Original Research

SAGE Open
January-March 2023: 1–10
Ó The Author(s) 2023
Factors Associated With the Use of DOI: 10.1177/21582440231153038
journals.sagepub.com/home/sgo
Traditional Medicine in Wolaita Zone,
Southern Ethiopia

Fitsum Meseret Legesse1 and Akalework Mengesha Babanto2

Abstract
Traditional medicine is widely used for the management of various health problems in Ethiopia. The aim of this study was to
explore factors influencing the use of traditional medicine in Wolaita zone, Southern Ethiopia. In conducting the study, the
qualitative method was used, involving 45 in-depth interviews with traditional practitioners, patients and caregivers. Thematic
analysis was conducted in analyzing data. The findings revealed that the use of traditional medicine was influenced by five
major themes: perceived inefficacy of biomedicine, perceived incurability of some diseases via biomedicine, testimonies of
effectiveness of traditional medicine, affordability of traditional medicine and feeling of embarrassment to present medical
conditions to practitioners of biomedicine. It was also found that traditional medicine was an accepted medical practice and
was likely to remain so despite the expansion of modern healthcare services. Therefore, it is imperative to understand the
role and use of traditional medicine as an alternative medical practice and ensure its best possible contribution to the local
healthcare system.

Keywords
traditional medicine, traditional practitioners, qualitative method, Wolaita Zone, Southern Ethiopia

Introduction As indicated by WHO, a considerable number of peo-

Traditional medicine is defined as ‘‘the sum total of the
knowledge, skill, and practices based on the theories,
beliefs, and experiences indigenous to different cultures,
whether explicable or not, used in the maintenance of
health as well as in the prevention, diagnosis, improve-
ment or treatment of physical and mental illness’’
(World Health Organization [WHO], 2003, p.15).
Complementary medicine, on the other hand, refers to
‘‘a broad set of healthcare practices that are not part of
that country’s own tradition or conventional medicine
and are not fully integrated into the dominant health-
care system’’(WHO, 2013, p.15).
It is marked that traditional medicine is mostly used in
the developing countries. Its popularity stems from the
fact that it serves as source of primary health care as well
as spiritual and cultural belief system (Falkenberg, 2012;
Mordeniz, 2019). It is also documented that complemen-
tary medicine has been very popular in the developed
countries despite high availability and accessibility of bio-
medicine. It has been increasingly embraced in the context
of developed countries by using herbal medications to
complement their standard healthcare (Falkenberg, 2012).
ple in Sub-Saharan Africa (SSA) rely on traditional and
complementary medicine to meet their primary health
care needs. In Ethiopia, it is estimated that 80% to 90%
of people use herbal medicine as primary source of
health care (WHO, 2009). Studies have reported a num-
ber of factors associated with the use of traditional medi-
cine in SSA, the most common of which include its
accessibility and affordability, deep-rooted cultural belief
in its effectiveness, barriers to biomedicine (such as long
distances to health facilities, long waiting times, lengthy
procedures, and disrespect and discrimination by health
workers), disease understanding and perceived inefficacy
of biomedicine (Aderibigbe et al., 2013; Adesiji &
Komolafe, 2013; Mwaka et al., 2015; Ondicho, 2015;
Sato, 2012; Stanifer et al., 2015; Wenzel, 2011). Personal
1
Hawassa University, Ethiopia
2
Wolaita Sodo University, Ethiopia
Corresponding Author:
Fitsum Meseret Legesse, Hawassa University, PO.Box: 05, Hawassa,
Ethiopia.
Email: fetsum2015@gmail.com

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2 SAGE Open
factors, such as low educational attainment, low eco-
nomic status and unemployment have also been identi-
fied as determinants of the use of traditional medicine
(Gyasi et al., 2013; Liwa et al., 2017; Sorsdahl et al.,
2009; Tamuno et al., 2010).
It is well documented that traditional medicine is an
ancient medical practice in Ethiopia that has been widely
used for the management of various health problems
(Addis et al., 2002; Gurmu et al., 2017; Melesse et al.,
2015). Evidence indicates that the majority of the popu-
lation in the country relies on traditional medicine as
source of health care (Kassaye et al., 2006; Kidane et al.,
2014; Mekuria et al., 2017). The old-aged Ethiopian tra-
ditional medicine incorporates wide-ranging healing
practices, the major ones being herbal medicine, spiritual
healing, bone-setting and traditional midwifery (Gurmu
et al., 2017; Kassaye et al., 2006).
Different studies assessing factors associated with the
use of traditional medicine have been conducted in
Ethiopia. In these studies, cultural acceptability, afford-
ability, accessibility, perceived effectiveness of traditional
medicine as well as low level of education emerged as the
most recurrent factors determining the use of traditional
medicine (Getnet, 2017; Habte et al., 2017; Mekuria
et al., 2017; Melesse et al., 2015; Sadik et al., 2013;
Wassie et al., 2015). However, these findings appear to
provide only the partial picture of the reality as the
majority of the studies are limited in scope in different
ways—some are age specific particularly focusing on the
use of traditional medicine in the case of children and
others are facility-based specifically focusing on the use
of traditional medicine by individuals with certain medi-
cal conditions, such as diabetes patients and pregnant
women attending maternal care. This has limited a
broader understanding of factors influencing the use of
traditional medicine.
There are also studies conducted in Wolaita zone in
relation to traditional medicine. These studies are mainly
conducted by biologists and pharmacy professionals -
particularly focusing on such issues as local knowledge
of medicinal plants and its usage and concentration of
selected essential and non-essential metals in traditional
medicinal plants (e.g., Hailemariam, 2019; Tora &
Helisob, 2017)—and there is paucity of medical sociolo-
gical/ anthropological studies. In what seems to be an
exceptional case, there is a study with a medical sociolo-
gical approach toward traditional medicine (Paulos &
Murugan, 2017) although it was confined to document-
ing the use of traditional medicine in relation to
Women’s reproductive health matters.
Therefore, with the intention of addressing the gaps
mentioned above, this study was conducted to explore
factors associated with the use of traditional medicine in
Wolaita Zone, Southern Ethiopia.
Methods
Study Design
A cross-sectional study was undertaken to explore the
factors associated with the use of traditional medicine in
Wolaita Zone, Southern Ethiopia. For the purpose of
data collection, the study entirely relied on the qualita-
tive research method, which helps to get rich information
from research participants through in-depth exploration
of their attitudes, behavior, and experiences (Dawson,
2007). The in-depth interview method was the qualitative
method employed in the study to collect data from the
target groups, which include traditional practitioners,
patients, and caregivers. This method was used because
it enables the researcher to gather thorough and richer
information by letting the subject narrate his/her experi-
ences in relation to the topic at hand (Kvale, 2009). The
data have been analyzed thematically by identifying pat-
terns and coding them from the data and reporting them
appropriately.
Setting
Wolaita Zone is one of the different Zonal administra-
tions found in Southern Nations, Nationalities and
Peoples’ Regional State (SNNPRS), Ethiopia. Wolaita is
one of the most densely populated areas in Ethiopia with
an estimated total population of 1.7 million in
2007(FDRE (Federal Democratic Republic of Ethiopia)
Population Census Commission (2008). Wolaita Sodo
town, the capital of Wolaita Zone, is located 385 km
from Addis Ababa, the capital of Ethiopia.
The study was particularly undertaken in three
Woredas (districts) in Wolaita Zone where traditional
medicine was commonly practiced: Damot Woyde
Woreda, Damot Gale Woreda & Sodo Zuria Woreda.
Kebeles (the lowest administrative unit in Ethiopia) were
purposively selected from each of these Woredas as final
targets of the study. Accordingly, three Kebeles (Bilbo
Bedesa, Mayo Kote &Tora Sedebo) were selected from
Damot Woyde Woreda; two Kebeles (Gedo Bodity & Ode
Choroke) were selected from Damot Gale Woreda; and
one Kebele(Gununu)was selected from Sodo Zuria
Woreda. The selection of these Kebeles was made in con-
sultation with staff members at Woreda health bureaus
and the selection criteria considered were availability of
known traditional healers in the Kebeles and accessibility
of the Kebeles to transportation.
Sample and Recruitment
Traditional practitioners who participated in this study
were selected based on the Purposive sampling technique:
Well-known traditional practitioners were selected with
Legesse and Babanto
the help of community members as it was thought that
they could provide reliable and rich data pertaining to
the objectives of the study. On the other hand, patients
(clients) and caregivers who took part in this study were
selected based on the convenient (availability) sampling
technique: clients and caregivers who attended treatment
at the moment the researchers visited traditional healers
were interviewed to generate the relevant data. A total of
45 informants—15 traditional practitioners, 20 patients
and 10 caregivers—were recruited into the in-depth inter-
view, in which semi-structured interview guide was used
to delve into the very details of the factors associated
with the use of traditional medicine in the study area.
This sample size was determined based on the principle
of data saturation; the researchers kept interviewing
informants until data was saturated and no further infor-
mation was emerging
Procedure and Instruments
Data gathering was conducted from March to April
2016. Two male researchers (authors of this article and
assistant professors of sociology) were involved in the
primary data collection, which took almost 2 months.
Traditional practitioners who participated in the study
were approached with the help of villagers who identi-
fied practitioners practicing in their neighborhood and
showed the researchers the way to their residence.
Some villagers were even eager to accompany the
researchers to the compound of the traditional practi-
tioners. Series of in-depth interviews, which took
30 min. on average, were conducted with selected tradi-
tional practitioners in a setting they arranged in their
compound. Patients and caregivers who took part in
the study were approached at the moment they come to
traditional practitioners seeking treatment. Traditional
practitioners were helpful in convincing patients and
caregivers to participate in the study and arranging the
setting where in-depth interview was conducted with
them. The interview with patients and caregivers took
30 min. on average. Semi-structured interview guides,
which were developed in English and then translated to
Amharic and Wolaitigna (local languages), were used to
conduct in-depth interviews. The researchers relied on
note-taking as well as audio recording while conduct-
ing the in-depth interview.
Analysis
Data was analyzed using thematic analysis, ‘‘a method
for identifying, analyzing, and reporting patterns
(themes) within the data’’ (Braun & Clarke, 2006, p. 79).
Field notes and audio files of interviews were transcribed
in the local languages (Amharic and Wolaitigna) and
3
transcripts were translated to English after they were
checked for accuracy through repeated reading and revi-
sion of field notes and replay of audio files. The trans-
lated transcripts were repeatedly read to go through the
coding process. Manual coding technique was used to
organize the data by identifying themes and categories
containing similar ideas. Coding of data continued until
key themes were saturated and no further information
was emerging. Two coders were involved in coding and
organizing the qualitative data. The coders resolved
overlapping themes and inconsistencies through regular
meetings and discussions to reach common understand-
ing. The analysis was based on themes of interview
guides and emergent themes derived from the data itself.
Ethical Consideration
Study participants were recruited into the study after
they were informed about the aim of the study and
method of data collection. The researchers presented an
official letter from Wolaita Sodo University to study par-
ticipants indicating the appropriateness and authenticity
of the research. Participation in the study was voluntary
and participants were required to offer informed con-
sent. Participants were clearly informed that they had
the right to decline and withdraw from the interview at
any time and to skip questions they did not want to
answer. Participants were also assured confidentiality;
they were informed that the data would be used only for
the research purpose and that their name would be anon-
ymous. Voice recording was made based on the consent
of participants, and the researchers relied on note taking
in cases consent was not obtained.
Results
Five major themes were found to influence the partici-
pants’ decision to use traditional medicine: perceived
inefficacy of biomedicine, perceived incurability of dis-
eases with biomedicine, testimonies of effectiveness of
traditional medicine, affordability of traditional medi-
cine and feeling of embarrassment to present medical
conditions to biomedicine practitioners.
Perceived Inefficacy of Biomedicine
Patients’ perception of inefficacy of biomedicine to treat
their particular condition was reported as a major fac-
tor in their decision to use traditional medicine. It was
discovered that traditional medicine was not viewed as
a top priority but rather as a backup plan in case mod-
ern biomedicine was deemed inadequate. Traditional
practitioners reported that, in most occasions, patients
4 SAGE Open
resorted to traditional medicine when they perceived
the failure of biomedicine in the cure of ailments.
Most patients come for treatment after they exhaust reme-
dies in health care facilities. They seek solution here when
they see no improvement in their health status after being
prescribed hospital medicine. This mostly occurs in case of
some medical conditions, such as intestinal parasites, where
relapse is common after initial sign of recovery. Patients
often complain about lack of effectiveness of the medicine
prescribed by physicians and they request me to give them a
long lasting solution. (Female practitioner interviewee, 45
years old)
In most instances, patients do not come here without attend-
ing health facilities. Most clients come to me after visiting
pharmacies and hospitals. They come here when they fail to
get remedies there. For example, patients diagnosed with
hemorrhoid visit me frequently claiming that hospital medi-
cine is not effective in treating their condition. Because
relapse is common after they undergo surgery assisted by a
physician, they want me to give them a medicine that can
heal the disease once and for all. (Female practitioner inter-
viewee, 25 years old)
Testimonies from patients also confirmed the above
views. They argued that they transitioned to traditional
medicine when they realized that there was no improve-
ment in health condition after they were admitted to
healthcare facilities.
I was diagnosed with intestinal parasite. I took the medicine
but the condition relapsed after initial improvement. Thus, I
decided to switch to traditional practitioners. The first time
I come, the practitioner prescribed herbal medicine and
appointed me to come after two weeks. I come now for the
second time and I hope I will be completely cured after I
take the medicine. (Male patient interviewee, 40 years old)
I’m diagnosed with menstrual problem. I attended treatment
at different hospitals. They prescribed medicine but there
was no cure or improvement in health status. Thus, I
decided to come here wishing that I would be cured.
Someone who got treatment here informed me of the effec-
tiveness of the treatment. (Female patient interviewee, 37
years old).
Caregivers do also have similar views regarding the issue:
My son was injured while playing with friends. His right
hand was broken and I took him to hospital. They told me
that the problem was so serious that it couldn’t be cured.
They said that amputation was the last resort. I rejected
that and took my son to a bone-setter. I told her every-
thing and plead her to get my son cured with the help of
God. The condition of my son improved after he got the
first treatment and there have been series of follow-ups
since then. We are here for the fourth time and my son is
almost cured thanks to God. (Female caregiver intervie-
wee, 50 years old).
Perceived Incurability of Diseases With Biomedicine
The use of traditional medicine was influenced by the
belief that biomedicine could not cure some medical condi-
tions. It was reported that patients avoided healthcare
facilities and visited traditional practitioners when biome-
dicine was believed to be incapable of healing their ill-
nesses. Traditional practitioners identified common
medical conditions for which patients sought their services
conceiving that they could not get cure in healthcare facili-
ties. One of such conditions is Sergeta (which literally
mean rainbow), which, according to traditional belief, is
caused when a person urinates facing the rainbow.
According to traditional practitioners, a person suffering
from Sergeta mainly presents with the symptom of change
in the color of an eye and urine into the colors of rainbow.
It was said that eye color was turned to red and green
while urine color was altered to yellow. Patients preferred
traditional medication for Sergeta mainly because it was
believed that the condition was not known to biomedicine.
There is a commonly held belief that traditional medicine is
the best source of treatment for Sergeta. Most often,
patients with Sergeta visit me seeking treatment as they
believe that hospital medicine cannot cure the condition.
The most common medicine I prescribe is a chopped herb
which is taken with Xawwa (a watery residue left after cheese
is made) used as the liquid component. (Female practitioner
interviewee, 48 years old)
Goromotte Ayanna (Evil Eye) stood out to be the other
common medical condition for the treatment of which peo-
ple preferred traditional medicine to biomedicine. It was
noted that patients who suffered from Goromotte Ayanna
frequently visited traditional practitioners believing in the
effectiveness of traditional medicine to cure their condition.
Traditional medicine is well accepted source of treatment for
some condition like Goromotte Ayanna, which isn’t believed
to be cured by hospital treatment. Patients keep on visiting
me seeking treatment for Goromotte Ayanna and I prescribe
different types of medicine admitted through different routes.
One of these medicines is a chopped herb with coffee used as
the liquid additive and the other one is a stem bark which is
burned to inhale the smoke. I also conduct prayer to get the
evil spirit out of the patient suffering from Goromotte
Ayanna. (Female practitioner interviewee, 50 years old).
Testimonies of Effectiveness of Traditional Medicine
The utilization of traditional medicine was also deter-
mined by witness testimonials which spread through
Legesse and Babanto
different arrays of social networks. Exhortation of close
acquaintances who gave testimonies of effective cure
received from traditional practitioners led patients to
access traditional medicine to get remedy for their condi-
tion. Successful treatment obtained from traditional
practitioner was often witnessed by peers, neighbors,
family members and community members.
I think one of the reason why clients decide to come to us is
the influence of other clients who previously got cured
receiving treatment here. There are plenty of occasions when
I get clients through referral from other clients who give tes-
timonies of the improvement of their health condition after
receiving treatment from me. Old clients send new clients
saying that ‘‘her medicine is effective. Get the treatment
there. Don’t go to hospital or other healthcare facilities.’’
(Female practitioner interviewee, 30 years old)
I was seriously injured falling from a tree. People in my
neighborhood who saw my mother worrying about my con-
dition referred us to this woman saying that she is a well-
qualified bone-setter who has previously cured plenty of sim-
ilar cases. I’m here now hoping that I will be cured. (Male
patient interviewee, 20 years old)
In some cases, rhetorical evidences of healing efficacy of
traditional medicine initiated patients to utilize services
located in remote and distant places. Patients who were
lured by stories of effective treatment were compelled to
travel long distance to visit the famous traditional practi-
tioner that they were referred to.
Clients often make use of witness testimonials of other cli-
ents in their decision to visit me. One tells the other about
the effectiveness of the medicine, and in such way of circula-
tion of information people come to me. Some people even
come from far places like Addis Ababa, Hawassa and
Oromia sent by people who previously suffered similar ill-
nesses and got successful treatment here. (Female practi-
tioner interviewee, 40 years old)
Affordability of Traditional Medicine
Affordability of traditional medicine appeared to be one
of the factors associated with patients’ decision regarding
its use. The availability of traditional medicine at mini-
mal cost as opposed to the unaffordable cost of biomedi-
cine was reported as an important factor influencing
patients to visit traditional practitioners rather than bio-
medical health units.
The rich people do not often prefer our service. It is in some
rare cases that they come here. It’s poor people like me who
commonly come here. The poor don’t have the money to
visit different hospitals. They come here seeking treatment
with least cost and hoping to be cured with the help of God.
5
The maximum I ask them is 40 birr (1.5 $) for hemorrhoid
and the least is 5 birr (0.2 $) for skin disease. (Female practi-
tioner interviewee, 47 years old)
Traditional practitioners’ strong sense of belongingness
to the community, which puts individual wellbeing rather
than financial matters at the forefront of social relation-
ship, was also found to influence patients’ choice of tra-
ditional medicine at the expense of biomedicine. As
traditional practitioners give primacy for long estab-
lished friendship and companionship rather than money,
community members are more encouraged to access tra-
ditional medicine without worrying much about financial
constraints. Traditional practitioners insisted that they
had been willing to assist clients with their knowledge
and skills at different occasions when clients did not
afford to pay for the service they were rendered.
I believe that I should give much concern for the wellbeing
of my fellows with whom I have lived for long sharing occa-
sions of sadness and happiness. I am not as such concerned
about money and I never hesitate to assist villagers who
may not afford cost of treatment or don’t have anything to
pay. I don’t feel disappointed for not receiving payment as
the satisfaction I get when I see them cured is much more
than everything that money could give. (Female practitioner
interviewee, 55 years old)
Embarrassment to Present Medical Conditions to
Biomedicine Practitioners
It was reported that people preferred traditional medicine
for some medical conditions which they considered were
embarrassing to present to biomedicine practitioner.
Especially, patients with sexually transmitted diseases
and hemorrhoids were reported to frequently visit tradi-
tional practitioners because of the fear to disclose such
conditions appearing before a health worker.
It is common that people come here when they have some cases
that they don’t want to tell physicians. For example, patients
with hemorrhoid often visit me for treatment mainly because
they don’t want to undergo surgery assisted by physicians at
hospitals. (Female practitioner interviewee, 52 years old)
It was also asserted that female patients with gynecologi-
cal problems often avoided healthcare facilities and vis-
ited traditional practitioners because they were frightened
of revealing such conditions to a male practitioner in the
healthcare facilities.
Elderly women with gynecological problems are among
those clients who commonly visit me seeking treatment.
They seem to feel embarrassed about telling their case and
undressing in front of male physicians and I think that’s the
6 SAGE Open
reason why they often come to me. They say that they feel
free to tell me everything about their condition and they
choose to pay whatever I ask than going to hospital.
(Female practitioner interviewee, 56 years old)
Discussion
We believe that the study contributes to the understanding
of the underlying factors for the persistence of traditional
medicine in Wolaita Zone despite the expansion of mod-
ern healthcare services over the recent decades, particu-
larly the health extension program that the Ethiopian
government has introduced throughout the country to
ensure universal coverage of primary healthcare. It was
reported that people have continued to rely on traditional
medicine because of five major factors: Inefficacy of bio-
medicine, Perceived incurability of diseases with biomedi-
cine, testimonies of effectiveness of traditional medicine,
Affordability of traditional medicine and feeling of embar-
rassment to present conditions to biomedicine practi-
tioners. In this section, an attempt is made to put the
current study in context by discussing its key findings
against the existing findings both in the local and interna-
tional literature.
Traditional Medicine Instead of Biomedicine
It was found that study participants visited traditional
practitioners when they perceived that biomedicine was
ineffective in treating their condition. This was particularly
evident in the case of some medical conditions, such as
intestinal problems and hemorrhoid, where relapse was
common after initial treatment in healthcare facilities. A
Similar finding is apparent in studies conducted in Ethiopia
and elsewhere in Africa, in which the majority of study par-
ticipants were reported to transition to traditional medicine
because of an initial treatment failure in healthcare facilities
(Getnet, 2017; Sorsdahl et al., 2009; Wenzel, 2011). In a
study conducted in Tanzania, exaggerated expectations of
cure, greater perceptions of treatment failure by biomedi-
cine and increased medical non-compliance was reported
to lead many participants with chronic condition to resort
to traditional medicine (Stanifer et al., 2015). However,
some other studies have reported a contrasting finding that
traditional medicine was a primary source of healthcare for
the majority of participants, with biomedicine being the last
resort to rely on in cases of traditional medicine inefficacy
(Birhanu et al., 2012; Ondicho, 2015).
Cultural Belief as a Factor Influencing the use of
Traditional Medicine
We found in this study that patients’ decision to use tra-
ditional medicine was influenced by the belief that some
medical conditions could not be helped by biomedicine.
It was reported that patients would not seek biomedical
treatment for certain medical conditions, such as evil eye,
which were assumed to be the domains of traditional
medicine because of the deep -rooted traditional beliefs
surrounding their etiology. The association between such
kind of perception and the decision to use traditional
medicine has been well established in previous studies
conducted in Africa. In a study in Tanzania, preference
to use traditional medicine for cervical cancer was
reported to be a function of the belief that it could not be
cured by biomedicine (Mwaka et al., 2015). In another
study in Tanzania, it was reported that the belief that
epilepsy and mental health conditions were caused by
‘‘evil spirits’’ led to a nearly ubiquitous use of traditional
medicine for these conditions (Stanifer et al., 2015). In a
study of cervical cancer in Ethiopia, the belief that bio-
medicine would not cure the condition- as it was believed
to be caused by supernatural powers, the devil, and/or
punishment for violating normal sexual behaviors-led
affected women to seek treatment from traditional prac-
titioners and use holy water(Birhanu et al., 2012). In a
study in Kenya, it was reported that illnesses which were
assumed to have arisen from the breaking of taboos,
witchcraft, evil eye and spirit possession were seen to be
best treated by traditional practitioners (Abubakar et al.,
2013)
Locals’ Confidence in Traditional Practitioners as a
Motivating Factor for Seeking Traditional Medicine
The findings from this study showed that feeling of
embarrassment to present some medical conditions to
healthcare facilities was an important factor influencing
people’s decision to use traditional medicine. Patients
with particular conditions, such as sexually transmitted
illnesses and gynecological problems, were reported to
be ashamed of presenting their condition to health work-
ers, which pulled them into traditional medicine use.
This compares with a finding from a study conducted in
Tanzania which reported that people tended to avoid
biomedicine and prefer traditional medicine for diseases
associated with sexual transmission or other forbidden
actions because of the privacy and confidentiality in tra-
ditional medical practices (Mwaka et al., 2015). In what
seems to be similar with this, it was reported in a
Bangladesh study that pregnant adolescent girls pre-
ferred to deliver at home because ‘‘they felt uncomforta-
ble at the thought of being seen by male doctors in the
hospital’’( Shahabuddin et al., 2017, p.7). This situation
hints the importance of re-emphasizing and assessing the
service delivery system in biomedicine as it has to con-
sider cultural appropriateness and acceptability.
Legesse and Babanto
Interpersonal Factors Influencing the Decision to Use
Traditional Medicine
The impact of social factors on health seeking behavior
has been well established in the literature. For instance,
the social ecological model holds that interpersonal level
factors- which refer to social influence from friends and
family and norms within social networks- have major
influence on health seeking behavior (Kumar et al.,
2012). In line with this, the impact of interpersonal rela-
tions on individual’s decisions to use traditional medicine
appeared to be evident in this study. In seeking treatment
from traditional healers, individuals were reported to be
influenced by people in their immediate social circle,
such as friends, neighbors and family members, who
claimed to have been cured by traditional medicine, and
this finding is similar with what has been reported by
previous studies from Ethiopia and elsewhere in Africa
(Aderibigbe et al., 2013; Habte et al., 2017; Liwa et al.,
2017; Ondicho, 2015; Oreagba et al., 2011). Ethiopian
society has a well-developed collectivist sentiment, and
social groups and networks are indispensable elements of
social life. The scale and intensity of interpersonal rela-
tionship is very high, giving wide opportunity for infor-
mation sharing and consultation on different matters of
daily life, which has its own effect on decision making.
Thus, the influence of significant others on individuals’
decision to use traditional medicine in the study area can
be understood in light of this broader cultural pattern.
Income as an Important Factor Affecting the
Utilization of Traditional Medicine
It is well documented in the health seeking behavior liter-
ature that economic factors have significant impact on
utilization of health care services. Andersen’s well known
behavioral model of health care utilization posits that
individual and family income level is one of the different
enabling factors determining health care utilization
(Kuuire et al., 2015; Tolera et al., 2020). Similarly, the
health belief model underscores that cost of health care
services is one of the different perceived barriers affecting
health seeking behavior: if a given mode of treatment is
perceived to be costly, it is less likely that a decision for
health seeking behavior will be made (Chandrika &
Kanbarkar, 2017; Metta, 2016; Sheeran & Abraham,
2015). In the current study, cost of treatment was found
to have its own impact on participants’ decision to seek
health care from traditional practitioners. Traditional
medicine was reported to be relatively cheaper, making it
preferable by people who could not afford biomedicine.
The relationship between affordability and traditional
medicine use has also been consistently reported in a
7
large number of studies conducted in Ethiopia and other
African countries (Aderibigbe et al., 2013; Getnet, 2017;
Gyasi et al., 2016; Liwa et al., 2017; Melesse et al., 2015;
Mwaka et al., 2015; Ondicho, 2015; Sato, 2012; Stanifer
et al., 2015; Tamuno et al., 2010).
Existing evidence suggests that several developing
countries have introduced community based health
insurance schemes as a way of financing healthcare and
enhancing health service utilization (Mebratie, 2015). In
2011, the government of Ethiopia launched community-
based health insurance (CBHI) schemes in 13 pilot
Woredas in Amhara, Oromia, Southern Nations,
Nationalities, and Peoples (SNNP), and Tigray regions
(Yilma et al., 2014). The CBHI scheme, which target the
very large rural agricultural sector and small and infor-
mal sector in urban settings (Feleke et al., 2015), aims to
reduce financial barriers and improve access to health
services by reducing the burden of out-of-pocket (OOP)
expenditure (Badacho et al., 2016). Studies conducted to
assess the impact of the pilot CBHI scheme reported that
the implementation of the program has resulted in the
reduction of health care costs and increase in the utiliza-
tion of health care services from public facilities
(Ethiopian Health Insurance Agency, 2015; Mebratie,
2015). Triggered by the pilot’s early successes, the gov-
ernment of Ethiopia has decided to scale-up the pilot to
161 Woredas (districts) all over the country in July 2013
(Feleke et al., 2015). Therefore, ensuring more affordable
healthcare services in the way of CBHI scheme may lead
to increased utilization of these services and reduced reli-
ance on traditional medicine in the study area. However,
given the fact that the use of traditional medicine is
affected by multidimensional factors as discussed in ear-
lier sections, it can be argued that affordability of mod-
ern healthcare services may not lead to reduced
utilization of traditional medicine in a significant way
and at greater scale.
In general, this study has managed to identify diverse
factors affecting peoples’ use of traditional medicine
despite the accessibility of modern healthcare system in
the study area. In terms of conceptual boundary, the
study is only limited to examine the factors that made
traditional medicine as persistent and strong option to
the community. And also methodologically, it entirely
relied on qualitative approach with the aim to bring
detailed description of the factors. The researchers sug-
gest that future research endeavor has to accentuate on
integrating both quantitative and qualitative approaches
in order to identify patterns and make generalizations to
have a better picture of the issue at hand. Besides, it will
be worthwhile to look at the policy context within which
traditional medicine is currently operating in order to
identify the gaps and inadequacies in practice.
8 SAGE Open
Conclusion
The finding of the study revealed that traditional medi-
cine has remained to be an important healthcare practice
in Wolaita Zone. Given the existing demand for tradi-
tional medicine among the local community, it is impor-
tant to dig out its valuable aspects and give recognition
for this medical practice and promote it as an alternative
healthcare system. It is imperative for concerned stake-
holders to take actions that ensure traditional medicine’s
best possible contribution to the healthcare system. In
fact, this has been enunciated clearly in the national
health policy. The health policy and the drug policy of
1993 both emphasize the need to develop the beneficial
aspects of traditional medicine through research and its
use in the official health delivery services. It states the
need to prepare standard of safety, efficacy and quality
of traditional medicines. It also dictates to issue licenses
for the use of traditional medicines in the official health
services. Traditional medicine is placed as one of the
eight priorities of the present Health Policy. Generally,
at the local level, there should be well-built efforts to
implement the national policies formulated to promote
and develop traditional medicine in Ethiopia.
Acknowledgments
We would like to thank informants of the study for the valuable
information and their precious time.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with
respect to the research, authorship, and/or publication of this
article.
Funding
The author(s) received no financial support for the research,
authorship, and/or publication of this article.
ORCID iD
Fitsum Meseret Legesse https://orcid.org/0000-0002-2678-
5673
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