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4. DEMAND FOR MEDICINAL PLANTS IN KWAZULU-NATAL


4.1 Quantity and trends in consumer demand
4.2 Market segments


Medicinal plants are used extensively by the black population throughout KwaZulu-Natal (KZN), and indeed South Africa. An active trade and market in medicinal plant material occurs in KwaZulu-Natal as a result of:

· a fragmented distribution of medicinal plant species due to the varied land use, topography and climate in the region,

· large spatial concentrations of consumer demand as more than half the province's population is concentrated in two urban centres,

· local extinctions of plants and the need to access more remote plant populations due to intensive harvesting, and

· various socio-economic factors (including culture and accessible health care) which maintain and stimulate demand.

In KwaZulu-Natal over 400 plants are actively traded [Cunningham 1988; McKean 1996] with an estimated trade volume of some 4 300 tonnes1 per year. As the market is large and dynamic, several market segments have developed in response to the users' demands and the supply of plants. The extent of trade and the market segments are discussed in the following sections2.

1 This estimate includes both dried products, such as bark and 'wet' products such as bulbs and live plants.

2 This survey has focused on the markets in Durban. However, some estimates are made of regional and national patterns, and these are derived by using the Durban survey as a proxy.

4.1 Quantity and trends in consumer demand


4.1.1 The quantity of plant material reported to be consumed
4.1.2 The quantity of plant material reported to be traded
4.1.3 Potential provincial and national consumption levels
4.1.4 Trends in the use of indigenous medicine


A survey of several Durban City medical clinics indicated that 53% of the black clinic patients made use of indigenous3 healers at least once during the previous year, with an average of 3.34 visits in the previous year (see Figure 4.1).

3 The term indigenous healers or medicine is preferred by the author to the more conventional term traditional healers or medicine. The healing practices used, while originating in African culture, are not purely traditional. The practice is dynamic, addressing new illnesses like AIDS, and adopts new technologies and new medicines. The healers also deal with all manner of urban social problems, which are not traditional. The term indigenous medicine may therefore be more appropriate as it relates to the practices of healing and divination within an indigenous but modem African culture which may not necessarily be traditional.

Figure 4.1: The number of times which clinic patients visited an indigenous healer in 1995

While respondents asked whether they visited a indigenous healer in the previous year, the survey omitted to ask respondents whether they purchased indigenous medicine without a healer's prescription. As a consequence, the above estimate of indigenous medicine use may be an underestimate. An indication of the extent of self-medication can be obtained from the expressed preference for hygienically packed medicines. Eighty-four percent of the black clinic patients indicated that they would prefer more hygienically packed indigenous medicines, indicating that 31% of the sample may not have visited an indigenous healer in 1995 but probably make use of indigenous medicine (see Figure 4.2).

Assuming that the clinic sample is representative of the black population in Durban4, the total number of users is estimated to be around 2 million people [that is 84% of 2.442 million blacks resident in Durban (Durban Metropolitan Government 19.96)]. This estimate can be considered a conservative minimum level, as 6% of the indigenous healers patients indicated that they did not make use of western clinics, and therefore using the clinic patients as a proxy for the Durban black population may be a slight underestimate.

4 Durban refers to the Durban functional region, which is larger than the city's administrative boundaries, and includes neighbouring communities which are essentially part of the city's economy.

Figure 4.2: The demand for hygienically packed indigenous medicines

4.1.1 The quantity of plant material reported to be consumed

Basing the quantity demanded on the reported number of times which the population sample visits indigenous healers (3.34 times per annum), it is estimated that between 900 tonnes and 1 500 tonnes of plant material were consumed in Durban in 1995 (see Appendix 1 for the model used to estimate the quantities traded)5.

5 As most of the estimates are based on relatively imprecise data regarding the numbers of market participants, the broad estimates will generally be rounded off to make for easier reading. However, detailed measurements made within the survey will be retained for descriptive accuracy and where calculations are made.

This estimate assumes that the indigenous medicine users not visiting indigenous healers, that is the remaining 31% of users, would use indigenous medicine at the same rate at which healers are visited (3.34 times a year). The estimate of 900 tonnes is derived if 53% of the population is assumed to use medicine at an average mass of 83.3g per use (the average mass of plant material prescribed by healers and shop traders) and the remaining consumers use the medicine at 216.5g per use (the average mass of plant material traded in the street markets). The estimate of 1 500 tonnes is obtained if all 84% of the black population uses medicine at 216.5g per use. This last estimate is likely to be more realistic given the extent of wastage associated with the poor storage of plant material.

4.1.2 The quantity of plant material reported to be traded

The shop traders are estimated to trade 340 tonnes per year, with approximately 50% reported to be purchased directly from plant gatherers (170 tonnes) and the remaining 50% purchased from street traders (170 tonnes) (see Information Box 4.1).

The quantities traded by the healers was problematic to estimate due to the unknown number of healers in the survey area. Various reports [Holdstock 1978; Gelfand 1985; Cunningham 1988] had been made regarding the ratio of indigenous healers to the population but these have not been used for a number of reasons. Firstly, the mode of operation differs considerably between healers, with some healers being extremely busy whilst others may only practise part-time. Secondly, the various healers' organizations have provided a rough indications of the number of healers which are registered with them, but it has not been possible to obtain membership lists from these groups (in addition, the membership makes no differentiation regarding the nature of the practitioners operation, that is, whether it is either full-time or part-time).

INFORMATION BOX 4.1

The approaches used to calculate quantity traded have had to make use of whatever information could be obtained from the various market players. As various market players differ considerably in their mode of operation, the approach used has had to adapt accordingly. Consequently, me method used to determine the volumes traded in each sector differs and is detailed below for clarity.

Approach Used to Calculate the Quantity of Medicinal Plants Sold by Shop Traders in Durban

Average number of customers per trader per day

[A]

192.86

Average number of customers per trader per year

[B]=[A x 276 days]

53229

Average value per sale per customer

[C]

US$ 0.719 [R 3.18]

Average annual income per trader

[D]=[B x C]

US$ 37 528 [R 169 191]

Average price per kilogram for products sold

[E]

US$ 5.41 [R 25.25]

Average annual quantity traded in kilogram

[P]=[D ÷ E]

6700.63

Total number of shop traders in Durban1

[G]

51

Total quantity traded by shop traders in Durban

[H]=[G x F]

341 tonnes

1Based on estimates by Cunningham 1988.

Due to the above problems, estimates are based on the visitation frequency reported by the clinic patients and the average number of patients, which the indigenous healers indicate they may treat per day. Following this approach an estimated 936 tonnes of medicinal plants are traded per year by indigenous healers in Durban7. The indigenous healers reported that they purchase plant material from two sources, approximately 50% from the street markets and 50% directly from plant gatherers. This suggests that approximately 468 tonnes are bought from each group (see Information Box 4.2).

7 This estimate uses an average mass of 216.5 g for a prescribed medicine dosage. This mass is the average mass of street traded products and is believed to be a more appropriate mass than the mass dispensed in traders shops and by healers (an average 83.3 g) for estimating the quantity used by healers. The traded products are generally unprocessed and poorly packaged, with a significant proportion (not quantifiable at present) of the plant material spoiled in the transportation and storage process. The author therefore considers the larger street traded mass to be a more accurate reflection of the quantities which healers will utilise but not necessarily dispense.

INFORMATION BOX 4.2

Approach Used to Calculate the Quantity of Medicinal Plants Dispensed by Indigenous Healers in Durban

Black population in the Durban region

[A]

2442000

Fraction of black population visiting healers annually

[B]

0.53

Total number of people visiting healers in & year

[C]=[A x B]

1294260

Average number of visits to healers per patient per year

[D]

3.34

Total number of visits to healers per year

[E]=[C x D]

4323824

Average mass of a dispensed dosage (in grams)

[F]

216.5g

Total mass used by healers in Durban (in 1995)

[G]=[B x F]

936 tonnes

Estimates of the street trade volumes in Durban, as reported by the street traders in terms of the number of sacks of plant material sold per week, indicate that some 1 100 tonnes may be traded per year (see Information Box 4.3).

9 An exchange rate of SA Rands 4.5: US$ 1 is used in the report (in 1996 prices).

INFORMATION BOX 4.3

Approach Used to Calculate the Quantity of Medicinal Plants Sold by Street Traders in Durban

Average number of sacks sold per trader per month

[A]

9.8

Average mass per sack (kg)

[B]

24 kg

Average mass of plant material traded per month

[C]=[A x B]

235 kg

Average annual mass traded by street traders

[D]=[C x 12]

2820 kg

Average number of street traders in Durban markets

[E]

380

Total quantity traded by street markets

[F]=[D x E]

1070 tonnes

Of the plant mass traded in the street markets, an estimated 20% of the trade or 220 tonnes, is reported to be traded between the street traders themselves and not to consumers, healers or shop traders. This implies that of the 1 100 tonnes traded in the market as a whole, only 880 tonnes of plant material is the physical stock of plants entering the street markets in a year (see Information Box 4.4).

By summing the quantities sold by the various market players to end consumers, it is estimated that some 1 500 tonnes of plant material were sold in the Durban markets in 1996 (see Information Box 4.4).

This estimate of 1 500 tonnes traded in the market approximates the estimate derived in 4.1.1 regarding the maximum quantity of plant material which may be consumed in Durban given the consumption rates of the clinic patients interviewed. While the two approaches are not entirely independent as both models use a common number in estimating the use associated with healers, there is sufficiently different information in the other sectors which gives confidence to the similarity of estimates.

INFORMATION BOX 4.4

Approach Used to Calculate the Total Quantity of Medicinal Plants Traded in Durban Markets

Total quantity of plants traded in street markets

[A]

1100 tonnes

Quantity of plants traded between street market players (20% of total trade)

[B]

220 tonnes

Total physical stock of plants leaving the street market

[C]=[A - B]

880 tonnes

Quantity of plants bought by healers from the street market (936 tonnes less 50%)

[D]

468 tonnes

Quantity of plants bought by shop traders from the street market (341 tonnes less 50%)

[E]

171 tonnes

Quantity of plants bought by end consumers from street traders

[P]=[C - [D + E]]

327 tonnes

Quantity of plants sold to end consumers by healers

[G]

936 tonnes

Quantity of plants sold to end consumers by shop traders (total less approximately 25% sold to healers)

[H] = [341 tonnes x 0.75]

256 tonnes

Total quantity of plants consumed in Durban (quantities sold to end consumers by street traders, healers and shop traders)

[I]=[F + G + H]

1519 tonnes

4.1.3 Potential provincial and national consumption levels

Several studies in different geographic localities throughout South Africa and in different cultural groups have shown that between 58 and 100% of the black population uses indigenous medicine. Holdstock [1978] estimated that between 80 and 85% of the black population in Soweto (a black township in Johannesburg) consumed indigenous medicine. Ellis [1986] found that 100% of a random sample of hospital patients in the Estcourt area (a typical rural population) used indigenous medicine. More recently, a study in peri-urban Bushbuckridge [Mander 1997a] estimated that 58% of the clinic patients used indigenous medicine. However, this estimate is known to be conservative due to the persecution of people suspected of witchcraft in the area, and consequently an unwillingness to admit to the use of indigenous medicine. Assuming that the characteristics of the Durban consumers are representative of the rest of the population in KwaZulu-Natal and South Africa, it is possible to provide a preliminary indication of provincial and national consumption patterns.

In KwaZulu-Natal the current population is estimated to be 8.7 million, with the black population comprising 83% of the total population or 7.2 million people [Central Statistical Services 1996]. Assuming that 84% of the black population use indigenous medicine in KwaZulu-Natal, the number of potential users of indigenous medicine could therefore be 6 million people. Based on an average frequency of uses of 3.34 visits/uses per year (this translates to 20 million uses a year), and assuming an average mass of 216.5g per use, then total quantity of medicinal plants used in KwaZulu-Natal could amount to 4 339 tonnes per year.

Similarly, at a national level there are 33 million blacks in South Africa [Central Statistical Services 1996] with an estimated 28 million (84%) users. Using the same visitation rate per year and the mass per use as above, the total national consumption could amount some 90 million uses per year with a mass of 19 500 tonnes of plant material.

4.1.4 Trends in the use of indigenous medicine

The survey of consumer trends at western clinics and at indigenous healers indicated that a large section of the population has not changed their use patterns, with similar percentages indicating both an increase and a decrease in use. There is, however, an overall increase in the use of indigenous medicine. The following figures (4.3 to 4.8) and discussion outline the changes and reasons for change in use frequency cited by healers and clinic patients.

Figure 4.3: The reported changes in use by indigenous healers' patients

Figure 4.4: Healers patients' reasons for a change in the frequency of indigenous medicine use

Figure 4.5: The reported changes in use by western clinic patients

Figure 4.6: Clinic patients' reasons for a change in the frequency of indigenous medicine use

Figure 4.7: The future use of indigenous medicines as reported by western clinic customers

Figure 4.8: The future use of indigenous medicines as reported by indigenous healers' customers

Figures 4.3 to 4.8 indicate that there is a considerable proportion in each group of consumers that continue to make use of indigenous medicines as before. However, of the clinic patients, 2.7 times more patients indicated a decline in their use than an increase in use. The healers' patients on the other hand indicated an equal increase and decrease in use. In contrast to the above, both groups of consumers anticipated a greater increase in future use of indigenous medicine than a decrease in use. There were 47% more healers' customers and 19% more clinic patients who anticipated that they would increase their frequency of use in the future than those patients who anticipated a decline in the use of indigenous medicine.

Of the indigenous healers interviewed, 90% believed that the demand for indigenous medicine would remain high. The shop traders shared the same perspective that trade would remain at high levels.

Discussions with market players and observations of the markets in southern Africa (South Africa, Mozambique, Swaziland, Lesotho and Namibia) have pointed to an increase in the demand for medicines [Scott pers. comm. 1996; Maseko pers. comm. 1997]. While the individual consumers surveyed may not have indicated a trend of increasing use, there is common consensus among traders and researchers that there has been an increase in the number of individuals consuming indigenous medicine. This may be the result of the following factors.

· The population growth throughout the region is around 2.4% per year [Central Statistics 1996], leading to an increase in the potential number of people who may make use of indigenous medicine. Coupled with this increase, are the accelerated urbanization rates, which increase the competition for resources and services, especially where economic growth lags behind population growth. Indigenous medicines are actively used to reduce competition for employment, housing, and other social resources that are associated with increasing urban competition. Competition in urban areas may also contribute to psychological stress, and indigenous healing and healers are used extensively to treat stress-related illness.

· The existence of poverty also fuels the demand for medicinal plants as households are forced to make use of affordable medicine. While consulting a healer may be more expensive than visiting a clinic (see Figure 4.9), medicines bought directly from the street traders are much cheaper than any other forms of health care, and consequently are an important health care option.

· Past government policies in South Africa discriminated against indigenous healing, giving it no positive recognition, and generally labelling the activities as primitive and even legislating against witchcraft practices (Suppression of Witchcraft Act). Perceptions are now changing from several quarters, with increasing official and societal recognition. For example, medical aids in South Africa are increasingly accepting claims, by their members, for visits to indigenous healers [Daily News, 14 January 1997], and black people themselves are developing increasing pride in the culture of indigenous healing.

· One of the greatest drivers of the demand for indigenous medicine are the widely held views by the black community that certain illnesses are 'cultural' sicknesses which can only be treated by indigenous medicine. In addition, AIDS is rapidly increasing within the South African community, and with little relief from western medicine, healers report that people with AIDS consult them. There are many healers who now advertise that they have a cure for AIDS, promoting the increased use of indigenous medicine.

· Apart from the above, the remote geographical location of many large rural populations also promotes the use of indigenous medicine as it is usually the most accessible source of health care, and the most available health care, as western clinics are either far away or visit rural communities only periodically.

Figure 4.9: The cost of visiting a clinic versus an indigenous healer as reported by healers' patients

In view of the above factors, the local demand for indigenous medicine is unlikely to decline and will probably increase as the population increases.

Apart from growing local demand, there are also indications of a growing international demand. Neighbouring countries (particularly Namibia and Botswana) are increasing their demand for South African medicinal plants due to the greater diversity, reliability of supply and quantities available. The dry environments have relatively low diversities of high value medicinal plants and in addition, the frequent and regular movement of people between southern African states results in considerable exchange in ideas and information, with foreign healers learning to use South African products. In addition, the declining ability of many countries to maintain the importation of synthetic drugs promotes the continued use of indigenous medicines8. International demand for local plant products is also likely to increase with the growing popularity of alternative medicines and natural products in developed countries [Lange 1997].

8 For example, discussions in 1996 with women from a remote area in western Mali, reported to the author that they did not bother travelling to the local clinic, in this case only a few kilometres away, as the only medicine which the clinic could provide was quinine and aspirin, and good alternatives for these drugs were more easily accessible in the bush close to where they lived.

4.2 Market segments


4.2.1 Direct consumers and the indigenous healers' patients
4.2.2 Pharmaceutical companies


Two major market segments, direct consumers and patients of indigenous healers, characterize the market for medicinal plants in KwaZulu-Natal. A third market segment is the pharmaceutical companies, but it is a minor market player at present (see Section 4.2.2).

The discussion will focus on the findings for Durban and will make projections for KwaZulu-Natal where appropriate.

4.2.1 Direct consumers and the indigenous healers' patients


4.2.1.1 The buyers - Who are they
4.2.1.2 The products purchased
4.2.1.3 The quantities demanded
4.2.1.4 The timing of purchases
4.2.1.5 The reasons for purchasing indigenous medicine
4.2.1.6 The purchasing power of consumers


This market segment represents those consumers who purchase medicinal products for self-medication from street markets, shops, rural markets, and healers' practices and/or who purchase prescribed medicines from indigenous healers.

The survey was not able to interview direct consumers in the street markets and shops9. Nevertheless, observations by the researcher and sales persons in the trade indicated that direct consumers and healers patients came from all socio-economic strata in the black community. Due to the survey limitations and the similarity between the two key market segments, the two market segments will be discussed together with differences indicated where they arise.

9 The survey was not able to make an assessment of the consumers from street markets and herb shops. The fast nature of transactions and the general pace of activity in the market did not make interviews possible. While sales persons were asked about consumer characteristics, the information obtained was not suitable for detailed analysis as it was based on genera! impressions. With these limitations, no distinction will be made between the characteristics of the direct consumers (those buying for self-medication) and the healers patients. The report therefore uses the healers' patients as a proxy for the all the indigenous medicine consumers. Some information from the clinic patients is used where appropriate.

4.2.1.1 The buyers - Who are they

The majority of users of indigenous African medicine in Durban, and for most of South Africa, are black. They represent a diverse group, with a wide range of social and economic characteristics. A number of figures are presented to indicate the range of consumer characteristics amongst the indigenous medicine users10. At present there is limited use of indigenous medicinal plants by other population groups in South Africa.

10 This has important implications for the market potential as this study has shown that there is currently little or no differentiation in the products marketed (Section 7.1) while there are considerable differences in amongst the consumers.

Photo 2: A typical stall at Mona market trading raw products. Note the range of plant products, from large plant pieces to the processed material in bags, indicating that they trade to both bulk buyers and consumers.

Photo 3: The Russel Street medicinal market in Durban, South Africa - one of the larger indigenous medicine markets in Africa, with over 300 stalls and 500 traders.

A survey of black clinic patients within Durban indicated that some 53% of the respondents visited indigenous healers in the last year and a further 31% may use indigenous medicine but did not visit healers in the previous year (see Figures 4.1 and 4.2). Assuming that the clinic sample represents the black population in Durban11, then some 1.3 million people may make use of healers every year, with an additional 760 000 people using indigenous medicine without going to a healer, that is, probably purchasing products directly from traders. In total there are approximately 2 million indigenous medicine consumers in Durban, and at a provincial level, basing the estimates on the Durban statistics, there may be some 6 million consumers in KwaZulu-Natal12, and 27 million in South Africa.

11 This assumption is valid as the socio-economic characteristics of the clinic patients are similar to that described by broader studies [Durban Metropolitan Government 1996] of the black population in the Durban region.

12 This is likely to be a conservative estimate given that some 50% of the population of KwaZulu-Natal is rural, and their frequency of indigenous medicine use is likely to be greater than the urban areas given the limited access to western bio-medical services in remote regions. This is likely to be the case for South Africa as a whole which has similar urban/rural population split.

The general characteristics of the buyers are illustrated in figures 4.10 to 4.16.

It is interesting to note that the age-class distribution for the sample tends to mirror the age class distribution for the population as a whole [Durban Metropolitan Government 1996], indicating a broad spectrum of use (see Figure 4.10). One expects that the use of healers would be greater in the older age classes of black society which are more traditional. This is not evident in the study.

Figure 4.10: An indication of the age of healers' patients

Figure 4.11 shows that slightly more females than males are visiting indigenous healers but the difference is insignificant13.

13 The sample used in Figure 4.11 is from the clinic patients as the indigenous healers sample was biased towards females on the days on which the survey was carried out. The survey was undertaken on days when large numbers of patients visited the healers focusing on the treatment of children. Hence the use of the Durban clinic sample as a more representative sample of the user population.

The education category distribution is similar to that recorded for the Durban region [Development Bank of Southern Africa 1994] and indicates that the sample selected is a relatively accurate representation of the Durban population (see Figure 4.12). Past speculation has predicted that low education levels would be strongly correlated to the use of indigenous medicine. However, Figure 4.12 indicates that over 60% of the consumers have at least some form of secondary education. Higher education levels do not appear to result in a reduction in the consumption of indigenous medicine.

Figure 4.11: The gender of clinic patients reported to use healers

Figure 4.12: The education level of healers' patients

One may also expect that certain religious affiliations are likely to influence the use of indigenous medicine, given the magic and ancestral worship associated with its use. The survey indicates that 96% of the consumers had a Christian affiliation (see Figure 4.13).

A broad spectrum of occupational classes are represented in the survey sample (see Figure 4.14). What is clear that the use of indigenous medicine is not confined to the lower earning occupations. This is confirmed in the figure illustrating the wide range of incomes earned by the consumers' household (see Figure 4.15).

Figure 4.13: Religious affiliations of the healers' patients

Figure 4.14: The occupation of healers' patients

Figure 4.15: Household's incomes

Figure 4.16 confirms the wide range of the people that make use of indigenous medicine. The range includes, people from conservative traditional backgrounds (the traditional homesteads), relatively wealthy people (big houses), average people (4-roomed house), recent migrants to the city, new families, and people affected by political violence (the shacks), and single people and poor people (the hostels and rented rooms). The diversity in the types of homes which consumers live in provides an indication of the diversity of social and economic backgrounds of the users.

The above discussion shows that the majority of the black population in Durban is making use of indigenous medicine irrespective of religion, age, education and economic status. The direct consumers and the healers patients represent a large consumer population with considerable socio-economic diversity within the group. This has important implications for the market's development.

Figure 4.16: The type of house occupied by healers' patients

4.2.1.2 The products purchased

The products consumed are generally unrefined plant medicines with limited processing apart from grinding, chopping, and mixing. Raw plant material is frequently bought directly by consumers who may grind it themselves following instructions provided by the healers or traders. Plant products are taken as medicines in the following forms:

· infusions (chopped bark, leaves, seeds/fruit, stems, bulbs, rhizomes and roots steeped in water) which can be drunk, used as an emetic, or as an enema,

· concentrates (infusions where the water is boiled off concentrating the liquid) which are usually drunk,

· inhalants (plant parts or powdered parts burnt to produce smoke or boiled to produce steam) which is breathed in,

· powder (ground plant parts, usually tree bark, roots and leaves - usually burnt or raw) and which can be licked, used as snuff, bathed with, rubbed on to the skin, or implanted under the skin,

· poultices (fresh leaves of fleshy plants) applied to wounds, sores, and other skin ailments, and

· protective charms (live or dried plants) used for planting or scattering around the homestead.

4.2.1.3 The quantities demanded

The Durban survey estimated that some 1 500 tonnes of plant material was consumed per annum (see 4.1.2 for the discussion on estimates). The average mass per plant product bought in the street markets was 216.5g, and was 83g per product in the traders' shops. Observations in the street markets indicated that customers usually purchased one item in the street market, whereas in the traders' shops, customers tended to buy more than one product. The shop traders reported that the customers buy on average 127.2g per visit or 1.5 items per visit. At the healers' practices, the customers purchased similar quantities to those traded by the shop traders but it was usually only one item per visit14.

14 The healers' patients did not select the quantity purchased but were prescribed a quantity by the dispensing healer. In addition, the item purchased was usually a mixture of various plant species (which is generally confidential information).

Photo 4: A typical street trader's stall showing both raw and semi-processed products being traded.

The indigenous healers' patients or customers15 consumed some 61% of the market produce (936 tonnes), while the direct consumers bought 22% of the market produce from traders' shops (340 tonnes) and 17% from street traders (256 tonnes).

15 Patients refers to someone who is prescribed a medicine, whereas a customer is someone who purchases a product from the healer's stock without a consultation.

At a provincial level, the consumers demand approximately 4339 tonnes a year and nationally some 19 500 tonnes may be consumed16.

16 This estimate assumes that the remaining KwaZulu-Natal and South African black population has similar consumption patterns to blacks in Durban. This assumption is reasonable given that rural areas are likely to have higher consumption rates and that some of the other ethnic groups may not be inclined to consume indigenous medicine at the same rate as the Zulu-speaking people.

Photo 5: Two popular medicinal plants, Callilepis laureola or impila (the brown root) and Synaptolepis kirkii or uvuma-omhiophe (the white root), being sold in relatively large piles to other traders.

4.2.1.4 The timing of purchases

Consumers visited indigenous healers on average 3.34 times a year17 and visited the markets towards end of the month when salaries were paid. Purchases of medicine were generally associated with doing other regular chores, such as travelling to work or going shopping. Visiting indigenous healers on the other hand usually involved a specific journey to the healer but with other activities attached.

17 This estimate is used to predict the visitation frequency of the entire user population (healers' patients and direct consumers) as the survey did not collect information on the frequency of indigenous medicine use (as opposed to the frequency of visiting a healer).

Observations of the market, and interviews indicated that there was greater buying activity on Mondays, Fridays and particularly Saturdays. Limited purchasing took place on Sundays. The time of purchases from shops and the street was normally between 10h00 and 16h00 during weekdays and on Saturdays between 10h00 and 14h00. Patients visiting healers tended to follow similar weekly patterns, but started earlier in the day. Patients arrived at the healers' practices between 07h30 until about 16h00 during weekdays, and up to 13h00 on Saturdays.

Consumption of certain species was generally constant throughout the year with a small peak in demand for chest-related medicines during the winter months and a small peak for homestead blessing products at the end of the year. The climate in Durban is tropical and consequently has a limited winter peak for chest-related medicines. In contrast, healers and traders in colder regions have reported substantial increases in the demand for Siphonochilus, Alepidea and Warburgia during the winter months (June, July and August in southern Africa).

4.2.1.5 The reasons for purchasing indigenous medicine

Consumers buy medicinal plants for a range of reasons as discussed in 4.1.4. Various experts and authorities have speculated that the high demand for indigenous medicine by the black population in South Africa is due to low income, poor education opportunities, high costs of western medicine, and the lack of clinics.

Some of these questions were posed in the survey and the results are illustrated in Figure 4.17.

An analysis of Figure 4.17 shows clearly the perspective that access to clinics and the cost of western medicines were not important considerations in determining the use of healers. On the other hand, strong sentiments were expressed regarding the desire for using indigenous health care systems and there was also strong support for the notion that clinics could not cure particular ailments. Respondents made it quite clear that the selection of healing systems depended on the type of illnesses or problems that they were experiencing. This indicates that in many cases, there are not western alternatives to the services provided by indigenous medicine. The survey obtained clear evidence indicating that black people in Durban make use of both the western and indigenous health care systems.

The survey showed little or no evidence of any positive relationship between low education and income levels and a higher frequency of visits to healers. On the contrary, the healers' customers reported that they would continue to use indigenous medicine even if it became more expensive (see Figure 4.18). In view of the above attitudes, indigenous medicine could be classified as a basic consumer good, such food, clothing, western medicine and housing.

Figure 4.17: Customers reasons for visiting indigenous healers [n = 99]

In fact, consumers reported that indigenous healers were already more expensive than western medicine (see Figure 4.9, Section 4.1.4).

While the cost of consulting healers may be relatively expensive when compared to clinics, it is important to note that self-medication, using indigenous medicines, was the cheapest form of health care available. This is especially relevant to rural communities. Unlike the cities, where clinics may be relatively easily accessible, rural areas have few clinics and consequently rural communities have little or no choice in the health care systems used. Indigenous health care being the only accessible system for a large proportion of the people given the distances to travel to clinics and the costs of transport.

Figure 4.18: The response of healers' patients to a potential increase in the price of indigenous medicine



4.2.1.6 The purchasing power of consumers

The purchasing power of consumers can be considered from the perspective of the household or from the individual consumer. Household income is discussed above (Figure 4.15) and shows that there is a wide range in purchasing power, with the majority earning relatively low incomes and therefore individuals having limited purchasing power. However, purchasing power is unlikely to be a significant limitation when buying products for self-medication as this could amount to US$ 1.50 (R 6.70) (the cost of two beers) per year18 for an individual consumer or US$ 9 (R 40) per household per year19.

18 Using an average of 3.34 purchases of indigenous medicine per year.
19 The average household size for healers' customers is six people.

On the other hand, consulting an indigenous healer is likely to represent a significant cost as the average consulting fee (US$ 8.2 or R37) and associated prescribed medicine is some 18 times more expensive than the average cost of medicine bought at the markets for self-medication, and could cost an individual consumer around US$ 28 (R 124) per year. The costs to a household (of six people) could amount to US$ 168 (R 744) per year. The average monthly income earned by households visiting healers is between US$ 178 (R 800) to US$ 333 (R 1 500) per month. Consequently, the average household could spend between one half a month's income (4.2% of annual income) and one month's income (8.3% of annual income) on indigenous medicine per year.

The traders (street, shops and healers) indicated that at least 75% of their customers accepted the price charged, with the remainder bargaining for a lower price. This may indicate that for most consumers, the prices charged are affordable.

While the purchasing power of a large segment of the population is limited due to low income and relatively high costs (in prescribed medicine), it is unlikely to be limited for purchasing products for self-medication. In addition, the consumers indicated that their demand would remain the same irrespective of high prices20.

20 'High prices' are probably relative to past experiences of price increases which, if considered by percentage, are considerable (for example, 50% increases in prices are common). However, given the real amount of money involved (US$ 0.11 or R 0.50 increase per product purchased) and the infrequent use of indigenous medicine, it does not constitute a significant cost.

At a community level, the purchasing power of the user group in Durban is significant and amounts to some US$ 1.02 billion (R 4.6 billion) per year21. The survey has shown that the demand for indigenous medicine is relatively inelastic, that is, the consumers consider indigenous medicine as a basic consumer good which needs to be purchased to maintain their well-being. Consequently, there is a high degree of certainty that considerable sums of money will be spent on indigenous medicine on an annual basis in Durban. Using the estimated annual expenditure per household on indigenous medicine (between 4.2% and 8.3% of annual household income), then one can estimate that between US$ 42 million (R 190 million) and US$ 84 million (R 380 million) could be spent per annum in Durban.

21 This estimate is based on a user population of 2 million, with an average monthly income of R1 150 (US$ 256) and an average household size of six people [Development Bank of Southern Africa, 1994].

Using the quantities of plants traded and the average price of raw products bought (R 14/kg), it is possible to estimate the value of expenditure on raw plant products22.

22 These values are the trade in raw products and exclude any value-added through processing or prescription.

In Durban some 1 500 tonnes were traded and this would have generated an expenditure of US$ 4.7 million (R 21 million) per annum.

In KwaZulu-Natal, the trade of 4 300 tonnes would have generated an expenditure of some US$ 13.3 million (R 60 million) per annum. This is approximately one-third of the value of the annual maize harvest in KwaZulu-Natal.

At a national level, a trade of 19 500 tonnes would generate an expenditure of US$ 61 million (R 273 million) per annum (assuming the average price of Durban products).

4.2.2 Pharmaceutical companies


4.2.2.1 Who are the buyers
4.2.2.2 Quantities demanded
4.2.2.3 The products purchased
4.2.2.4 The timing of purchases
4.2.2.5 The reasons for purchases
4.2.2.6 The purchasing power



4.2.2.1 Who are the buyers

Several pharmaceutical companies are currently developing products for the African market in South Africa. There are reports that some companies are buying raw materials from plant harvesters in rural areas. One pharmaceutical company, which has a major share of the domestic market for western bio-medical products, is currently establishing partnerships to cultivate plants for their production process. Very little information is available regarding the pharmaceutical companies given the high degree of competition and secrecy that exists.

It is known that one of the companies is currently focusing on producing products for the upper-end of the consumer market. The large pharmaceutical company, is also focusing on products which would be registered by the Medicines Control Council, which has high standards matching the conventions in Europe and North America.

4.2.2.2 Quantities demanded

The quantity of plants demanded is unknown at present, and is likely to remain so for the short term until the practices become more established and transparent.

4.2.2.3 The products purchased

A small number of plants are being focused on due to the high costs of pharmacological screening and testing. Some 10 to 20 species are probably the focus of current formal commercial activities23. The focus is also likely to be on species, which are relatively easily cultivated to ensure that commercial production can be sustained.

23 Commercial activities undertaken by conventional businesses (in the western sense) rather than informal markets which dominate the current trade in indigenous medicine.

4.2.2.4 The timing of purchases

Whilst the products are still being developed and consumer preferences have not been tested in the market place, the timing of purchases is likely to be unknown.

4.2.2.5 The reasons for purchases

Pharmaceutical companies purchase material to process and trade to consumer outlets. The business opportunities associated with the large numbers of indigenous medicine consumers have, until recently, been largely ignored by the pharmaceutical industry. Recent research into the size of the indigenous medicine market has fuelled considerable interest by local companies.

4.2.2.6 The purchasing power

The purchasing power of large pharmaceutical industries is considerable relative to other market players in the trade. The access of large corporations to finance is far greater than the monies available to the operators in the current indigenous medicine trade. However, despite the greater purchasing power, established pharmaceutical companies are unlikely to purchase large volumes of material from existing traders, due to the unreliability of supply and current legislation.


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