Integrating *Sangoma* and *Inyanga*: An Ethnography of Therapeutic Pluralism in Eswatini’s Post-Pandemic Healthcare Landscape

{ "background": "The COVID-19 pandemic catalysed significant shifts in healthcare utilisation globally, including in Eswatini, where traditional healers (sangoma and inyanga) constitute a foundational healthcare resource. Contemporary policy debates centre on the integration of these plural therapeutic systems, yet ethnographic insights into their post-pandemic operational dynamics remain scarce.", "purpose and objectives": "This study aims to ethnographically document and analyse the evolving practices and interrelations between sangoma (diviner-mediums) and inyanga (herbalists) within the nation's healthcare landscape, examining the mechanisms and challenges of therapeutic pluralism in a post-crisis context.", "methodology": "A 14-month immersive ethnography was conducted in the Hhohho and Manzini regions, employing participant observation, in-depth interviews with 27 traditional healers and 18 biomedical practitioners, and focus group discussions with community health forum members.", "findings": "A key finding is the emergent, structured collaboration where approximately two-thirds of observed inyanga now routinely refer clients to sangoma for spiritual diagnosis before administering herbal treatments. This represents a significant consolidation of historically distinct roles. Furthermore, healers developed formalised symptom-checking protocols aligned with public health messaging, facilitating triage and co-management with clinics.", "conclusion": "The post-pandemic landscape is characterised not by simple coexistence but by active, pragmatic integration at the grassroots level, driven by healers' agency. This has enhanced systemic resilience but operates largely independently of formal policy frameworks.", "recommendations": "National health policy should recognise and support these organic collaborative models through inclusive dialogue platforms. Training programmes for biomedical staff should incorporate modules on the specific logics and referral practices of sangoma and inyanga to foster safer, more effective co-ordination.", "key words": "therapeutic pluralism, traditional healers, health systems integration, ethnography, post-pandemic recovery, Swati medicine", "cont