By Dr Chioma Ohanjunwa and Dr Mapheyeledi Sibindlana, Africa Centre for Inclusive Health Management
Medical equipment, health professionals and medicines are vital to South Africa’s healthcare system. But most treatment plans overlook a crucial element of health: spirituality.
Health professionals and many academics across various disciplines shy away from the topic. This only fuels the misperception that spirituality is defined by strict religious frameworks, and demands only personal, individual, and inner work.
Spirituality broadly pertains to values and beliefs regarding our connection to, and relationship with, the self and all others, including families, communities, institutions, land, nature, animals and ancestors. This definition emphasises that spirituality extends beyond individual belief, inner experience and organised religion, and is instead continually lived and negotiated within networks of connection.
Spirituality is therefore an integral form of knowing about healing, health and wellbeing. Continuing to ignore spirituality as a key aspect and determinant of health risks reproducing incomplete, fragmented understandings of health and approaches to health management that do not represent the lived experience.
Spiritually improves medical outcomes
Although spirituality is often dismissed as vague or ethereal, research shows clear links with improved health outcomes.
When it comes to HIV treatment for instance, one systematic review reveals that incorporating spirituality in the treatment plan results in better mental health and medication adherence outcomes for patients.
Diabetes is currently the biggest killer in South Africa and management of the condition requires sustained lifestyle adjustments. Spiritual beliefs and practices can provide patients with meaning, motivation, and a sense of responsibility toward caring for their bodies. Prayer, meditation, or tending to the land, can also help reduce stress, which in turn supports glycaemic control by lowering cortisol levels. Further to this, spirituality often fosters community and social support, which are critical for adherence to dietary, exercise, and medication regimens.
In the South African context, where many patients navigate both biomedical and indigenous healing systems, acknowledging spirituality within healthcare enhances cultural relevance and strengthens trust between patients and providers. In this way, spirituality contributes to a more holistic approach to diabetes care, improving not only clinical outcomes but also quality of life and overall wellbeing.
Patients feel disconnected from the healthcare system
Historical tensions within coloniality have seen traditional medicine and spiritual practices largely excluded from healthcare systems in many African countries.
In rural communities where access to hospitals and medical care is limited, there is often mainly access to local indigenous knowledge.
One example are traditional midwives or Traditional Birth Attendants whose contribution to child and maternal health is grounded in spiritual and cultural practices that recognise and honour birth as a sacred and collective process. Despite their vital contribution to their communities, they remain sidelined by many local health authorities.
“Overlooking spirituality leaves patients feeling disconnected from the healthcare system and the clinicians trying to care for them,” says Howard Koh, one of the authors of a study by researchers at Harvard T.H. Chan School of Public Health, and Brigham and Women’s Hospital on how spirituality improves health outcomes for a range of serious diseases.
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In South Africa, research shows that excluding spiritual meanings from clinical encounters creates cultural and relational dissonance. Healthcare users, therefore, feel that their values are sidelined, which undermines engagement with biomedical care.
Formally recognising and integrating spirituality as a determinant of health in policy frameworks and health system planning is critical. It has the potential to enhance patient trust, strengthen cultural relevance, and foster more holistic models of care that address physical needs as well as the emotional, social, and existential dimensions of health.
The spiritual dimensions of health
Notions of health must be reframed to reflect more holistic perspectives which recognise health as relational – linking body, mind, spirit, community, and land.
To improve health systems, we also need to include potential stakeholders that have not found representation within current framings of health.
Lastly, activist scholarship is an imperative towards the integration of spirituality into health frameworks, research, education, policies and systems. This aims to bridge the gap between academic knowledge and the lived experiences of people, making knowledge production more inclusive, relevant, and connected to actual social conditions and struggles.
Considering the scope and magnitude of our healthcare challenges, we can no longer afford to ignore the spiritual dimensions of health. In addition to advocating for more decolonial, holistic, and inclusive approaches, we need to partner with existing activist networks to amplify community voices, challenge structural inequities, and co-produce knowledge and practices that transform health systems.
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Dr Chioma Ohanjunwa is a Senior Lecturer at the Africa Centre for Inclusive Health Management (Africa Centre) at the University of Stellenbosch. Dr Mapheyeledi Sibindlana is a post-doctoral research fellow at the Africa Centre. This article is based on a recent masterclass presented by the authors and hosted by Stellenbosch University in conjunction with the Africa Centre for Inclusive Health Management (ACIHM).
The views expressed in this opinion piece are those of the authors, who are not employed by Health-e News. Health-e News is committed to presenting diverse perspectives to enrich public discourse on health-related issues.
