Traditional medicine keeps the system afloat for millions
Across Nigeria, where modern clinics are scarce and orthodox treatment often unaffordable, traditional herbal medicine has long served not as an alternative but as the only option for millions. Now, a quiet but consequential shift is underway: government agencies and international health bodies are moving to bring this ancient practice under scientific scrutiny and regulatory order. The question Nigeria is asking is one that echoes through every society that has inherited two ways of healing — not which system to trust, but how to make both worthy of trust.
- Up to 90 percent of people in some rural Nigerian communities depend entirely on herbal remedies, not by choice but because modern healthcare is too distant, too costly, or simply absent.
- A study of 46 herbal products found not one passed efficacy tests — unregulated dosages, inconsistent batches, and oral-tradition recipes mean the same treatment can vary dramatically from one household to the next.
- Delayed diagnoses and practitioners unwilling to acknowledge their own limits mean that patients with serious conditions like malaria can worsen while waiting on remedies that may be safe but not effective.
- Nigeria is now conducting clinical trials, establishing professional ethics codes, and partnering with WHO-affiliated centers to validate traditional remedies and build a regulatory framework that treats herbalists as allies rather than obstacles.
- A sickle cell drug developed through this integration process is already in use across more than 40 countries — a signal that the roadmap, though incomplete, is beginning to yield results.
A conversation at a medical conference — a trained Algerian doctor quietly seeking herbal relief from kidney stones — opens a window onto a question that is anything but abstract in Nigeria: what does healthcare actually mean when the system meant to provide it cannot reach you?
In rural Nigeria, up to 90 percent of people rely solely on traditional herbal remedies. A malaria treatment can cost as little as 400 naira. Modern clinics are sparse, doctors sparser still. For millions, herbal medicine is not a supplement — it is the entire system. Expectant mothers deliver with traditional birth attendants not out of preference but because the alternative is too far or too expensive. Cultural trust and family tradition deepen these choices, making the herbalist a first and often final resort.
Yet accessibility and safety are not the same thing. A Nigerian Institute of Medical Research study found that none of 46 tested herbal products passed efficacy trials. Dosages are unregulated, batches inconsistent, and quality control nearly absent. Neem — known as Dongoyaro in Yoruba and Dogonyaro in Hausa — illustrates the tension well. Ubiquitous, versatile, and genuinely bioactive, it is used for everything from malaria to dental care. The UN has praised its broader potential. But its anti-malarial potency is mild compared to standard drugs, and relying on it alone for severe malaria can be dangerous. Traditional knowledge even recognized one of its limits: neem is avoided during pregnancy because it can trigger uterine contractions.
Nigeria is now moving from neglect toward integration. A code of ethics for practitioners has been introduced. A WHO Collaborating Centre at the University of Lagos is developing standards for herbal formulations and toxicological evaluation. NAFDAC and the Nigeria Natural Medicine Development Agency are running clinical trials — including one for a sickle cell drug now used in over 40 countries. The model is not new: China, India, Germany, and much of the EU have already built regulatory frameworks that treat herbal medicine with pharmaceutical-grade rigor.
The path forward is not a choice between two systems but a reckoning with what each owes the people who depend on it. Traditional medicine keeps millions afloat. Science can make it safer. Without the infrastructure to bring both together, Nigerians will continue choosing between a remedy they can afford and a treatment they cannot reach.
A doctor from Algeria sat beside me at a conference, excusing himself repeatedly to vomit from kidney stones that had plagued him for years. He had endured injections and medications, dodged surgery, and now wanted to try herbal medicine instead. That a highly trained specialist would turn away from orthodox treatment to explore traditional remedies seemed jarring at first, but it opened a conversation that stretched across continents and centuries—about how people actually access healthcare, and what happens when modern medicine is too expensive, too distant, or simply not there.
In Nigeria, this is not a theoretical question. Up to 90 percent of people in some rural areas rely solely on herbal remedies, not by preference but by necessity. A single herbal treatment for malaria costs between 400 and 2,500 naira, often far less than orthodox alternatives. Modern clinics are scarce, doctors scarcer still, and the infrastructure to house them barely exists. For millions of Nigerians, traditional medicine is not a supplement to healthcare—it is healthcare. It fills the void left by an underfunded public system and makes treatment accessible to people who would otherwise have none. Expectant mothers deliver babies with traditional birth attendants rather than travel to modern facilities, not out of stubbornness but because the modern facilities are expensive, distant, or both. Cultural belief and family tradition reinforce these choices, making herbal care a trusted first resort.
But accessibility and safety are not the same thing. A study by the Nigerian Institute of Medical Research tested 46 herbal products and found that not a single one passed efficacy tests. The entire sector operates without standardization. Dosages are unregulated. Quality control is inconsistent. One person treats malaria with a mug of Agbo Iba, another with a teacup. Producers follow family recipes passed down by oral tradition, so each batch differs from the last. Some patients visit traditional healers first and delay diagnosis of conditions that require modern intervention. Practitioners sometimes lack the honesty to acknowledge their own limits and instead persist with trial-and-error approaches that only postpone proper treatment. Many herbal products are safe but may not be effective—a distinction that matters little to someone whose malaria worsens while they wait.
Neem, called Dongoyaro in Yoruba and Dogonyaro in Hausa, exemplifies both the promise and the problem. Originally from India, it has naturalized so completely in Nigeria that most people assume it is native. It grows wild like a weed, lining roads and filling vacant plots. Almost every part of it serves a purpose: leaves boiled for malaria and fever, bark chewed for dental care and stomach ailments, seed oil applied as an antiseptic for skin rashes and ringworm, twigs used as chewing sticks. Its extreme bitterness comes from compounds like azadirachtin, which possess strong antibacterial, antifungal, and anti-malarial properties. The United Nations has called it the tree of the 21st century for its potential in sustainable agriculture and medicine. Yet research shows its anti-malarial potency is mild compared with standard drugs. Relying on it alone to treat severe malaria can delay proper treatment. Traditional knowledge understood this too—neem is strictly avoided during pregnancy because it can stimulate uterine contractions.
The government has begun to shift from ignoring traditional medicine to integrating it. A strategic plan and code of ethics for practitioners have been unveiled to promote evidence-based practice. The World Health Organisation Collaborating Centre at the University of Lagos College of Medicine now houses the African Centre of Excellence for Drug Research, Herbal Medicine Development and Regulatory Science, dedicated to developing standards for herbal formulations, quality assurance, and toxicological evaluation. The National Agency for Food and Drug Administration and Control and the National Institute for Pharmaceutical Research and Development are working to standardize and scientifically validate remedies. NAFDAC, in partnership with the Nigeria Natural Medicine Development Agency, is conducting clinical trials to validate safety and efficacy, including a sickle cell drug now used in more than 40 countries. This represents a significant shift from a hands-off approach to a structured system that treats traditional healthcare providers as allies rather than rivals.
Other countries have already traveled this road. China, India, and Germany have legalized and extensively integrated herbal medicine. Within the European Union, the United Kingdom, and the United States, herbal medicines are regulated like pharmaceuticals—they must be registered and demonstrate acceptable safety profiles. Nigeria is moving in that direction, though the work is far from finished. The challenge is not to choose between traditional and modern medicine but to harness the accessibility of one with the rigor of the other. Traditional medicine keeps the healthcare system afloat for millions. Its full potential is hampered by quality concerns and weak regulation. A comprehensive plan of action, professional codes of ethics, and standardized practices could provide the roadmap. Without them, people will continue to choose between an accessible remedy that may not work and a modern treatment they cannot afford or reach.
Citações Notáveis
Traditional medicine is vital to keeping the healthcare system afloat, but its full potential is hampered by quality concerns and weak regulation.— Analysis in source material
The government is moving from a hands-off approach to a structured system that integrates evidence-based traditional medicine into the national healthcare framework.— Analysis in source material
A Conversa do Hearth Outra perspectiva sobre a história
Why does a doctor—someone trained in modern medicine—turn to herbal remedies for kidney stones?
Because he had exhausted what modern medicine offered him without relief. Injections, medications, the threat of surgery. At some point, suffering makes you willing to try something else, even if it seems to contradict your training.
But isn't that dangerous? Doesn't he risk making things worse?
Yes. But he was already suffering. The question becomes: worse than what? For him, the risk of trying something unproven seemed smaller than the certainty of ongoing pain.
In Nigeria, though, people don't have that choice. They use herbal medicine because there's nothing else.
Exactly. It's not a choice between two options. It's a choice between herbal medicine and no medicine at all. That's why 90 percent of people in some rural areas rely on it. The system has failed them.
So the government should just regulate what's already happening?
Not just regulate—validate. Test what works, standardize what's safe, and integrate it into the official system. Right now, traditional practitioners operate in the shadows. Bring them into the light, set standards, and you solve two problems at once: you make traditional medicine safer, and you acknowledge that it's already the primary healthcare system for millions.
What about neem? Is it actually effective against malaria?
Mildly. It has real antimalarial properties, but they're weaker than standard drugs. That's the trap: it works enough to seem promising, but not enough to treat severe cases. People delay proper treatment waiting for it to work.
So integration means what, exactly?
It means clinical trials, quality standards, dosage guidelines, and honest labeling about what each remedy can and cannot do. It means training traditional practitioners in when to refer patients to modern medicine. It means treating traditional and modern healthcare as parts of one system, not competitors.