1. Hareya Fassil
hfassil@sph.emory.edu
Extraordinary Balancing Acts:
Local health knowledge and survival strategies in rural Malawi

2. Building on women’s traditional health and
medicinal plant knowledge in Malawi
Opportunities for Support by the Malawi Social
Action Fund
Knowledge & Learning Group, Africa Division, World Bank
Consultancy study under GENFUND provision (2004)

3. Overview
I. The study
Objectives and research questions
Study communities and methods
II. The big picture: at national level …
III. Local realities:
 Home-based ‘practitioners’ vs. specialists vs. herb
vendors
 Balancing the ‘old’ vs. ‘new’: ‘modernization’ and
biomedicine
 The gender balance
 The plants: use patterns and sustainability
 Imbalances: poverty vs. deforestation
 Local views and initiatives
 Field notes on malaria and HIV/AIDS
 Hypotheses revisited: lessons learned
IV. Proposals for MASAF action:
striking balances
V. Way forward …

4. I. The Study: objectives & research
questions
To elucidate local women’s knowledge and
reliance on traditional health protective and
restorative plants in meeting household health and
nutrition needs; and their contributions to relevant
household decision-making
To inform MASAF Phase III: how to
integrate/ build on women’s local health
knowledge/resources1. How is knowledge distributed and
transmitted/acquired?
(knowledge in the ‘public’ domain vis-à-vis knowledge of
specialist traditional healers and herb vendors)
2. What types of plants are used as home
remedies? supplies? use patterns? sustainability?
3. Overall significance of home-based traditional
knowledge and use of medicinal/food plants?

5. 3 rural villages:
Central, Northern & Southern Regions
Selection criteria:
 regional representation
 distance from urban-center: ≥ 25 km
 ongoing/ past MASAF involvement
1. Chala, Malili, Lilongwe Rural (27km
south of Lilongwe) – MASAF Materezi
Maize Mill Project (since 2002)
2. Jombo Nation Nhelma, Mzimba
(40km N. Mzuzu)
MASAF under-5s health unit
3. Mpemba, Kantukule, Somba Blantyre
Rural District (25 km SE Blantyre)
Study communities

6. 1. Focus group discussions (FGD)
MIXED GROUP FGD
•data verification
• key gender differences
• participatory needs/priorities ranking
•possible initiatives for MASAF support
2. Key informants
3. Village TBAs
4. Traditional healers
6. Herb vendors at local markets
5. Village elders
Qualitative methods: six components
WOMEN’S FGD MEN’S FGD
SEMI-STRUCTURED
INTERVIEWS:

7. II. The big picture: at the national level…
 Diverse efforts and interests - but lacking
national-level coordination
 Some community-based efforts; but not community-driven per se
 ‘Policy vacuum’; ‘persistent negative views
among biomedical community’
 4 traditional medicine associations
 Herbalists Association of Malawi (Kasungu, Central);
 Yohane Herbalists Association of Malawi (Lilongwe, Central);
 Int’l Traditional Medicines Council of Malawi (Blantyre, Southern)
 Chizgani Ethnomedical Association (Mzuzu, North)
 Integration as a single national organisation remains a challenge
 Women represented in associations
 Home-based medicinal plant knowledge and use largely disregarded

8. “… I learned from my late
husband and my father
[both ofunamankwhala] I am
just interested in medicines
…I have never been to a
sing’anga… I don’t think
they help …If you don’t
know the medicine, you
should go to the
‘chipatala’…
When villagers come to me
or go to ofunamankwhala
they already know what is
wrong… they describe their
illness ...when they go to
the sing’anga he tells them
what is wrong, then gives
them medicine …”
Mines Nyasulu: widow; farmer
Jombo (North)
Cited 18 medicinal plants; many found in nearby ‘uchire’
Ofunamankwhala(herbalists) vs. sing’anga (spiritual healers) vs.
‘others’III. Local realities…
“… I am not really
ofunamankwhala - I just
learned some medicines that
work …mostly from my
grandmother…not many
people in the village know that
I know medicines…”
Ilesi Yona: widow; farmer
Mpemba (South)
Cited plant treatments for 12 health
problems, most found near farm plot

9. Doctor Mateyu: sing’anga
(spiritual healer) & herb vendor (15 years)
High demand: fertility & STD treatments (trees)
Most scarce: muowani tree
Likuni Market (Central)
Mai Nezia Peliaz: ofunamankhwala
& herb vendor (12 years)
High demand: ‘good fortune’ treatments
Most scarce: mwavi tree
Likuni Market (Central)
At the market… healthcare vs. livelihoods
most expensive medicines:
300-350 MKW ($2-3 USD)

10. Tereza Chipe
Traditional birth attendant (TBA)
(15 years)
Chala Village (Central)
Cited only 2 birth-related herbal remedies:
both fertility treatments
“… I got TBA training at Likuni
Hospital … I also delivered all my
children there..
All I tell pregnant women is to go to the
hospital to get advice… they should also
eat green vegetables (pumpkin leaves,
‘ntambe’, fruits…)
…But our main problem is transport –
especially when we have delivery
problems in the night time, we have no
way of taking the mother to the
hospital…we need an ambulance at
night or at least a bicycle to send a
messenger…also a proper delivery room
for our village
…People always come and ask
questions, questions…but nothing
happens, nothing is done…”
Village child-delivery room vs. urgent hospital
care

11.  ‘mpungabwi’: traditional herbal mosquito-repellent, deemed
effective but increasingly viewed as “a thing of the past”
‘chitukuko’: [Tumbuka] i.e. ‘modernization’; ‘development’
‘Old’ vs. ‘new’ : ‘mpungabwi’ & ‘chitukuko’
mpungabwi (Ocimum sp.)
Jombo (North): Women’s Focus Group
…it is useful
but it’s the old
way…
Dynamism of local health knowledge &
…mpungabwi
spray!!?...
“e’ya!”

12. The gender balance: health
knowledge/skills Symptom recognition/ diagnosis:
 consultation (adult household members + neighbors)
 women often the first to notice symptoms in children
 ‘unambiguous’ symptoms often treated promptly
 Plant identification/ growth habit/collection:
 men & women generally know similar range of plants;
 elders generally cited more plants
Processing/ preparation of plant treatments:
 women’s remit of food processing:
grinding/pounding, infusions, etc…
food-based medicines…
knowledge of remedies for
‘women’s problems largely limited to
women

13. “...Of course, we decide !...”
“ We decide, the men
provide!”
The gender balance: healthcare decision-
making

14. …what is this plant?
…must be one of the
women’s … ask the
women!
Vital: in-depth
understanding women’s
health problems and
home-based treatments
Sensitizing/educating
men about women’s
health problems
The gender balance…

15. The plants : main types
 Total: 70 medicinal species
used as home-based remedies
recorded
Majority: native tree
species occurring in nearby
‘uchire’(uncultivated
grasslands/ ‘bush’)
Some shrubs and herbs;
To date, afforestation
schemes have not prioritized
medicinal species
‘mvunguti’ (Kigelia africana)
‘mbula’ (Parinari curatellifolia )‘naphini’ (Terminalia sericea)
‘chipembere’
(Catunaregam spinosa)

16. The plants: health restorative vs. health
protective
several traditional
vegetables cited: semi-
domesticated/ wild leafy
greens (likely vitamin/
mineral-rich) used as
relishes
some viewed as
‘famine foods’; largely,
taken for granted
variety of native fruit
species

17. The plants: use patterns
subsistence use + significant
medicinal plant trade
in all town centers
 markets: wide array of root
parts and bark
harvesting increasingly
monitored in ‘protected’ areas
Last muowani tree (Cassia sp.)
in Jombo (N. Malawi)
Effects of bark over-harvesting
over-harvesting threatens sustainability of supplies

18. Imbalances: poverty vs. deforestation…
Uphill ! - En route to Mzuzu (North)
poverty
ever-increasing demand
for fuel wood
loss of indigenous trees
destruction of habitats of
other useful wild species

19. Makray Fundeni
Farmer, carpenter, ‘ofunamankwhala’
Cited treatments for > 10 health problems
(ranging: ‘cough’ – diarrhea – gonnorhea)
Mpemba (South)
“…I learned medicines from my
father…village people now often
come to me with problems and
give me what they can for
medicines…I find most medicines
in the ‘uchire’
…We hear MASAF does good
things …but our village has not
benefited…
What we need is help planting
multipurpose trees… [hardwood
and medicinal]; …we know which
trees …and we need carpentry
training and tools…that way
people will stop cutting trees for
charcoal …”
Local views: ‘multipurpose’

20. “ …I started writing
them down years ago …
so I wouldn’t forget… ”
Local initiatives: ‘Secrets’ & Eunice’s prized
notebookEunice Qongwani
Jombo (North)
openness about widely
known home-based herbal
remedies
but reluctance to disclose
special ‘family medicines’
from which small, in-kind
compensation can be derived
documentation of
knowledge at the community
level viewed as ‘extraneous’

21. Malaria : balancing prevention vs.
treatment …
perceived as the major health problem
use of modern anti-malarials essentially part of home-
based strategies and ‘local health knowledge’
BUT: notable ambiguity in symptom recognition
e.g. ‘kugnu’ (‘epileptic seizures’ ); ‘sila’ (acute fever/
convulsions) vs. cerebral malaria symptoms
Training: building on women’s ‘diagnostic’ skills
better detection & timely home treatment
culturally-sensitive IEC – use of bed-nets

22. HIV/AIDS: awareness/knowledge vs. attitudes/
behaviorongoing education/prevention
programs appear to have made in-
roads  considerable HIV/AIDS
awareness/ understanding among
communities
 yet a ‘fatalistic’ attitude prevails
no traditional treatments for
secondary infections cited
need to address cultural practices
which increase HIV and STD risk
need for funding/program support for
care of HIV/AIDS orphans was key
among the priorities identified by all the
study communities
“…Edzi
irrimufa!...”
[AIDS is in the maize flour!]

23. Hypotheses revisited…
Local
knowledge/practices :
understand
document
enhance:
strengthening the beneficial
changing the harmful
building on economic benefits
Medicinal plants:
sustainable supplies
protect, conserve/cultivate
women
EMPOWER COMMUNITIES
dynamic; ever-changing
unevenly distributed
pluralisitic healthcare
seeking patterns
variable appreciation of
‘modern’ vs. ‘traditional’
‘culture of secretiveness’
diverse plant sources and
use patterns
host of urgent competing
concerns;
expanding cultivation;
 fuel wood demand &
deforestation
poverty, food
insecurity & the
struggle to survive

24. Lessons learned : local actions and
proposals …Local
knowledge/practices :
understand
document
enhance:
strengthening the beneficial
changing the harmful
building on economic benefitsMedicinal plants:
sustainable supplies
protect, conserve/cultivate
* women*
EMPOWER COMMUNITIES
“boreholes, boreholes, more boreholes…!”
The power of basic literacy:
‘documenting ‘secret’ knowledge
Home-based efforts:
strengthening malaria
diagnosis/treatment; prevention
HIV/AIDS risk-related
cultural practices
Alternative livelihood
strategies: building skills/
community funds for
averting deforestation
Multipurpose tree species:
aforestation

25. … Lessons learned : leverage of the
borehole …
 Clean water: significant and direct health gains
 Convenience: allocation of women’s labour to
productive/income generating activities
 Empowering women

26. “…How can we even worry about
health or walk to the ‘chipatala’
to get treatment if we are already
so weak because we do not have
enough to eat? What can MASAF
do to help us with that?...”
WOMEN’S FGD PARTICIPANT MPEMBA (SOUTH)
chronic food insecurity
 maize crop failure/ looming threat of hunger
… Lessons learned : stark realities…
poverty health

27. IV. Proposals for MASAF action: striking balance
“Inter-packaging” & ‘looking outside the ‘health box’
medicinal plant gardens as adjuncts of infrastructure projects: health units,
schools, village child-delivery units…
alternative livelihood strategies: building skills/ community funds for averting
deforestation
Health infrastructure vs. services
More staff for health units; training appreciation of home-based efforts and
local health knowledge/practices
TBA training: reform under discussion…
Culturally/gender sensitive IEC in all health initiatives
Malaria prevention balanced with hands-on training for detection/treatment
HIV/AIDS risk
Empowering women: disseminators of IEC, e.g. through local organizations
Upholding CDD by leveraging projects with strong
community support
Community-based HIV/AIDS Orphan care programs
Boreholes and roads

28. V. Way forward: more leveraging …
Opportunities and challenges for MASAF:
 Catalyzing coordination of diverse efforts
 Raising awareness (balanced messages:
beneficial vs. harmful cultural practices)
Diverse partnerships: biomedical
community, MOH, NGOs, Universities,
CBOs…

29. “ Dzanja limodzi silikumba mankhwala ”
“One hand alone cannot dig up medicinal
herbs”
A popular Chichewa proverb

30. Malawi
 Participating members of the
study communities
Chala, Jombo, Mpemba
 Field research partner:
Ms. Lexa Kawala (Nurse/ Lecturer Kamuzu
College of Nursing, Lilongwe)
 All MASAF Staff
 Ms. Juliana Lunguzi
(Dept. of Reproductive Health, Lilongwe)
World Bank
 Mr. Reiner Woytek
& The Knowledge & Learning Group
 Dr. N. Mungai Lenneiye
 Dr. Khama Rogo
GENFUND - Norwegian Trust Fund for
Mainstreaming Gender
Acknowledgements: