Reimagining traditional medicine is a global imperative for achieving Universal Health Coverage (UHC).[1] In 2024, Madagascar’s UHC index estimated that only 35% of the population had access to quality healthcare services.[2]This is largely due to unsustainable out-of-pocket healthcare expenses that households must pay. To address this situation, structural interventions are needed to improve citizens’ access to healthcare services. At the same time, it is necessary to reflect on other ways in which citizens try to promote their health, that is, by turning to traditional medical and faith-healing practices, which the majority of the Malagasy population relies on.
Hence, this article outlines traditional Malagasy healing practices, examines contemporary challenges to these practices, and explores how theological insights can inform efforts to embrace integral ecology. The core argument is that a shared vision, informed decision-making, and collective action among traditional practitioners, spiritual healers, and local authorities can create a holistic and integrative traditional Malagasy medicine, thereby restoring biological order and cosmological harmony.
Madagascar
Madagascar, an island nation located in the Indian Ocean, serves as a living laboratory, housing more than 5% of the world’s biodiversity on just 0.004% of the world’s landmass.[3] According to recent data, the island exhibits extraordinary endemism, with approximately 82% of its 11,516 described vascular plant species and 28% of its 1,215 bryophyte species.[4] This makes the island one of the world’s top biodiversity conservation areas. However, Madagascar is also one of the world’s underdeveloped countries, with a Gross Domestic Product (GDP) per capita estimated at only $ 616 in 2025.[5] This rich yet vulnerable biodiversity, along with the island’s geographical and socioeconomic realities, is a significant factor in making traditional medicine practices a primary source of healthcare and well-being for the majority of the Malagasy population.
The World Health Organization (WHO) defines traditional medicine as an evidence-based healthcare system rooted in diverse cultural, historical, and experiential traditions that predates modern biomedicine.[6] Malagasy traditional medicine, in turn, is a dynamic and complex system in which therapeutic, social, and sacred dimensions are inextricably linked. Malagasy traditional healing is not merely a collection of plant-based remedies. It also understands health as a state of equilibrium across multiple realms, including the living, the living-dead (ancestors), the not-yet-born, and the natural environment.
The encounter between Malagasy traditional beliefs and the first Protestant missionaries in 1818, which led to the conversion of the former diviner Rainisoalambo, gave rise to the Fifohazana (awakening, revival) movement in 1894. Unlike other indigenous movements, the Fifohazana is modeled on the earliest Christian communities (Acts 4:32-35) and engages in both corporal and spiritual works of mercy through the ministry of Mpiandry (shepherds), a group of consecrated lay leaders. The movement maintains a close relationship with the Lutheran and Reformed Churches, offering communion with Christ through participation in the faith community and practicing faith healing while being open to modern medicine.[7]
Contemporary Challenges of Malagasy Traditional Medicine
Malagasy traditional medicine practices face multifaceted challenges rooted in history, social stigma, and institutional constraints. Colonial and missionary discourses branded traditional medicine as harmful superstition and witchcraft.[8] This stigmatization has created epistemic injustice, devaluing indigenous knowledge while promoting Western biomedicine as the only legitimate form of healing. It has also forced practitioners into secrecy and led many Malagasy Christians to live double lives, publicly distancing themselves from traditional medicine while privately seeking help from traditional healers during serious physical and spiritual crises.
In 1957, the Malagasy Institute of Applied Research (IMRA) was established to bridge indigenous medicine and modern science, ensuring that indigenous knowledge is first harnessed for local benefit. However, weak institutional structures and a lack of intellectual property protection in Madagascar facilitate economic exploitation and biopiracy of its natural resources and indigenous knowledge.[9] For example, the exploitation of a flowering plant, Madagascar periwinkle (Catharanthus roseus), from which Western pharmaceutical companies, such as Eli Lilly, have developed two vital anti-cancer drugs (vincristine and vinblastine), has generated substantial profits for these companies for years. However, the economic and health conditions of the Malagasy farmers and local communities where the periwinkle grows remain fragile.
Additionally, faith-healing movements face theological tensions. These tensions often center on the question: “Does no recovery mean a lack of faith?”[10] Institutionally, faith-healing movements struggle with gender inequality. Historian Miller Sigg notes that “The Malagasy Lutheran Church does not ordain women and, even though the Reformed Church does ordain women, an unwritten ‘rule’ allows no more than a 10 percent quota of women to be admitted to theological colleges and seminaries every year.”[11] Yet 80 percent of the shepherds are women. Socially, the Fifohazana movement is criticized for failing to address social justice issues and for focusing solely on individual spiritual needs. The movement’s unpaid shepherds endure significant financial and emotional burdens while caring for their families and patients. Yet the movement does not address the root causes of the structural injustice and socioeconomic problems its members endure.
Theological Ethics and Traditional Medicine: Toward Integral Ecology
Theological insights and African values can help address the challenges facing traditional medicine and faith-healing practitioners. The principle of human dignity and the African value of vital force both support the sacredness of indigenous knowledge and medicinal plants as God’s gifts rather than harmful superstitions. The functional interpretation of human dignity, rooted in the imago Dei, engages humans in their stewardship of creation.[12] From this perspective, indigenous knowledge is understood as an exercise of human reason that uses medicinal plants for the common good. The African understanding of vital force as a spiritual essence dispensed by God, and permeating all the created order,[13]highlights how the use of medicinal plants is a form of participation in a sacred energy intended to enhance life and restore cosmic harmony, rather than a matter of superstition.
The principle of subsidiarity empowers all health stakeholders and public leaders, urging them to be attentive to those in need, including marginalized groups, to shape a collective vision, make informed decisions, and take collaborative action. Furthermore, solidarity and social friendship foster a “culture of encounter.” These principles can enhance collaboration between healthcare professionals and traditional practitioners by embracing Pope Francis’s “polyhedral reality,”[14] in which diverse healing traditions converge for the common good. This approach is further strengthened by the collective decision-making process of palaver, which ensures that every voice is heard. This approach helps resolve theological tensions and empowers faith-healing ministers, most of whom are women, yet remain institutionally excluded.
Furthermore, the scriptural mandate of the Good Samaritan and Lucan soteriology, which emphasize the present (σήμερον: today) need for moral conversion, compel immediate, pragmatic action to alleviate the poor’s suffering using available resources. By embracing these theological lenses, stakeholders in the traditional medicine and faith healing movement, as well as public authorities, can collectively transform the healthcare system into an integral ecology that restores cosmic harmony and social justice.
Ultimately, reimaging traditional healing in Madagascar is a collective ethical and bioethical task that seeks to move beyond an individualistic focus and abstract biomedical principles toward needed structural approaches and, at the same time, a relational, inclusive model of healing in which all stakeholders and healing practices ensure the well-being of all creatures and cosmic harmony.
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Austnaberg, Hans. “‘Healing Requires Faith’: The Understanding of Faith in Faith-Healing Practices in the Awakening Movement in Madagascar.” Exchange 54, no. 2 (2025): 135–56. https://doi.org/10.1163/1572543x-bja10098.
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Sigg, Michèle Miller. “Carrying Living Water for the Healing of God’s People: Women Leaders in the Fifohazana Revival and the Reformed Church in Madagascar.” Studies in World Christianity 20, no. 1 (2014): 19–38. https://doi.org/10.3366/swc.2014.0069.
Sison, Alejo José G., Ignacio Ferrero, and Gregorio Guitián. “Human Dignity and The Dignity of Work: Insights from Catholic Social Teaching.” Business Ethics Quarterly 26, no. 4 (2016): 503–28. https://doi.org/10.1017/beq.2016.18.
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[1] See World Health Organization, “Global Traditional Medicine Strategy 2025-2034,” 2025, https://iris.who.int/server/api/core/bitstreams/cf37a4ad-4d27-4244-a7ee-001de39841ee/content;
Yuk Ming Alice Wong et al., “Policy Implications of WHO’s Global Traditional Medicine Strategy 2025–2034,” Bulletin of the World Health Organization 103, no. 11 (2025): 715–21, https://doi.org/10.2471/BLT.25.293414.
[2] See Organisation Mondiale de la Santé, “Rapport Annuel 2024,” 2024, 9, https://www.afro.who.int/sites/default/files/2025-09/Rapport_2024_OMS%20MDG_12_08_25%20LM.pdf
[3] See Manveen Puri et al., “Harnessing Biodiversity: The Malagasy Institute of Applied Research (IMRA),” BMC International Health and Human Rights 10, no. 1 (2010): 2, https://doi.org/10.1186/1472-698X-10-S1-S9.
[4] See Alexandre Antonelli et al., “Madagascar’s Extraordinary Biodiversity: Evolution, Distribution, and Use,” Science 378, no. 6623 (2022): 1, https://doi.org/10.1126/science.abf0869.
[5] See Worldometer, “Madagascar GDP (2025),” Worldometer, https://www.worldometers.info/gdp/madagascar-gdp/.
[6] See World Health Organization, “Global Traditional Medicine Strategy 2025-2034,” 2025, ix, https://www.who.int/publications/i/item/9789240113176.
[7] See Michèle Miller Sigg, “Carrying Living Water for the Healing of God’s People: Women Leaders in the Fifohazana Revival and the Reformed Church in Madagascar,” Studies in World Christianity 20, no. 1 (2014): 19–38, at 21–23, https://doi.org/10.3366/swc.2014.0069.
[8] See, for example, Gabriel Lefèvre, “Les Discours sur la Médecine Traditionnelle à Madagascar, entre Idéologie Coloniale, Salut de l’Âme, Raison Économique, et Pouvoir Biomédical,” Revue des Sciences Sociales 39, no. 1 (2008): 46–59, https://doi.org/10.3406/revss.2008.1112; Thomas Anderson, “Converting the Hospital: British Missionaries and Medicine in Nineteenth-Century Madagascar,” Itinerario 41, no. 3 (2017): 539–54, https://doi.org/10.1017/S0165115317000675.
[9] See Puri et al., “Harnessing Biodiversity”; C. Pierlovisi and L. Pourchez, “Traditional Medicine in Madagascar – Current Situation and the Institutional Context of Promotion,” Health, Culture and Society 7, no. 1 (2014): 16–27, https://doi.org/10.5195/hcs.2014.176.
[10] See, for example, Hans Austnaberg, “‘Healing Requires Faith’: The Understanding of Faith in Faith-Healing Practices in the Awakening Movement in Madagascar,” Exchange 54, no. 2 (2025): 135–156, https://doi.org/10.1163/1572543x-bja10098.
[11] Sigg, “Carrying Living Water for the Healing of God’s People,” 20.
[12] See Alejo José G. Sison, Ignacio Ferrero, and Gregorio Guitián, “Human Dignity and the Dignity of Work: Insights from Catholic Social Teaching,” Business Ethics Quarterly 26, no. 4 (2016): 508–9, https://doi.org/10.1017/beq.2016.18.
[13] See Jude Buyondo, Holistic Bioethics (Eugene, OR: Wipf and Stock, 2024), 92.
[14] Francis, “Fratelli Tutti,” October 2020, no. 145, https://www.vatican.va/content/francesco/en/encyclicals/documents/papa-francesco_20201003_enciclica-fratelli-tutti.html.