African traditional medicine: historical legacy, colonial disruption, and pathways for integration into modern healthcare.

African Traditional Medicine (ATM) remains an important component of healthcare across Africa and continues to play a significant role within pluralistic healthcare systems where traditional and biomedical practices coexist. This narrative review critically examines the historical development, ethnopharmacological relevance, scientific validation, integration models, governance frameworks, and ethical considerations surrounding ATM within contemporary African healthcare systems. A structured literature search was conducted using PubMed, Scopus, Web of Science, Google Scholar, and institutional policy sources including publications from the World Health Organization (WHO), African Union (AU), and African Medicines Agency (AMA). The literature was synthesized thematically to examine historical foundations, indigenous knowledge systems, medicinal resources, clinical evidence, healthcare integration, regulation, and policy development related to ATM. The review demonstrates that ATM encompasses diverse therapeutic modalities including herbal medicine, spiritual and ritual healing, manual therapies, traditional birth attendance, and community-based preventive care. Africa's extensive medicinal biodiversity and indigenous knowledge systems provide substantial ethnopharmacological potential for natural-product research and drug discovery. However, integration of ATM into formal healthcare systems remains constrained by limited clinical validation, challenges in standardization and quality control, fragmented regulatory systems, insufficient research infrastructure, and persistent epistemological tensions between biomedical and indigenous healthcare paradigms. The review further highlights the influence of colonial disruption on the marginalization of indigenous medical knowledge and examines evolving efforts toward integration through institutional, collaborative, referral-based, and regulated product models. Regional and international governance initiatives, including WHO strategies and the African Medicines Agency, are increasingly promoting harmonized regulation, practitioner oversight, and evidence-informed integration of traditional medicine across Africa. Ultimately, effective integration of ATM requires interdisciplinary research, strengthened regulatory frameworks, ethical governance, biodiversity conservation, and equitable protection of indigenous knowledge systems. Balanced and context-specific approaches that combine scientific rigor with cultural responsiveness may contribute to safer, more inclusive, and sustainable healthcare systems within contemporary African contexts.