A qualitative study of patient choices between herbal and hospital care for infectious diseases in Somalia

Somalia's healthcare system is marked by a reliance on traditional medicine and under-resourced modern facilities. This study explores how communities navigate treatment choices for infectious diseases, such as malaria and cholera, amid competing trust in herbal remedies and biomedical care. We conducted in-depth interviews with 30 participants, including 15 patients, 10 traditional healers, and 5 healthcare providers, alongside 3 focus group discussions (FGDs). Data were analyzed using thematic analysis. Three key themes emerged: (1) the cultural legitimacy of traditional medicine, (2) the perceived efficacy and safety of herbs versus antibiotics, and (3) structural barriers to accessing hospitals. Participants expressed divergent perspectives, with some preferring hospitals for severe infections due to perceived reliability, while others relied on herbal medicine due to financial constraints and cultural alignment. Somalia's healthcare challenges require integrating traditional and modern medicine while addressing structural barriers. Key solutions include training traditional healers, implementing health subsidies, and launching community education on proper medication use. By combining these approaches, Somalia can build a culturally sensitive, accessible healthcare system that improves public health outcomes.