A Manifesto for Ecological Healing: Valuing Traditional Knowledge in Mozambique

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I enjoyed this manuscript and have learned a lot in several areas:

1. As a true strength, the manuscript effectively weaves legal, moral, historical, and philosophical perspectives, providing a multi-layered argument that elevates the discourse beyond health policy into cultural sovereignty and epistemic justice.
2. It is also well grounded in Mozambique’s socio-political and historical realities. It avoids abstraction and centers real stakeholders (healers, patients, state, etc.). I learned a lot here because of those specificities. 
3. One of my personal favorites has to do with the linking of the discussion to the SDGs, planetary health, and decolonial theory. This manuscript positions Mozambican traditional healing within broader global justice debates.
4. But if you ask me about my most favorite part in the article, I can tell you that I loved how the author convincingly frames emancipation as not mere integration but recognition that is anchored in rights, dignity, and pluralism. The legal-moral-consequentialist framework is a particular strength of this manuscript.

Like any other manuscript, I also see areas of growth and potential improvement:

1. I understand that the paper is structured as a policy and ethical analysis. While it is conceptually rich and theoretically depth notable, it does not clearly state its methodological approach. It would benefit from a short paragraph (possibly in the introduction or a footnote) explaining that it uses. That way, more empirical or field-based references would further strengthen the argument, for example, data on patient outcomes, case studies of healer integration, or comparative models from other countries.
2. Two other minor changes: Firstly, some ideas, particularly around epistemic injustice and healer marginalization, are repeated across sections. Tightening these areas would improve pacing and reduce my fatigue as a reader. Secondly, some terms (e.g., “epistemic extractivism,” “Cartesian-Taylorist validation”) could benefit from brief definitions or simplification for accessibility beyond academic audiences.

Author Response

Dear reviewer,

Please find below my response to your comments:

 

Comment 1:

I enjoyed this manuscript and have learned a lot in several areas:

1. As a true strength, the manuscript effectively weaves legal, moral, historical, and philosophical perspectives, providing a multi-layered argument that elevates the discourse beyond health policy into cultural sovereignty and epistemic justice.
2. It is also well-grounded in Mozambique’s socio-political and historical realities. It avoids abstraction and centers real stakeholders (healers, patients, the state, etc.). I learned a lot here because of those specificities. 
3. One of my personal favorites has to do with the linking of the discussion to the SDGs, planetary health, and decolonial theory. This manuscript positions Mozambican traditional healing within broader global justice debates.
4. But if you ask me about my favorite part in the article, I can tell you that I loved how the author convincingly frames emancipation as not mere integration but recognition that is anchored in rights, dignity, and pluralism. The legal-moral-consequentialist framework is a particular strength of this manuscript.

Thank you very much. It is satisfying to receive your comments, and I will make sure all your recommendations are fulfilled.

Comment 2:

Like any other manuscript, I also see areas of growth and potential improvement:

• I understand that the paper is structured as a policy and ethical analysis. While it is conceptually rich and theoretically depth notable, it does not clearly state its methodological approach. It would benefit from a short paragraph (possibly in the introduction or a footnote) explaining its use. That way, more empirical or field-based references would further strengthen the argument, for example, data on patient outcomes, case studies of healer integration, or comparative models from other countries.

Response: Thank you for this observation. The original manuscript did include a section on the methodological approach, but it was removed at the request of the Editor. I will reinstate a concise version of this section and await the editorial decision.

• Two other minor changes: Firstly, some ideas, particularly around epistemic injustice and healer marginalization, are repeated across sections. Tightening these areas would improve pacing and reduce my fatigue as a reader. Secondly, some terms (e.g., “epistemic extractivism,” “Cartesian-Taylorist validation”) could benefit from brief definitions or simplification for accessibility beyond academic audiences.

Response: Thank you for your suggestion. I have reduced the repeated ideas around epistemic injustice and healer marginalisation to improve pacing. Regarding terminology, I removed the phrase epistemic extractivism and retained only its explanatory wording. I also replaced Cartesian-Taylorist validation with more accessible expressions, such as mainstream biomedical establishment or mainstream science, and reviewed the manuscript for other terms that required clarification or simplification.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear authors, I really appreciate your paper. Here are some comments to improve it:

• Since Mozambico is 2-3 times bigger than Germany, I suppose traditional healing methods could be different from area to area. Please clarify this point.
• You mention that traditional healing is more relevant in rural areas rather than in cities. Can you say something more about this difference? It's clear that traditions are stronger in rural areas, anyway it would be useful for an international reader to have some examples of differences in patient approach by traditional healing and bio-medical professionalism.
• You write that traditional healing can be more effective in primary care. I suggest to strenghten this point.
• Moreover, I suggest to clarify if traditional healing has a different impact for different health conditions. I mean for different severity of illness.
• you mention that traditional hearing, medical professionalism and policymaking should/could be integrated. Which are the strategies for the integration?
• you mention that traditional healing is based on spiritual, religious, social values, while biomedical approach is based on objectivity, physical, mental dimensions. Am I right? If so, please qualify which are the most positive and arguable impact of both approaches.
• I don't see any references to effectiveness and cross benefits impact of traditional healing. Is it mainly a matter of trust and tradition or are there also economic aspects to be highlighted?
• Even if you already wrote something about the issue, i suggest to strenghten the different impacts of traditional healing in underdeveloped classes and reach highly educated classes?
• With reference to literature review, Is it possible to mention other countries that have a similar situations?
• last but not least, i suggest strenghtening or broading the socio-economic sustainability aspect.

Author Response

Dear reviewer,

Please find below my responses to your comments:

Dear authors, I really appreciate your paper. Here are some comments to improve it:

Comment 1:

• Since Mozambique is 2-3 times bigger than Germany, I suppose traditional healing methods could be different from area to area. Please clarify this point.

Response: Thank you for this observation. Indeed, Mozambique’s size and cultural diversity mean that traditional healing practices vary significantly across regions. I have clarified this point in the manuscript by noting that there is no single, uniform Mozambican traditional healing method and that practices reflect the distinct ethnic, linguistic, and ecological contexts of each area.

Comment 2:

• You mention that traditional healing is more relevant in rural areas than in cities. Can you say something more about this difference? It's clear that traditions are stronger in rural areas; it would be helpful for an international reader to have some examples of differences in patient approach between traditional healing and biomedical professionalism.

Response: Thank you for this helpful suggestion. I have expanded the section to clarify the rural–urban differences in both relevance and patient approach. The revised text now explains how, in rural areas, consultations with traditional healers often take place in the patient’s home or a community space, allowing for extended interaction, family involvement, and the integration of spiritual rituals with plant-based remedies. In contrast, biomedical facilities typically offer shorter, standardized consultations, prioritizing diagnostic efficiency and clinical protocols. An illustrative example compares how a healer might treat infertility—combining herbal preparations with divination to address perceived spiritual causes—whereas a biomedical practitioner would focus on physiological testing and pharmaceutical interventions. These additions should help international readers better visualize the cultural and procedural contrasts between the two systems.

 

Comment 3:

• You write that traditional healing can be more effective in primary care. I suggest strengthening this point.

Response: Thank you very much. I have strengthened the section accordingly. The revised text explains that, in certain contexts, traditional healing can be more effective in primary care due to its accessibility, cultural consonance, and integration within local support networks. Examples now include early intervention for common ailments, the role of community reinforcement in treatment adherence, and responses to culturally framed illnesses. An illustrative case contrasts how a healer might address a persistent cough with both herbal infusions and rituals for perceived spiritual causes, whereas biomedical consultations may focus solely on physiological symptoms.

 

Comment 4:

• Moreover, I suggest clarifying if traditional healing has a different impact for different health conditions. I mean for different severities of illness.

Response: Thank you for this suggestion. I have expanded the text, section 7, to address the possible relationship between illness severity and patients’ choice of care. The revised text acknowledges that little is known about whether Mozambican patients explicitly consider severity when deciding between traditional and biomedical care. It also notes examples from HIV/AIDS programs where healers are encouraged to refer severe cases to hospitals, alongside anecdotal accounts of patients turning to traditional healing after unsuccessful biomedical treatment. This addition highlights the complexity of the issue and the need for further systematic research.

 

Comment 5:

• You mention that traditional healing, medical professionalism, and policymaking should/could be integrated. What are the strategies for the integration?

Response: Thank you for your comment. Strategies for the integration of traditional healing, biomedical professionalism, and policymaking are addressed in Section 5 of the manuscript. In summary, at the policy level, Mozambique has established AMETRAMO to give legal recognition to traditional healers, adopted the Traditional Medicine Policy to guide regulation, training, and collaboration, and taken steps to protect intellectual property and promote equitable benefit-sharing from medicinal plant use. At the clinical level, integration involves creating sustained dialogue and mutual respect, expanding referral systems to be reciprocal, providing training for healers on safe biomedical practices, and encouraging biomedical professionals to understand patients’ cultural models of illness. These measures are framed within a broader effort to preserve the sociocultural context of healing while addressing safety, quality, and equity.

 

Comment 6:

• You mention that traditional healing is based on spiritual, religious, and social values, while the biomedical approach is based on objectivity and physical and mental dimensions. Am I right? If so, please specify the most positive and arguable impacts of both approaches.

Response: Thank you for your observation. Yes, your understanding is correct: the manuscript frames traditional healing as being rooted in spiritual, religious, and social values, while biomedicine is based on objectivity and the physical and mental dimensions. In response to your request, we have clarified this comparison in Table 2 (Section 5), which now explicitly lists the most positive and arguable impacts of each approach, with supporting citations.

 

Comment 7:

• I don't see any references to the effectiveness and cross-benefits impact of traditional healing. Is it mainly a matter of trust and tradition, or are there also economic aspects to be highlighted?

Response: We appreciate the suggestion and have expanded Section 8 to discuss traditional healing’s effectiveness, examples of cross-benefits with biomedical services, and its economic accessibility in underserved areas.

 

Comment 8:

• Even if you already wrote something about the issue, I suggest strengthening the different impacts of traditional healing in underdeveloped classes and reaching highly educated classes.

Response: I appreciate the insightful suggestion to strengthen the discussion on the varied impacts of traditional healing across different social strata. In response, I have expanded Section 3.1 (Framing the Epistemic Conflict) to explicitly address how traditional healing serves both as a crucial health resource in underdeveloped communities—where it often represents the most accessible or culturally aligned form of care—and as a subject of intellectual and cultural interest among highly educated groups, who may engage with it through research, policy debates, or integrative health models.

 

Comment 9:

• With reference to the literature review, is it possible to mention other countries that have a similar situation?

Response: Thank you for the suggestion. I have added a paragraph to the introduction (end of the second paragraph) that notes comparable contexts. I highlight examples from Southern Africa—South Africa, Zambia, Uganda, Botswana, Malawi, and the Central African Republic—where traditional healers have been engaged in public health programs, and I reference broader evidence from Africa, Asia, and Latin America, where traditional medicine plays a major role in primary care. I also draw a parallel with Brazil, which blends Indigenous, African, and European practices and faces similar cultural and institutional integration challenges. These additions broaden the comparative scope and situate the Mozambican case within a broader global context.

 

Comment 10:

• Last but not least, I suggest strengthening or broadening the socio-economic sustainability aspect.

Response: Thank you. In the revised manuscript, I have expanded the socio-economic sustainability discussion (see Section 8, final paragraphs). This new content emphasizes how traditional healing contributes to local economies, job creation, and household income, citing examples from Mozambique, South Africa, and India. It also addresses the roles of traditional healers in public health, biodiversity conservation, and cultural sustainability, while noting threats such as marginalization and limited intergenerational knowledge transfer. These additions strengthen the link between traditional healing, community resilience, and sustainable development.