JUSTIFICATION FOR THE CONTINUED PATRONAGE OF TRADITIONAL HEALTH FACILITIES IN RURAL NIGERIA: A FUNCTIONALIST PERSPECTIVE

Contact IJRGP Copyright & Licensing Page 1 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. Research Article JUSTIFICATION FOR THE CONTINUED PATRONAGE OF TRADITIONAL HEALTH FACILITIES IN RURAL NIGERIA: A FUNCTIONALIST PERSPECTIVE Julius Olugbenga OWOYEMI, Ph.D1, Muhammed AUDU, Ph.D2, Edime YUNUSA3*, John Arome VINCENT4 and Kashim AKOR, Ph.D5. 1,2,3&4Department of Sociology, Faculty of Social Sciences, Prince Abubakar Audu University Anyigba Kogi State – Nigeria 5Industrial Arbitration Panel, Federal Ministry of Labour and Employment, Abuja. Abstract This paper provided an analysis of the enduring relevance of traditional health facilities in rural Nigeria through a robust functionalist lens. Despite the increasing, albeit often uneven, penetration of modern healthcare infrastructure into rural areas, traditional medicine continues to serve as a critical and often primary source of healthcare for a significant proportion of the rural populace. This paper posited that the sustained patronage of traditional health facilities is not merely a matter of historical inertia or a consequence of the absence of alternatives, but rather a reflection of the crucial social, cultural, economic, and psychological functions these systems fulfil within their specific contexts. By exploring the intricate socio-cultural embeddedness, enhanced accessibility, perceived affordability, culturally congruent explanatory models of illness, and the holistic care offered by traditional medicine, this paper offers a justification for its continued significance. The paper concluded that the significant patronage of traditional health facilities in rural Nigeria can be justified from a structural functionalist perspective. These facilities serve essential and multifaceted social functions that extend beyond mere healthcare provision, encompassing cultural preservation, economic support, social cohesion, and the provision of culturally congruent explanatory models of International Journal of Multidisciplinary Department Published by: International Journal & Research Global Publisher ISSN: XXXX-XXXX Article History: Received: 12 September 2025 | Accepted: 27 September 2025 | Published: 3 October 2025 ** Related declarations are provided in the final section of this article. Contact IJRGP Copyright & Licensing Page 2 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. illness and holistic care. Furthermore, it advocates for a more integrated and collaborative approach between traditional and modern healthcare systems in Nigeria to enhance overall healthcare access and affordability of service delivery and achieve health equity in rural communities. Keywords: Justification, Continue Patronage of Traditional Medicine, Health Facilities, Rural Communities, Functionalist Perspective, Nigeria Introduction The healthcare access in rural Nigeria presents a complex interplay of evolving modern medical infrastructure and deeply entrenched traditional health systems. While national and international efforts have focused on expanding the reach and quality of modern healthcare facilities across the country, significant disparities persist, particularly in remote and underserved rural areas (Federal Ministry of Health, 2024; United Nations Children’s Fund, 2023). In these settings, traditional medicine, with its diverse array of practices, practitioners, and remedies, remains a vital and often the most readily available source of healthcare for a substantial segment of the population (World Health Organization, Regional Office for Africa, 2022). Traditional health systems in Nigeria are not monolithic; they encompass a wide range of healing traditions, knowledge systems passed down through generations, and practitioners who often hold esteemed positions within their communities (Ezeanolue et al., 2021). The continued reliance on these systems is driven by a confluence of factors that extend beyond mere geographical constraints, encompassing cultural beliefs about health and illness, socioeconomic realities, and the perceived effectiveness and holistic nature of traditional care (Tolu et al., 2020). Understanding the multifaceted reasons behind this enduring patronage is paramount for formulating effective healthcare policies that are both culturally sensitive and responsive to the actual needs of rural populations. This paper therefore examines the functionalist perspective as a valuable framework for comprehending the persistent significance of traditional health facilities by highlighting the essential social functions they perform within the rural context in Nigeria. Globally, there is a growing recognition of the potential role of traditional and complementary medicine (T&CM) in achieving universal health coverage, particularly in lowand middleincome countries where it often represents a significant healthcare resource (World Health Organization, 2019). The World Health Organization has increasingly advocated for the integration of T&CM into national health systems, emphasizing the need for evidence-based practices and regulatory frameworks to ensure safety and quality (World Health Organization, 2023). Within the African region, traditional medicine is not simply a historical phenomenon but a dynamic and evolving system that continues to be a primary source of healthcare for a large proportion of the population, especially in rural areas where access to modern medical services remains a challenge (African Union Commission on Social Affairs, 2022). Factors Contact IJRGP Copyright & Licensing Page 3 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. such as limited infrastructure, shortages of healthcare professionals, and financial barriers often impede the effective delivery of modern healthcare in these settings. In Nigeria, despite considerable investments in strengthening the formal healthcare sector, particularly at the primary health care level, a significant proportion of the rural population continues to rely on traditional health facilities for their healthcare needs (National Bureau of Statistics, 2023). This reliance is not solely attributable to the lack of access to modern facilities but is also deeply rooted in cultural beliefs, trust in traditional healers, the perceived affordability of traditional medicine, and the holistic approach often adopted by traditional practitioners (Anyaegbunam et al., 2021). While modern medicine excels in certain areas, traditional medicine often addresses the socio-cultural and spiritual dimensions of illness that are highly valued within rural communities (Ogbole et al., 2020). However, there remains a significant gap in the comprehensive understanding and effective integration of these traditional health systems within the broader national health policy framework. Often, traditional medicine operates outside the formal regulatory structures, leading to concerns about quality, safety, and standardization of practices (Lawal et al., 2022). Furthermore, there can be a lack of effective communication and collaboration between traditional healers and modern healthcare providers, potentially hindering optimal patient care and referral pathways (Erhun & Babalola, 2019). This gap in understanding the functional roles, strengths, and limitations of traditional health facilities impedes the development of inclusive, culturally appropriate, and ultimately more effective healthcare strategies for rural populations in Nigeria. Addressing this gap requires a rigorous examination of why these systems continue to be patronized and how they can be constructively engaged within the national health system. Aim and Objectives This paper aims to provide a robust justification, from a functionalist perspective, for the continued patronage of traditional health facilities in rural Nigeria. The specific objectives of this paper are to: a. Analyse the socio-cultural factors that significantly contribute to the sustained reliance on traditional health facilities in rural Nigeria. b. Examine the accessibility and affordability of traditional health services in rural Nigeria in comparison to modern healthcare alternatives. c. To evaluate the perceived efficacy and cultural relevance of traditional medicine in addressing the diverse health concerns of rural populations in Nigeria. Methodology This paper adopted secondary sources of data drawing upon an extensive body of existing literature. This includes in-depth analyses of scholarly articles published in peer-reviewed journals, detailed reports from national and international health organizations (such as the World Health Organization and UNICEF), relevant sociological and anthropological studies Contact IJRGP Copyright & Licensing Page 4 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. that have explored healthcare practices in Nigeria, and policy documents from the Nigerian Federal Ministry of Health and related agencies. Literature Review The review of relevant and related literature for this paper was done in tandem with the aim and objectives of the paper as follows: Justification for the Continued Patronage of Traditional Health Facilities in Rural Nigeria The enduring and significant reliance on traditional health facilities in rural Nigeria is deeply interwoven with the intricate fabric of social structures, deeply ingrained cultural norms, and long-standing belief systems. Traditional healers within rural communities often occupy positions of considerable respect and influence, extending their roles beyond mere healthcare provision to encompass those of spiritual advisors, social mediators, and custodians of cultural knowledge (Ademuwagun, 2019). Their profound understanding of local cosmologies, indigenous concepts of health and illness causation, and the intricate web of social relationships within the community resonates deeply with the lived experiences of rural dwellers in ways that the often more impersonal and biomedically focused approach of modern medicine may not fully address (Peltzer et al., 2022). This profound cultural congruence fosters a strong sense of trust and familiarity, encouraging individuals and families to continue seeking care from traditional practitioners who are seen as integral members of their communities and who speak their cultural and often literal language (Jegede & Green, 2020). Accessibility and Affordability of Traditional Health Services in Rural Nigeria in Comparison to Modern Healthcare Alternatives Accessibility and affordability are critical and often decisive factors influencing healthcare choices in rural Nigeria, where geographical terrain can be challenging and economic resources are often limited. Modern healthcare facilities, even when present, may be located at significant distances, necessitating considerable travel time and incurring transportation costs that can be prohibitive for many rural residents whose livelihoods are often based on subsistence farming or informal economic activities (Onwujekwe et al., 2018). In stark contrast, traditional healers are typically embedded within the community itself, making their services readily and immediately accessible, often without the need for extensive travel or significant upfront costs (Uzochukwu et al., 2019). Furthermore, the economic transactions associated with traditional medicine are often more flexible and culturally attuned to the local context, sometimes involving payment in kind (such as agricultural produce), delayed payment arrangements, or negotiated fees, which aligns more closely with the often precarious economic realities of rural livelihoods (Akinyemi et al., 2021). This inherent accessibility and economic flexibility render traditional healthcare a viable and often preferred option for many rural Nigerians. Contact IJRGP Copyright & Licensing Page 5 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. Perceived Efficacy and Cultural Relevance of Traditional Medicine in addressing the Diverse Health Concerns of Rural Populations in Nigeria The perceived efficacy of traditional medicine in treating a wide range of ailments, both physical and psychosocial, also plays a significant role in its continued patronage. Rural Nigerians often hold strong beliefs in the healing power of traditional remedies, which are frequently based on generations of accumulated empirical knowledge, anecdotal evidence passed down through oral traditions, and a deep understanding of local flora and fauna with medicinal properties (Sofowora, 2017). Moreover, traditional healing practices often incorporate rituals, spiritual interventions, and symbolic elements that address the holistic well-being of the individual, encompassing the interconnectedness of the physical, psychological, social, and spiritual dimensions of illness (Browne et al., 2023). This holistic approach can provide a sense of comfort, cultural reassurance, and comprehensive care that may not always be explicitly addressed within the biomedical model of modern medicine, thereby reinforcing the perceived value and effectiveness of traditional health systems within rural communities. Empirical Review A substantial body of empirical research conducted across various rural communities in Nigeria consistently underscores the significant and enduring role of traditional healers and traditional health facilities in healthcare provision. Among the relevant ones are as follows: Iliyasu et al., (2024) carried out a study on the pattern of healthcare utilisation in rural communities of northern Nigeria. The study employed a cross-sectional descriptive research design. A sample size of 420 households was selected using a multistage sampling technique. Data were collected through the use of structured questionnaires administered to household heads. Descriptive statistics and chi-square tests were used for data analysis. The major findings revealed that a significant proportion of the respondents (68.3%) first sought healthcare from traditional healers for common ailments such as malaria, cough, and diarrhoea before considering modern healthcare facilities. The study concluded that traditional healers play a crucial role as the initial point of care in these rural communities due to factors like accessibility and cultural beliefs. Oladepo et al., (2022) investigated healthcare seeking behaviour and the role of traditional medicine in rural southwestern Nigeria. This research was carried out in selected rural communities in southwestern Nigeria. The study utilized a descriptive cross-sectional survey design. A sample of 384 household heads was selected through a multistage random sampling technique. Data were collected using semi-structured questionnaires. Descriptive statistics and regression analysis were employed to analyse the data. The major findings indicated that cultural beliefs about the causes of illness, the perceived effectiveness of traditional remedies, and the affordability of traditional healthcare significantly influenced the choice of healthcare provider. The study concluded that traditional medicine remains a prominent healthcare Contact IJRGP Copyright & Licensing Page 6 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. option in rural southwestern Nigeria, deeply embedded in the cultural fabric of the communities. Ezeh et al., (2019) conducted a research on the use of traditional birth attendants in rural Nigeria: A survey of their practices and perceptions of modern healthcare. The research was conducted in rural communities within Enugu State, southeastern Nigeria. The study adopted a descriptive survey design. A sample of 250 traditional birth attendants (TBAs) was selected using a snowball sampling technique. Data were collected through the administration of semistructured questionnaires and in-depth interviews. Descriptive statistics were used to analyse quantitative data, while thematic analysis was used for qualitative data. The major findings showed that TBAs were still widely patronized for childbirth in these rural areas due to their accessibility, affordability, and the cultural acceptability of their practices. The study concluded that while TBAs play a significant role, there is a need for training and collaboration with modern healthcare facilities to improve maternal and child health outcomes. Atinmo et al., (2020). The use of traditional medicine in the management of chronic diseases in rural Nigeria: A mixed-methods study. This study was conducted in selected rural communities in Oyo State, southwestern Nigeria. A mixed-methods research design, combining quantitative and qualitative approaches, was employed. The quantitative phase involved a survey of 310 individuals with chronic diseases selected through a purposive sampling technique. The qualitative phase involved focus group discussions with patients and in-depth interviews with traditional healers. Quantitative data were analysed using descriptive and inferential statistics, while qualitative data were analysed using thematic analysis. The major findings revealed that a significant number of individuals with chronic conditions used traditional medicine, either as a complementary or alternative therapy, citing reasons such as cost, perceived effectiveness in managing symptoms, and accessibility. The study concluded that traditional medicine plays a considerable role in the management of chronic diseases in rural Nigeria and warrants further investigation and potential integration. Anyaegbunam et al., (2021) examined cultural determinants of healthcare seeking behaviour in rural communities in southeastern Nigeria. The study employed a descriptive crosssectional survey design. A sample size of 400 household heads was selected using a multistage sampling technique. Data were collected using structured questionnaires. Descriptive statistics and chi-square analysis were used to analyse the data. The major findings highlighted the significant influence of cultural beliefs about the aetiology of diseases, trust in traditional healers, and the perceived cultural appropriateness of traditional medicine on healthcare seeking behaviour. The study concluded that cultural factors are critical determinants in the choice between traditional and modern healthcare in these rural communities. Contact IJRGP Copyright & Licensing Page 7 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. Overall, the empirical review effectively establishes the continued relevance of traditional health facilities in rural Nigeria by presenting findings from various studies that consistently point to their significant role in healthcare delivery and health-seeking behaviours. Theoretical Framework This paper was anchored on Structural Functionalism and Rational Choice Theory as discussed below: i. Structural Functionalism Structural Functionalism is primarily associated with the seminal works of Émile Durkheim (1895), who emphasized the importance of social facts and the collective consciousness in maintaining social order, and was further developed by Talcott Parsons (1951), who conceptualized society as a complex system of interrelated parts, each fulfilling specific functions to maintain the overall equilibrium of the system. Robert Merton (1967) refined this perspective by introducing the concepts of manifest functions (the intended and recognized consequences of a social pattern) and latent functions (the unintended and often unrecognized consequences). Applying the structural functionalism theory to the continued patronage of traditional health facilities in rural Nigeria allows us to understand this phenomenon not merely as a residual practice but as a functional response to the specific needs and conditions of rural society. From this perspective, traditional health facilities serve several crucial functions that contribute to the social stability and well-being of rural communities. Firstly, they provide essential healthcare services in geographical areas where access to modern medical facilities is limited or non-existent, thus fulfilling a critical manifest function of healthcare delivery. Secondly, they play a vital latent function in reinforcing cultural beliefs, values, and social cohesion by embedding healthcare practices within local traditions, rituals, and community networks. The interaction with traditional healers often involves shared cultural understandings of illness causation and treatment, strengthening social bonds and a sense of collective identity. Thirdly, traditional health systems can have latent economic functions, providing livelihoods for traditional healers and their families and contributing to the local informal economy through the trade of medicinal plants and related products. Furthermore, the functionalist perspective helps us understand how traditional medicine addresses the specific needs of rural populations in ways that modern medicine may not always do. For instance, the holistic approach of traditional healers, which often considers the social, psychological, and spiritual dimensions of illness alongside the physical, can be seen as fulfilling a latent function of providing comprehensive care that aligns with the cultural understanding of well-being in these communities. The accessibility and affordability of traditional medicine can also be viewed as functional adaptations to the socio-economic realities of rural life, ensuring that healthcare is available to those who might otherwise be excluded by the costs and logistical challenges of modern healthcare. Contact IJRGP Copyright & Licensing Page 8 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. However, it is important to acknowledge the limitations of the functionalist perspective. It has been criticized for potentially overemphasizing social harmony and stability, sometimes at the expense of recognizing issues of power imbalance, social inequality, and the potential for dysfunction within social systems. In the context of traditional medicine, a purely functionalist view might inadvertently downplay potential risks associated with certain traditional practices, the lack of standardization, and the need for regulation to ensure patient safety. Despite these limitations, the structural functionalism theory provides a valuable and insightful framework for understanding why traditional health facilities continue to be patronized in rural Nigeria by highlighting the crucial and multifaceted social functions they perform within their specific socio-cultural and economic context. It moves beyond simply acknowledging their existence to explaining their persistence as a response to fundamental needs and social realities. ii. Rational Choice Theory Rational Choice Theory, primarily advanced by Gary Becker in the early 1960s, emerged as a significant theoretical framework in economics and the social sciences. It builds on the works of earlier thinkers such as Adam Smith and Jeremy Bentham but was systematically articulated by Becker (1962) to explain human behaviour beyond economics into other areas of social life. The theory assumes that individuals are rational actors who make decisions based on the calculation of costs and benefits to maximize their utility. In essence, human actions are viewed as purposive and guided by preferences, constraints, and available information. Within this framework, people are presumed to possess stable preferences and to make choices that yield the greatest personal advantage, even in situations with limited resources or imperfect information. The strength of Rational Choice Theory lies in its simplicity and predictive power. By assuming that individuals act to maximize their self-interest, it provides a universal explanation for behavior across different social contexts, from economics to politics, health, and education. This theoretical clarity allows researchers to model human behavior systematically, making it easier to test hypotheses and predict outcomes. Its versatility also makes it adaptable to diverse cultural and institutional settings, including rural communities in Nigeria. In the context of this paper, Rational Choice Theory is highly relevant. It explains why rural dwellers might continue to patronize traditional health facilities despite the availability of modern healthcare. Individuals in these settings often weigh the perceived benefits of traditional healthcare such as affordability, accessibility, trust in the healer, cultural familiarity, and perceived effectiveness, against the costs associated with formal healthcare, which may include long travel distances, higher fees, or unresponsive services. Through this lens, continued patronage of traditional health facilities can be understood as a rational Contact IJRGP Copyright & Licensing Page 9 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. decision made to maximize health outcomes within the constraints of socio-economic and cultural realities. By application, Rational Choice Theory highlights how cultural norms and institutional factors influence individual choices. For instance, in rural Nigeria, traditional healthcare is not only a medical alternative but also a socially embedded practice. People may consider not only the cost and effectiveness but also social obligations, community acceptance, and the perceived legitimacy of traditional healers. Rational Choice Theory provides a robust framework for analyzing these decisions because it accounts for both tangible and intangible factors influencing health-seeking behavior. However, despite its utility, the theory has weaknesses. It tends to oversimplify human behaviour by assuming that individuals always act rationally and have access to complete information, which may not be the case in rural Nigeria where misinformation, low literacy levels, and deeply rooted cultural beliefs can shape health decisions in non-rational ways. Moreover, it underestimates the role of emotions, traditions, and collective decision-making in shaping individual choices, which are particularly strong in communal societies like rural Nigeria. Thus, while Rational Choice Theory offers a compelling explanation for the continued patronage of traditional health facilities, its assumptions must be contextualized within the socio-cultural environment to fully capture the complexities of health-seeking behaviors in rural communities. Appraisal of the Reviewed Theories Rational Choice Theory, developed by Gary Becker in the early 1960s, explains behaviour as the outcome of individuals weighing costs and benefits to maximise their welfare. In rural Nigeria, this theory helps explain why people continue to patronise traditional health facilities. These choices are influenced by affordability, accessibility, cultural familiarity, trust in local healers, and the perceived effectiveness of traditional care compared to modern services that are often costly, distant, or slow to respond. This perspective shows that the decision to rely on traditional healthcare is a deliberate and purposeful action, not simply a cultural habit. The Functionalist Perspective, rooted in the work of Émile Durkheim and expanded by Talcott Parsons, views society as a system in which institutions serve roles that maintain order and stability. In this study, traditional health facilities are seen as institutions that provide more than medical treatment; they preserve cultural knowledge, strengthen community ties, and fill gaps left by the shortcomings of formal healthcare systems. This perspective reveals how these facilities contribute to the functioning of rural communities and why they remain relevant. When these two theories are applied together, they explain both the individual and collective reasons behind the continued use of traditional health facilities. Rational Choice Theory clarifies the personal decision-making process, while the Functionalist Perspective highlights Contact IJRGP Copyright & Licensing Page 16 of 16 This article is licensed under a Creative Commons Attribution 4.0 International License. Peltzer, K., & Ebersöhn, L. (2022). Cultural health beliefs and practices in Africa. In I. B. Weiner, R. J. Brown, S. F. Bornstein, & M. Thoresen (Eds.), The encyclopedia of crosscultural psychology (pp. 1–7). Wiley. Sofowora, A. (2017). Medicinal plants and traditional medicine in Africa. Spectrum Books. Tolu, L. B., Ogunleye, O. O., & Adekunle, T. O. (2020). 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