose portfolio carries strategic responsibility for public health positioning within a plural health architecture.
Public health transformation cannot occur in isolation from Indigenous Health Knowledge Systems. In South Africa’s plural health landscape, the question is no longer whether Traditional Health Practitioners (THPs) exist within public health realities — but how they are structurally recognised, governed, and ethically integrated without absorption or dilution.
Below is a consolidated reflection from the Head of Public Health, Integrated Care & Community Services:
1. Public Health Reform & Plural Systems
Transformation requires the deliberate design of co-existing systems with mutual legitimacy. This includes legal recognition with clear regulatory safeguards, parallel yet linked governance channels, and decision-making authority retained by Traditional bodies in matters affecting their practice.
Structured platforms must be funded for plant medicine standards, hospital–community liaison mechanisms, and policy co-design - ensuring the Traditional Health sector commands institutional respect rather than symbolic inclusion.
2. Community-Based Primary Care
THPs are already de facto primary care actors within communities. Reform must formalise this role through defined scopes of practice, structured referral pathways, and partnership models - not assimilation into biomedical hierarchies.
A two-way capacity-building model is required:
◇ Cultural competency training for biomedical clinicians
◇ Basic clinical literacy, hygiene protocols, and record-keeping support for THPs
Identity must be preserved while safety and collaboration are strengthened.
3. Referral Pathways & Ethical Boundaries
A credible bi-directional referral framework must be formal, auditable, and ethically grounded.
This includes standardised referral documentation, electronic or SMS-based logs where feasible, urgency categorisation, red-flag escalation protocols, and joint ethical standards protecting consent, confidentiality, and withdrawal rights.
Contested cases should be reviewed by a mediation structure composed of respected elders, THPs, clinicians, and legal advisors.
4. Mental Health & Psychospiritual Care
African-centred mental health approaches must be recognised as legitimate components of community mental health systems. Ritual practice, communal healing, and psychospiritual intervention should not be marginalised but positioned as complementary modalities.
Outcome measures must extend beyond symptom reduction to include reintegration, spiritual wellbeing, and restored social functioning.
5. Women’s & Reproductive Health
Maternal and reproductive health transformation requires co-design. Traditional antenatal care, birthing support, postpartum practices, and fertility interventions must operate alongside clinical safeguards in culturally safe environments.
Cultural safety should be measurable, not rhetorical.
6. Governance & Accountability
Credibility in public health spaces demands strengthened internal governance.
Transparent complaints mechanisms, enforceable codes of conduct, accredited training pathways, CPD requirements, and publicly accessible practitioner registries are foundational.
Professionalisation is not Westernisation - it is structured accountability rooted in Indigenous authority.
7. District & Provincial Alignment
Meaningful engagement requires formalised participation in district and provincial planning forums. Recognised Traditional bodies should hold permanent seats with protected agenda time and transparent budget lines.
MoUs must define autonomy safeguards, referral mechanics, shared data principles, and funding transparency to prevent co-option.
8. Practitioner Professionalisation
Internal transformation within the THP sector is imperative.
Core competencies must include danger-sign recognition, infection prevention, referral literacy, ethical conduct, and safe record-keeping; without compromising sacred knowledge systems or initiation integrity.
Certification must be co-designed and led by Traditional authorities. Peer networks, mentorship systems, and CPD frameworks must incentivise public health participation while respecting lineage and secrecy protocols.
Policy Trajectory
The forthcoming policy direction under this portfolio will centre on:
♤ Plural recognition with legal clarity
♤ Auditable bi-directional referral systems
♤ Two-way capacity development
♤ Measurable cultural safety outcomes
♤ Strengthened governance and accreditation
♤ A sustained research and evidence agenda evaluating safety, effectiveness, and social impact of integrated care models
Transformation is not symbolic inclusion.
It is structural redesign.
Under the leadership of Ngaka Tladi Motaung oa Machela, this portfolio advances a model of public health participation that is dignified, accountable, culturally anchored, and systemically credible.
